Leading Health Indicators for Healthy People 2020 Letter Report (2011) / Chapter Skim
Currently Skimming:
Letter Report
Letter Report
Pages 1-64
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 1... ...
It was anticipated that the work of the commit tee would build upon the 1999 IOM report, Leading Health Indicators for Healthy People 2010, and on the work of the Committee on the State of the USA Health Indicators. The product of the committee was to be a consensus letter report.
|
From page 2... ...
A detailed discussion of each of the selected objectives is then presented as well as suggestions for measures that could be used in the three Healthy People topic areas for which no objectives exist: social determinants of health; health-related quality of life and well being; and lesbian, gay, bisexual, and transgender health. HEALTHY PEOPLE 2020 Healthy People has evolved during the three decades in which it has existed.
|
From page 3... ...
Recommendation 1: The committee recommends that the following indicators be used by HHS as the Healthy People 2020 Leading Health Indicators. These indicators are: 1.
|
From page 4... ...
11. HDS 2: Reduce coronary heart disease deaths.
|
From page 5... ...
The remaining two meetings were held in closed session during which the committee reviewed, analyzed, and synthesized different approaches to indicator development, among which were Leading Health Indicators for Healthy People 2010 (IOM, 1999) , the State of the USA Health Indicators (IOM, 2009b)
|
From page 6... ...
Chronic Disease Prevalence and 8. HDS 2: Reduce coronary heart disease mortality of deaths.
|
From page 7... ...
In the document Leading Health Indicators for Healthy People 2010: Final Report (IOM, 1999) , the committee found the use of the terms topic, indicator, and objective confusing.
|
From page 8... ...
In identifying topics, indicators, and objectives, the committee sought to use the available base of scientific knowledge to identify important domains of health in terms of statistics on mortality, morbidity, functional health status, and the extent to which a current health state also represented a risk for future health concerns. Within these broad principles, the com mittee chose specific objectives using the criteria listed in Table 2, which were similar to those used to select the Healthy People 2010 Leading Health Indicators.
|
From page 9... ...
proposed a framework of health determinants that included disease, health functioning, well-being, and behavioral and biological responses to social and physical environments. A population health framework for setting national and state health goals proposed by Kindig and colleagues (2008)
|
From page 10... ...
The life course approach is based on two concepts: first, the impact of specific risk factors and determinants of health varies during the life FIGURE 1 Framework for Objectives for Leading Health Indicators Health Determinants and Health Outcomes Social and Physical Health and Econo Environ- Health Health Care Policy mic Outcomes Life Stage ment Behavior Services Pregnancy and infancy: birth, growth, and maternal bond Childhood: growth, learning and development of familial and social bonds Adolescence: transition to independence Young adult: independence and work Adult: work, family, societal contribution Elderly: meaning, legacy, decline FIGURE 1 Framework for objectives for leading health indicators.
|
From page 11... ...
In the 1999 IOM report Leading Health Indicators for Healthy People 2010, the criteria listed were identified as criteria for selecting leading health indicators. To reflect its definitions of topics, indicators, and objectives, the committee modified the criteria used in Healthy People 2010, for its use in selecting objectives.
|
From page 12... ...
that combines life course and health determinants and health outcomes. Using data from the National Vital Statistics System and several national health surveys, the group compiled information for each life stage on the leading causes of death, the most common hospital discharge diagnoses, common chronic diseases seen in the ambulatory setting, and frequently self-reported health conditions.
|
From page 13... ...
During this review of the Healthy People 2020 objectives, the committee found it frustrating that some objectives, such as those concerned with reducing obesity, were stated as applying to a nar 3 The Healthy People 2010 Leading Health Indicators can be found at http://www. healthypeople.gov/2010/LHI/lhiwhat.htm (accessed February 3, 2011)
|
From page 14... ...
