Priorities for Health: Leading Health Indicators for 2020

The US Institute of Medicine (IOM) has again tackled the difficult problem of turning a cacophony of priorities and objectives for improving Americans' health that is Healthy People 2020 into something that, as they put it in their Leading Health Indicators for Healthy People 2020 Letter Report this week:

"...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."

Hopefully this list of Leading Health Indicators (LHIs) will survive longer than the ones created for Healthy People 2010. In that case, the LHIs were developed by the IOM at the end of the Clinton administration. When President Bush's team then took over, it was not long until items such as Responsible Sexual Behavior attracted their attention. The LHIs were quickly dumped, and evolved into the Steps to a HealthierUS initiative (remember that one? If not, you can download a ppt overview of it) that featured a set of objectives for both behaviors and specific diseases (including asthma and diabetes, that curiously enough, were not included as chronic disease objectives in the newest version of LHIs).

The 2020 Leading Health Indicators, and the specific Healthy People 2020 Objectives to which they are linked, include:

Topics	Indicators	Objectives
Access to care	Proportion of the population with access to health care services	1. Increase the proportion of persons with health insurance. 2. Increase proportion of persons with a usual primary care provider. 3. Increase the proportion of persons who receive appropriate evidence-based clinical preventive services.
Healthy behaviors	Proportion of the population engaged in healthy behaviors	4. Increase the proportion of adults who meet current federal physical activity guidelines for aerobic physical activity and for muscle-strengthening activity. 5. Reduce the proportion of children and adolescents who are considered obese. 6. Reduce consumption of calories from solid fats and added sugars in the population aged 2 years and older. 7. Increase the proportion of adults who get sufficient sleep.
Chronic disease	Prevalence and mortality of chronic disease	8. Reduce coronary heart disease deaths. 9. Reduce the proportion of persons in the population with hypertension. 10. Reduce the overall cancer death rate.
Environmental determinants	Proportion of the population experiencing a healthy physical environment	11. Reduce the number of days the Air Quality Index exceeds 100.
Social determinants	Proportion of the population experiencing a healthy social environment	12. Improve the health literacy of the population. 13. 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. 14. Increase educational achievement of adolescents and young adults.
Injury	Proportion of the population that experiences injury	15. Reduce fatal and nonfatal injuries.
Mental health	Proportion of the population experiencing positive mental health	16. Reduce the proportion of persons who experience major depressive episodes.
Maternal and infant health	Proportion of healthy births	17. Reduce low birth weight and very low birth weight.
Responsible sexual behavior	Proportion of the population engaged in responsible sexual behavior	18. Reduce pregnancy rates among adolescent females. 19. Increase the proportion of sexually active persons who use condoms.
Substance abuse	Proportion of the population engaged in substance abuse	20. Reduce past-month use of illicit substances. 21. Reduce the proportion of persons engaging in binge drinking of alcoholic beverages.
Tobacco	Proportion of the population using tobacco	22. Reduce tobacco use by adults. 23. Reduce the initiation of tobacco use among children, adolescents, and young adults.
Quality of care	Proportion of the population receiving quality health care services	24. Reduce central line-associated bloodstream infections.

Source: Institute of Medicine.

As states and communities consider how they will be allocating their resources to improve people's health, the LHIs can be considered the first among equals of the 42 topic areas and hundreds of specific objectives in HP2020 (depending on where you sit, and the conditions you find there, which HP2020 objectives you  focus on will shift).

In the IOM letter report, the authors conclude;

"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."

For social marketers in the United States, the LHIs can point us to where we should strive to demonstrate our capabililties to address the most important health issues (see Comparative Effectiveness Research and Social Marketing for other priority areas for social marketing research).