Leading Health Indicators for Healthy People 2010 Final Report (1999) / Chapter Skim
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3 Proposed Leading Health Indicator Sets
3 Proposed Leading Health Indicator Sets
Pages 25-56
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From page 25... ...
Finally, the Healthy People 2010 vision of eliminating health disparities and increasing quality and years of healthy life will be integrated into the selection of leading health indicators. The Institute of Medicine committee followed an iterative process to guide the selection of conceptual frameworks and specific indicators for potential indicator sets.
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From page 26... ...
These three sets are the Health Determinants and Health Outcomes Set, the Life Course Determinants Set, and the Prevention-Oriented Set. The presentation of each of the 3 sets includes a description of the conceptual framework underlying the set and a brief Ascription of the proposed indicators and measures as operationalized by the committee.
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From page 27... ...
In proposing the field model as the underlying conceptual framework for the Health Determinants and Health Outcomes Set of leading health indicators, particular emphasis is placed on the term leading. According to the field model, determinants can also be predictors: How well the nation is doing on specific indicators informs not only about where the nations stands today, but where the nation and its diverse population groups are headed.
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From page 28... ...
for a defined population Proposed Indicators The proposed indicators in He Health Determinants and Health Outcomes Set were chosen because there is substantial and credible evidence Hat they are significantly related to health problems that are important today in the United States, that are likely to persist or worsen in the general population or diverse population groups unless action is taken, and against which it is, in fact, possible to make improvements. In addition, each of the indicators were considered to meet the six criteria considered essential for inclusion of an indicator in a set and the selection of the indicators was guided by the conceptual framework described above.
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From page 29... ...
In some cases illness can lead to poverty, but far more frequently, poverty is associated with higher rates of a wide range of social and behavioral risk factors for disease as well as poor health outcomes. The pathways between poverty and ill health have not been fully specified, but they are likely to include poor nutritional status, poor housing, lower levels of educational attainment, residence in neighborhoods with higher rates of crime and violence, and reduced access to and utilization of health care services.
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From page 30... ...
At the same time, a regular program of physical activity has some of its most salubnous effects on conditions faced by older persons. The Youth Risk Behavior Survey, the Behavioral Risk Factor Surveillance Survey, the National Health Interview Survey, and the National Health and Nutrition Examination Survey might all be useful in measuring the status of this indicator during the course of Healthy People 2010 .
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From page 31... ...
. Potential sources of data regarding these types of disabilities might include the National Health Interview Survey, and the National Disability Survey.
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From page 32... ...
Third, the depiction of life course health development in terms of a health development trajectory incorporates the differential effects of determinants across the life-course and the effects of determinants on the attainment of health states and long-term health outcomes. Such a trajectory demonstrates how early experience affects later health status and decline and how such experiences have important implications for the way in which the role of hearth promotion and disease prevention is conceptualized across the lifecourse.
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From page 33... ...
Proposed Indicators Table 3.2 describes the specific indicators included in the Life-Course Determinants Indicator Set. As noted above for the Health Determinants and Health Outcomes Indicator Set, the selection of the indicators was guided by three factors: (~)
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From page 34... ...
Low-birth-weight births are associated with disparities in a number of risk and protective factors ranging from poverty, utilization of appropriate prenatal care, and exposures to stressful environments. From a life course health development perspective, low birth weight is associated with a more fragile entry into the world and the need for a range of ongoing medical and social interventions that may require ongoing application through adolescence.
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From page 35... ...
Data from the Youth Risk Behavior Survey, Behavioral Risk Factor Surveillance Survey, and the National Health Interview Survey may contribute to the monitoring of this indicator. Poverty.
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From page 36... ...
The likelihood of experiencing violence is exacerbated by poverty, lower levels of educational attainment, lower socioeconomic status, and unemployment. The levels of violence in a community are not easily measured by a single factor, but the indicator proposes for the Life Course Determinants Set might be useful as a sentinel measure.
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From page 37... ...
Tertiary prevention, which is perhaps less familiar to many professionals, business groups, and the lay public, embodies the principle that even in the face of overt clinical illness, there can be opportunities to apply preventive interventions that may impede the worsening or even improve the function of and prognosis for a patient. Similar to the Health Determinants and Health Outcomes and LifeCourse Determinants Sets of leading health indicators, the Prevention-Oriented Set includes social indicators, with the most important being level of poverty.
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From page 38... ...
Heals care access Percentage of population with health insurance and a regular source of medical care diminished because of the dysfunction. Sources of data for this item might include the National Health Interview Survey, the National Disability Survey; and special local and regional surveys.
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Potential data sets have been cited above in the description of indicators for the Health Determinants and Health Outcomes Set and the Life Course Determinants Set. Tobacco Use.
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From page 40... ...