They are also listed below, in abbreviated form, in Figure 2 to indicate where in the framework the objectives belong. Given the importance to health of the three unpopulated Healthy People 2020 topic areas (social determinants of health; health-related quality of life and well being; and lesbian, gay, bisexual, and transgender health)
|
From page 15... ...
15 LETTER REPORT FIGURE 2 Framework for Objectives for Leading Health Indicators Health Determinants and Health Outcomes Physical Health and Environ- Social and Health Health Care Life Stage Policy ment Economic Behavior Services Outcomes Pregnancy AHS 1: EH 1: Air AHS 1: AHS 3:Primary C 1: Cancer and infancy: Health Quality Health Care Provider Mortality birth, growth, Insurance Insurance AHS 7: HDS 2: and maternal AHS 3: HC/HIT 1: Preventive CHD bond Primary Health Services Mortality Care Literacy HA 1: IVP 1: Provider Bloodstream Injuries AHS 7: Infections MICH 8: Preventive HDS 5: Birth Services Hypertension Weight FP 8: Pregnancy Rate MHMD 4: Reduce MDEs Childhood: AHS 1: EH 1: Air AH5: NWS 17: AHS 3:Primary C 1: Cancer Health Quality Educational Fats and Care Provider Mortality growth, Insurance Achievement Sugars AHS 7: HDS 2: learning, and AHS 3: AHS 1: TU 3: Preventive CHD development Primary Health Tobacco Services Mortality of familial Care Insurance Initiation HA 1: IVP 1: and social Provider EMC 1: Bloodstream Injuries bonds AHS 7: School Infections Preventive Readiness HDS 5: Services HC/HIT 1: Hypertension NWS 17: Health MHMD 4: Fats and Literacy Reduce MDEs Sugars NWS 10: TU 3: Obesity Tobacco Initiation AHS 3:Primary Adolescence: AHS 1: EH 1: Air AH 5: HIV 17: C 1: Cancer Care Provider Health Quality Educational Condom Mortality transition to AHS 7: Insurance Achievement Use HDS 2: independence Preventive AHS 3: AHS 1: NWS 17: CHD Services Primary Health Fats and Mortality Care Insurance Sugars FP 8: Pregnancy IVP 1: Provider HC/HIT 1: SA14: Rate Injuries AHS 7: Health Binge HA 1: Preventive Literacy Drinking Bloodstream Services SA 13: Infections Illicit HDS 5: NWS 17: Substances Hypertension Fats and SH 4: MHMD 4: Sugars Sleep Reduce MDEs TU 3: TU 3: NWS 10: Tobacco Tobacco Obesity Initiation Initiation continued FIGURE 2 Populated framework for objectives for leading health indicators.
|
From page 16... ...
16 LEADING HEALTH INDICATORS FOR HEALTHY PEOPLE 2020 FIGURE 2 continued Young Adult: AHS 1: EH 1: Air AH5: HIV 17: AHS 3:Primary C 1: Cancer Health Quality Educational Condom Care Provider Mortality independence Insurance Achievement Use AHS 7: HDS 2: and work AHS 3: AHS 1: NWS 17: Preventive CHD Primary Health Fats and Services Mortality Care Insurance Sugars HA 1: IVP 1: Provider HC/HIT 1: PA 2: Bloodstream Injuries AHS 7: Health Physical Infections Preventive Literacy Activity HDS 5: Services SA14: Hypertension NWS 17: Binge MHMD 4: Fats and Drinking Reduce MDEs Sugars SA 13: SH 4: Sleep Illicit TU 1: Substances Tobacco SH 4: Use Sleep TU 3: TU 1: Tobacco Tobacco Initiation Use TU 3: Tobacco Initiation AHS 3:Primary C 1: Cancer Adult: work, AHS 1: EH 1: Air AHS 1: HIV 17: Care Provider Mortality family, Health Quality Health Condom AHS 7: HDS 2: societal Insurance Insurance Use contribution AHS 3: NWS 17: Preventive CHD HC/HIT 1: Primary Fats and Services Mortality Health Care Sugars HA 1: IVP 1: Literacy Provider PA 2: Bloodstream Injuries AHS 7: Physical Infections Preventive Activity HDS 5: SA14: Hypertension Services Binge MHMD 4: NWS 17: Drinking Reduce MDEs Fats and Sugars SA 13: SH 4: Sleep Illicit Substances TU 1: SH 4: Tobacco Sleep Use TU 1: Tobacco Use Elderly: AHS 3: EH 1: Air HC/HIT 1: HIV 17: AHS 3:Primary C 1: Cancer meaning, Primary Quality Health Condom Care Provider Mortality legacy, Care Literacy Use AHS 7: HDS 2: decline Provider NWS 17: Preventive CHD AHS 7: Fats and Services Mortality Preventive Sugars HA 1: IVP 1: Services PA 2: Bloodstream Injuries NWS 17: Physical Infections Fats and Activity HDS 5: Sugars SA14: Hypertension SH 4: Sleep Binge MHMD 4: TU 1: Drinking Reduce MDEs SA 13: Tobacco Illicit Use Substances SH 4: Sleep TU 1: Tobacco Use FIGURE 2 Continued
|
From page 17... ...
