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--> Leading Health Indicators for Healthy People 2010 Final Report Carole A. Chrvala and Roger J. Bulger, Editors Committee on Leading Health Indicators for Healthy People 2010 Division of Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY OF SCIENCES Washington, D.C. 1999

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--> Institute of Medicine 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter of responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Support for this study was provided by the Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, (contract no. 282-98-0018). The views presented are those of the Institute of Medicine Committee on Leading Health Indicators for Healthy People 2010 and are not necessarily those of the funding organization. Additional copies of this report are available in limited quantities from: Division of Health Promotion and Disease Prevention 2101 Constitution Avenue, N.W. Washington, DC 20418 Call (202) 334-2383 for more information. Call (800) 624-6242 or (202) 334-1318 (in the Washington metropolitan area) or visit the NAP's on-line bookstore at http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at http://www2.nas.edu/iom. Copyright 1999 by the Institute of Medicine. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatliche Musseen in Berlin. ISBN 0-309-06539-9

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--> Acknowledgments Healthy People has been a product of the efforts of many agencies and individuals during the course of the past two decades. The committee expresses its appreciation to the presenters at the June 1998 public session for providing an excellent overview of the leading health indicators as they relate to Healthy People 2010. The presenters addressed many of the issues under consideration by the committee, and the committee appreciates the participants' insights. The presenters were: Edward Sondik, National Center for Health Statistics; Mike Stoto, Department of Epidemiology, George Washington University; Ronald Bialek, Public Health Foundation; Thomas Milne, National Association of City and County Health Officials; Laverne Snow; Association for State and Territorial Health Officers; and Olivia Carter-Pokras, Office of Minority Health. The committee also thanks Michael McGinnis for providing the committee with his summary of leading health indicators for Healthy People 2010. This report has been reviewed by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the authors and the Institute of Medicine in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The content of the review comments and draft manuscripts remain confidential to protect the integrity of the deliberative process. The committee thanks the following individuals for their participation in the review of this report: Ross Brownson, St. Louis University; Ezra Davidson, Charles R. Drew University of Medicine and Science; Paul Frame, Tri-County Family Medicine; Randolph Gordon, Bon Secours Richmond Health Systems; Maureen Henderson, University of Washington; LaDene Larsen, Utah Public Health Association; Anthony Robbins, Tufts University; Susan Scrimshaw, University of Illinois at Chicago; and Hugh Tilson, Glaxo Wellcome Company. Although the individuals listed above have provided many constructive comments and suggestions, responsibility for the final content of this report rests solely with the authoring committee and the Institute of Medicine.

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--> Committee on Leading Health Indicators for Healthy People 2010 Roger Bulger, MD (Chair), Association of Academic Health Centers, Washington, DC Susan Allan, MD, JD, MPH, Department of Human Services, Public Health Services, Arlington, VA Neal Halfon, MD, MPH, School of Medicine, and School of Public Health, University of California, Los Angeles Barbara S. Hulka, MD, MPH, Department of Epidemiology, University of North Carolina, Chapel Hill Thomas J. Kean, MPH, Strategic Health Concepts, Inc., Englewood, CO Scott C. Ratzan, MD, MPA, MA, Academy for Educational Development, Washington, DC Stephen C. Schoenbaum, MD, MPH, Harvard Pilgrim Health Care of New England, Providence, RI Mark Smith, MD, MBA, California Health Care Foundation, Oakland Shoshanna Sofaer, DrPH, Baruch College, New York, NY Robert B. Wallace, MD, Department of Preventive Medicine, University of Iowa, Iowa City Staff Carole A. Chrvala, Study Director Kelly Norsingle, Project Assistant Kathleen R. Stratton, Director, Division of Health Promotion and Disease Prevention Donna D. Duncan, Division Assistant

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--> Contents   Executive Summary   1     Charge to the Committee   1     Overview of Indicator Set Development   2     Description of Proposed Indicator Sets   3     Linkage of Indicator Sets to Healthy People 2010   5     Crosscutting Data Issues   5     Dissemination Strategies   6     Conclusions and Recommendations   7 1   Background and Significance   11     Healthy People - The First Decade   11     Healthy People 2000   12     Healthy People 2010   13     Leading Health Indicators   15 2   Approach to Development of Leading Health Indicator Sets   17     Charge to Committee   18     Review of Relevant Literature   18     Development of Criteria to Guide Selection of Specific Leading Health Indicators   19     Regional Meetings   20     Selection of Conceptual Frameworks for Indicator Sets   21     Interim Reports   22     Public Hearing   22     Selection of Candidate Indicator Sets   22 3   Proposed Leading Health Indicator Sets   25     Health Determinants and Health Outcomes Indicator Set   26     Life Course Determinants Set   32     The Prevention-Oriented Set   37     General Discussion of Issues Relevant to the Proposed Indicator Sets   48

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--> 4   Linkage with Healthy People 2010   57     Overarching Goals   57 5   Cross-cutting Data Issues for Leading Health Indicators sets   63     Data Sources for Proposed Leading Health Indicator Sets   63     General Data Issues for Proposed Leading Health Indicator Sets   65 6   Conclusions and Recommendations   69     Commitment of Adequate Resources and Effort for Dissemination of Indicator Set   70     Health Disparities   71     Poverty As A Leading Health Indicator   73     General Data Issues and Analysis at Multiple Jurisdiction Levels   74   References   77