As with other types of tertiary prevention, the data for this indicator is not likely to be regularly available and additional survey items to be developed for ongoing national and regional surveys may be required. Suggested Steps for Action on Proposed Indicators Each of the three proposed sets of leading health indicators were selected, in part, because their conceptual Frameworks acknowledge that the nation's health objectives can only be met if those with professional or personal concerns about health and medicine work collaboratively with those in other sectors of society.
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From page 41... ...
The committee does not expect each suggestion to be acted upon and suggests that actions directed toward a numerous set of diverse interventions may, in fact, be unlikely to have sufficient specificity and sensitivity to achieve sustained changes in any given indicator. The sections below provide specific examples of suggested actions and actors for each of the 19 unique indicators included in at least one of the three proposed indicator sets.
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From page 42... ...
Alternative behaviors such as physical activity programs should be advocated to youth, to provide them with a more positive self-image and to increase self-esteem. Use of role models and credible spokespeople for specific population groups can also effect change in smoking initiation rates, patterns oftobacco use, and smoking cessation efforts.
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From page 43... ...
population that achieves and maintains their recommended body mass index. Physical Activity Although vigorous physical activity is associated with a decreased risk of cardiovascular disease, hypertension, and some cancers, a growing body of literature indicates that more moderate levels of activity can be beneficial to a person's health status.
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From page 44... ...
For example, local communities might organize efforts to encourage appropriate physical activity programs and diets for older women to prevent or reduce the effects of conditions such as osteoporosis and osteoarthritis. Local businesses might participate in efforts to reduce the rate of occurrence of disabilities resulting from lower back injury or repetitive strain either by the use of preventive ergonomic steps, through the provision of employee training in healthy work habits, or by the provision of access to state-of-the-art physical therapy services.
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From page 45... ...
Health Care Access This is an ongoing national issue that will be highlighted by inclusion as a leading health indicator in two of the three proposed sets. Federal and state actions will be necessary to address access to health care comprehensively, especially to fully respond to issues associated with the costs of access to care for those without any form of health insurance.
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From page 46... ...
In addition, community-based efforts can be undertaken to inform and motivate populations at risk of non-compliance with the recommended vaccination protocols for young children. Examples of such efforts might include integration of immunization information into childbirth preparation classes, worksites, schools, religious communities, and descriptions of covered benefits In health insurance plans.
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From page 47... ...
It will also motivate actions among those involved in the delivery of primary care and the medical subspecialty groups in which the more technological aspects of cancer screening are practiced. In addition, the health education sector could support cancer screening efforts that enhance self-care, such as breast self examination, and the development of communications skills of health care providers to make effective referrals for screening examinations.
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From page 48... ...
operationalization of measures for the specific indicators; (3) clarification of the role and functions to be filled by the leading health indicators; (4)
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From page 49... ...
First, the focus of the three conceptual frameworks underlying the proposed indicator Sets strongly influenced the committee's selection of specific measures for shared indicators. For example, the LifeCourse Determinants Set emphasizes measures that are targeted to younger populations for whom interventions will yield some of their most beneficial effects by modifying behaviors early in the life course and thus, preventing or delaying the onset of disease morbidity and mortality.
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From page 50... ...
This indicator underscores the absolute necessity of efforts directed toward elimination of disparities in health status and health outcomes associated with socioeconomic status. Furthermore, the health care access indicator, included in the Life Course Determinants and Prevention-Oriented Sets and the health insurance indicator in the Health Determinants and Health Outcomes Set are intended to focus attention on social and health care system factors associated with the delivery of care for preventive health as well as urgent and chronic conditions.
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From page 51... ...
Consequently, dietary patterns are not included as a leading health indicator in the three proposed indicator sets It should be noted, however, that the Health Determinants and Health Outcomes Set includes weight and appropriate body mass index as a proxy measure for dietary habits. The suggested indicator addresses both underweight and overweight and is considered by the committee to be an indirect reflection of dietary choices and eating patterns.
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From page 52... ...
. Social support and isolation are suggested as indicators for consideration in future sets of leading health indicators in part because ofthe complexity of collection of information about these issues across multiple jurisdictional levels and diverse population groups.
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From page 53... ...
Physical Environment The Health Determinants and Health Outcomes Set includes a limited measure of the physical environment that focuses on air and water quality. However, many other components of the physical environment have a significant effect on health.
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From page 54... ...
, communications theory, and diffusion of innovations theories (Rogers, 1996) in order to develop a realistic strategy to encourage the nation's diverse populations to adopt the leading health indicators.
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From page 55... ...
Although it is anticipated that the general public will be a primary target population for information about the leading health indicators, it is likely that the principal audiences for early adoption of the indicator set will be the leadership in the general public health, health service delivery, and health care policy communities. The initial development of communications and dissemination plans for the selected indicator set should include communication audits and target group profiles to describe the preferred dissemination mechanisms for a group and their subsequent expected use for the dissemination of the leading health indicators.
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