The organization of topics and objectives in this manner provided for a logi cal approach to develop the 12 leading health indicators. A disadvantage of the thematic approach is that the presentation does not highlight the framework that guided its development.
|
From page 18... ...
TABLE 3 The Framework Approach to Identifying Topics, Indicators, and Objectives Topic Indicator Objectives · FP 8: Reduce pregnancy rates among Pregnancy and Proportion of infancy healthy births adolescent females. · MICH 8: Reduce low birth weight (LBW)
|
From page 19... ...
· Objectives for all life stages* · PA 2: Increase the proportion of adults Adult Proportion of healthy adults who meet current Federal physical activity guidelines for aerobic physical activity and for muscle-strengthening activity.
|
From page 20... ...
experiencing · PA 2: Increase the proportion of adults healthy natural and built who meet current Federal physical activity environments guidelines for aerobic physical activity and for muscle-strengthening activity. · AH 5: Increase educational achievement of Social and Proportion of economic population adolescents and young adults.
|
From page 21... ...
· NWS 17: Reduce consumption of calories from solid fats and added sugars in the population aged 2 years and older. · PA 2: Increase the proportion of adults who meet current Federal physical activity guidelines for aerobic physical activity and for muscle-strengthening activity.
|
From page 22... ...
the population · HDS 2: Reduce coronary heart disease experiencing positive health deaths. · MICH 8: Reduce low birth weight (LBW)
|
From page 23... ...
. Many of the leading health indicators selected for Healthy People 2010 also show a clear relationship with education (HHS, 2006b)
|
From page 24... ...
Figure 3 -- Bitmapped AHS 1: Increase the Proportion of Persons with Health Insurance Provisions of the Patient Protection and Affordable Care Act seek to improve access to health insurance through a variety of mechanisms, including the individual mandate that requires all citizens to have health insurance coverage; the employer requirement that requires businesses with more than 50 employees to offer coverage to its employees or pay an assessment; the regional or state exchanges that will provide coverage plans of varying benefits and costs for purchase by individuals or businesses; and the expansion of Medicaid eligibility to individuals who earn up to 133 percent of the federal poverty level. Other provisions eliminate lifetime limits on coverage, prohibit insurance companies from dropping individuals from their plans, and prohibit denying coverage to children with preexisting conditions.
|
From page 25... ...
found that adults who reported a regular source of primary care are healthier than those who do not have a regular source even after controlling for initial differences in health status, demographic characteristics, health insurance status, health perceptions, reported diagnoses, and smoking status. She also reported that populations served by community health centers that emphasize primary care (a requirement for federal funding)
|
From page 26... ...
found that utilization rates of recommended, cost-effective preventive services remains low and that "increasing the use of just five preventive services would save more than 100,000 lives each year in the United States." C 1: Reduce the Overall Cancer Death Rate Cancer is the second leading cause of death in the United States with 563,875 deaths in 2007 (CDC, 2010g)
|
From page 27... ...
