Last December, the Department of Health and Human Services (HHS) announced Healthy People 2020, the nation’s new 10-year goals and objectives for health promotion and disease prevention. HHS acknowledged that the Healthy People initiative “in just the last decade, has either progressed toward or met 71 percent of its Healthy People targets.”
The 2020 initiative includes a number of new topic areas including: Adolescent Health, Blood Disorders and Blood Safety, Dementias, including Alzheimer’s Disease, and several others.
Additionally, the new initiative includes “myHealthyPeople,” a new challenge for technology application developers. This challenge encourages developers to create easy-to-use applications for professionals who are working with the new national health objectives and state- and community-level health data. The idea is that “myHealthyPeople‟ apps challenge will help spur innovative approaches to information technology that will help communities track their progress using Healthy People objectives and targets as well as develop an agenda for health improvement.”
Consequently, HHS requested that the Institute of Medicine (IOM) evaluate the Healthy People 2020 initiative. In response to this request, the IOM established the Committee on Leading Health Indicators for Healthy People 2020 to develop and recommend 12 indicators and 24 objectives for consideration by HHS for guiding a national health agenda and for consideration for inclusion in Healthy People 2020.
Recently, the Committee released its Letter Report, entitled, “Leading Health Indicators for Healthy People 2020.” In conducting its work, the committee was asked to:
- Review current and past health indicators sets, including Healthy People 2010 Leading Health Indicators, the State of the USA (SUSA) indicators, and the Community Health Status Indicators;
- Give consideration to provisions of the Patient Protection and Affordable Care Act that mandate the establishment of key national indicators and prevention-related measures, goals, and objectives;
- Define basic principles or purposes for Healthy People 2020 Leading Health Indicators;
- Develop criteria for selecting Healthy People 2020 Leading Health Indicators. Such criteria should be actionable and reflect the importance of science, evidence, and public health concerns. Development of such criteria should involve consideration of Healthy People 2010 Leading Health Indicators and reflect the Healthy People 2020 framework that includes new issues and topics (e.g., health communication and health information technology);
- Choose indicators that, to the extent possible, have annual data sources, with comparable data available at the state and county level; and
- Identify 24 objectives drawn from Healthy People 2020 and 12 topics under which the selected objectives will be organized.
During the HHS presentation of the charge to the committee on November 8, 2010, the committee was informed that since only 39 of the 42 Healthy People 2020 topics had written objectives, the committee could propose objectives for the three topics under development.
Those topics are: social determinants of health; health-related quality of life and well-being; and lesbian, gay, bisexual, and transgender health. The committee also received clarification from HHS that the 12 topics selected by the committee did not need to be drawn from the list of 42 topics listed in Healthy People 2020.
Healthy People 2020
The mission of Healthy People 2020 strives to identify nationwide health improvement priorities. It also looks to increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress. Additionally, it strives to:
- Provide measurable objectives and goals that are applicable at the national, State, and local levels.
- Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge; and
- Identify critical research, evaluation, and data collection needs.
IOM Report
The report consists of the committee’s recommendations concerning topics, indicators, and objectives. It then goes into the discussion of the committee process, the framework and the process used to select objectives, and a discussion of the selection of topics and indicators. The report also includes a detailed discussion of each of the selected objectives 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.
Consequently, the committee developed and recommended 12 indicators and 12 topics, and selected 24 objectives from the Healthy People 2020 objectives that relate to the identified indicators and topics. A list of the objectives with accompanying subobjectives, quantitative goals, and data sources are in the report. Specifically, the committee recommended that the following indicators be used by HHS as the Healthy People 2020 Leading Health Indicators. These indicators are:
- Proportion of the population with access to health care services
- Proportion of the population engaged in healthy behaviors
- Prevalence and mortality of chronic disease
- Proportion of the population experiencing a healthy physical environment
- Proportion of the population experiencing a healthy social environment
- Proportion of the population that experiences injury
- Proportion of the population experiencing positive mental health
- Proportion of healthy births
- Proportion of the population engaged in responsible sexual behavior
- Proportion of the population engaged in substance abuse
- Proportion of the population using tobacco
- Proportion of the population receiving quality health care services
The committee also recommended the following 24 objectives, selected from the Healthy People 2020 objectives, as important objectives related to these indicators.
- Increase educational achievement of adolescents and young adults.
- Increase the proportion of persons with health insurance.
- Increase proportion of persons with a usual primary care provider.
- Increase the proportion of persons who receive appropriate evidence-based clinical preventive services.
- Reduce the overall cancer death rate.
- Reduce the number of days the Air Quality Index (AQI) exceeds 100.
- Increase the proportion of children who are ready for school in all five domains of healthy development: physical development, social emotional development, approaches to learning, language, and cognitive development.
- Reduce pregnancy rates among adolescent females.
- Reduce central line-associated bloodstream infections (CLABSI).
- Improve the health literacy of the population.
- Reduce coronary heart disease deaths.
- Reduce the proportion of persons in the population with hypertension.
- Increase the proportion of sexually active persons who use condoms.
- Reduce fatal and nonfatal injuries.
- Reduce the proportion of persons who experience major depressive episodes (MDE).
- Reduce low birth weight (LBW) and very low birth weight (VLBW).
- Reduce the proportion of children and adolescents who are considered obese.
- Reduce consumption of calories from solid fats and added sugars in the population aged 2 years and older.
- Increase the proportion of adults who meet current Federal physical activity guidelines for aerobic physical activity and for muscle-strengthening activity.
- Reduce the proportion of persons engaging in binge drinking of alcoholic beverages.
- Reduce past-month use of illicit substances.
- Increase the proportion of adults who get sufficient sleep.
- Reduce tobacco use by adults.
- Reduce the initiation of tobacco use among children, adolescents, and young adults.
Ultimately, the committee concluded that the indicators and selected objectives in Healthy People 2020 should prove valuable in eliciting interest and awareness among the general population; motivating diverse population groups to engage in activities that will exert a positive impact on specific indicators and, in turn, improve the overall health of the nation; and providing feedback on progress toward improving the status of specific indicators.
The committee also stated that HHS may wish to highlight the indicators and objectives in communications to state and local health departments, use them as a guide for funding priorities in department programs, and use them as priority guides for ongoing departmental public health data collection and reporting activities.