. The leading causes of cancer death among women are lung cancer (40.0)
|
From page 28... ...
found that there was a positive association between ozone and hospital admissions for asthma and chronic obstructive pulmonary disease in elderly people. Consistent associations were also found between ozone and asthma emergency room visits in children.
|
From page 29... ...
found · hildren's physical development (e.g., motor skills and coordina C tion) are important to their academic achievement; · Emotional health and social competence help children learn; · Language and literacy skills enable children to develop cognitive " skills and knowledge"; · ognitive development is important to learning, solving problems, C and asking questions; and · Children's school success depends not only on academic skills, " but also on learning styles, habits, and attitudes with which they approach learning." FP 8: Reduce Pregnancy Rates Among Adolescent Females Forty-six percent of U.S.
|
From page 30... ...
HA 1: Reduce Central Line-Associated Bloodstream Infections (CLABSI) Central line-associated bloodstream infections (CLABSI)
|
From page 31... ...
. HDS 2: Reduce Coronary Heart Disease Deaths Approximately 17.6 million people in the United States have coronary heart disease -- about 9.2 million males and 8.4 million females (American Heart Association, 2010)
|
From page 32... ...
. Coronary heart disease is the leading cause of death in the United States today and is responsible for one of every six deaths.
|
From page 33... ...
SOURCE: American Heart Association, 2010. sion although condoms do not provide absolute protection (CDC, 2010c; Porche, 1998; Steiner et al., 1999; Warner et al., 2006)
|
From page 34... ...
. MHMD 4: Reduce the Proportion of Persons Who Experience Major Depressive Episodes (MDE)
|
From page 35... ...
estimated that the cost to workplaces of major depressive disorder and bi-polar disorder (both forms of major depressive episodes) was "96.2 million lost workdays and $14.1 billion salary-equivalent lost productivity per year associated with bi-polar disorder and 225.0 million workdays and $36.6 billion salary-equivalent lost productivity per year associated with major depressive disorder."
|
From page 36... ...
. Low birth weight "is the major determinant of infant mortality in developed countries" (Paneth, 1995)
|
From page 37... ...
. NWS 17: Reduce Consumption of Calories from Solid Fats and Added Sugars in the Population Aged 2 Years and Older As the Healthy People 2020 website states, "The Nutrition and Weight Status objectives for Healthy People 2020 reflect strong science supporting the health benefits of eating a healthful diet and maintaining a healthy body weight."6 Healthy eating is important for healthy development.
|
From page 38... ...
PA 2: Increase the Proportion of Adults Who Meet Current Federal Physical Activity Guidelines for Aerobic Physical Activity and for MuscleStrengthening Activity HHS and the Department of Agriculture jointly released the Physical Activity Guidelines that provide information about the types and amounts of physical activity needed to provide health benefits. Key guidelines for adults include the following: · ll adults should avoid inactivity.
|
From page 39... ...
SA 13: Reduce Past-Month Use of Illicit Substances According to the Substance Abuse and Mental Health Administration (SAMHSA)
|
From page 40... ...
. SA 14: Reduce the Proportion of Persons Engaging in Binge Drinking of Alcoholic Beverages In the 2009 National Survey on Drug Use and Health, 130.6 million Americans (51.9 percent of the population aged 12 or older)
|
From page 41... ...
. There are numerous consequences of binge drinking.
|
From page 42... ...
, smokers are 20 times more likely to develop peripheral vascular disease than nonsmokers (Fielding et al., 1998) , and smokers are two to four times more likely than nonsmokers to develop coronary heart disease (HHS, 1989)
|
From page 43... ...
Social determinants of health, for example, play an important role in health "in that they impact health outcomes directly as well as indirectly by influencing the other determinants" (IOM, 2009b)
|
From page 44... ...
That objective is AH 5: Increase educational attainment of adolescents and young adults.
|
From page 45... ...
How ever the committee is unaware of any single metric or index that captures the comprehensive set of social determinants. The Hardship Index (Intercity Hardship Index, Urban Hardship Index)
|
From page 46... ...
Some of the components might need modification. Despite these drawbacks, the committee believes that measures of the social determinants of health are crucial to Healthy People 2020 and that the Hardship Index is ripe for monitoring the socioeconomic com
|
From page 47... ...
is a multidimensional concept that includes domains related to physical, mental, emotional, and social functioning. It goes beyond direct measures of population health, life expectancy, and causes of death, and focuses on the impact health status has on quality of life.
|
From page 48... ...
This committee supports the recommendations of the IOM report and urges HHS to consider developing and using a summary measure of population health to estimate and track health-adjusted life expectancy. Health-Related Quality of Life There are a wide variety of measures whose developers or others have identified as being about health-related quality of life (Brown et al., 2009; Robert et al., 2009)
|
From page 49... ...
. These metrics have recently been applied to population health, especially in Canada and Europe (Fryback et al., 2010)
|
From page 50... ...
50 LEADING HEALTH INDICATORS FOR HEALTHY PEOPLE 2020 TABLE 8 Health-Related Quality-of-Life (HRQol) Indices Number of Data Response Time Scoring Collection Levelsa Index Domains Frame Algorithm Method EQ-5D Mobility, 3 "your Trade-off 5 questions self-care, health assessment usual today" (population activities, sample, pain/ USA)
|
From page 51... ...
In developing objectives and related metrics and indicators under the broad label of health-related quality of life, then, the committee suggests that HHS pay particular attention to those measures that are capable of producing summary measures of health in the form of a 0–1 health utility score. Quality of Life or Well-Being Overall quality-of-life measures have also been developed and con ceptualized as measuring subjective well-being through the assessment of happiness and life satisfaction (Helliwell, 2005)
|
From page 52... ...
reviewed the literature on the relationship between happiness and physical health and the consequences for preventive health care. Strong evidence is provided indicating that happiness cannot cure already existing diseases; nonetheless, happiness or subjective well-being is important in increasing healthy behaviors and positive health status.
|
From page 53... ...
, suicide (Kenagy, 2005) , and are less likely to have health insurance than heterosexual or LGB indi viduals (National Gay and Lesbian Taskforce, 2009)
|
From page 54... ...
For ease of comparison with the original Healthy People 2020 objective, the number of the objective has been modified by placing an L immediately after the number to indicate its use with LGBT populations: · H 5L: Increase the educational achievement of lesbians, gay men, A and bisexual and transgender adolescents and young adults. · HS 1L: Increase the proportion of lesbians, gay men, and bisexual A and transgender persons with health insurance.
|
From page 55... ...
These include · Social Determinants of Health o Explore the use of the Hardship Index for use in monitoring socioeconomic aspects of the social determinants of health. · Health-Related Quality of Life and Well-Being o Use health-adjusted life expectancy as an indicator for health related quality of life.
|
From page 56... ...
2002. A life course approach to chronic disease epidemiology: Conceptual models, empirical challenges and interdisciplinary perspectives.
|
From page 57... ...
2010. Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000-2007.
|
From page 58... ...
2010i. Physical activity and health: At-a-glance.
|
From page 59... ...
1998. Methodological issues in measuring health status and health-related qual ity of life for population health measures.
|
From page 60... ...
1999. Leading health indicators for Healthy People 2010: Final report.
|
From page 61... ...
2009b. State of the USA health indicators: Letter report.
|
From page 62... ...
2007. Ischemic and throm botic effects of dilute diesel-exhaust inhalation in men with coronary heart disease.
|
From page 63... ...
2001. The long-term costs of preterm birth and low birth weight: results of a systematic review.
|
From page 64... ...
2008. Does extending health insurance coverage to the uninsured improve population health outcomes?
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.