State of the U.S.A. Health Indicators

Committee on the State of the USA Health Indicators, Institute of Medicine, 2008

Available online at: http://www.nap.edu/catalog.php?record_id=12534

“………..Policymakers, the media, and the public should focus on 20 specific health indicators as "yardsticks" to measure the overall health and well-being of Americans, says a new report from the Institute of Medicine (IOM).

By providing information that can be compared over time, these 20 indicators will also help Americans track the nation's progress on improving our health and the effectiveness of public health and care systems.

The indicators are intended for the health section of a new Web site that the nonprofit State of the USA Inc. (SUSA) http://stateoftheusa.org/ is building as a tool for measuring and monitoring the nation on several fronts. The site will aim to help people become more-informed and active participants in national discussions about important topics — such as health, education, and the environment — by giving them a way to measure national progress from year to year and to compare it to that of other countries. Until recently, only researchers and academics have had the capacity for this kind of analysis.

The 20 proposed indicators together provide a broad picture of Americans' health and the nation's health systems. They reflect a range of factors that determine well-being, including how many individuals engage in certain risky or healthy behaviors, how well patients fare from the care they receive, and to what extent health professionals and facilities are meeting specific goals.

SUSA asked IOM to recommend no more than 20 indicators of health, each with a substantial body of high-quality data behind it. Reputable organizations are generating new data on each of these markers annually, providing a reliable means to track changes over time. The data can be sorted by population subgroups or geographic region, allowing detailed analyses and comparisons. For example, one could use the data to compare current rates of obesity in different race and ethnic groups or to track whether the national obesity rate goes up or down over the next five years.

Social and environmental factors — such as income, race and ethnicity, education level, and pollution — also influence people's health, noted the committee that wrote the report. The SUSA Web site will have sections devoted to education and the environment as well as other topics. Given the interconnectedness of health and these other areas, the committee urged SUSA to create links between the different sections that will enable visitors to see and explore these relationships…..”

IOM's Proposed Health Indicators

Health Outcomes
• Life Expectancy at Birth — number of years that a newborn is expected to live if current mortality rates continue
• Infant Mortality — number of deaths of infants less than 1 year old per 1,000 live births
• Life Expectancy at Age 65 — number of years of life remaining to a person at age 65 if current mortality rates continue
• Injury-Related Mortality — age-adjusted mortality rates due to intentional and unintentional injuries
• Self-Reported Health Status — percent of adults reporting fair or poor health
• Unhealthy Days, Physical and Mental — mean number of physically or mentally unhealthy days in past 30 days
• Chronic Disease Prevalence — percent of adults reporting one or more of six chronic diseases: diabetes, cardiovascular disease,
chronic obstructive pulmonary disease, asthma, cancer, and arthritis
• Serious Psychological Distress — percent of adults with serious psychological distress as indicated by a score of 13 or higher on the K6 scale

Health-Related Behaviors
• Smoking — percent of adults who have smoked 100 or more cigarettes in their lifetime and who currently smoke some days or every day
• Physical Activity — percent of adults meeting the recommendations for moderate physical activity, which are 30 minutes of
moderate intensity activity at least five days a week or 20 minutes of vigorous intensity activity at least three days per week
• Excessive Drinking — percent of adults consuming 4 (women) or 5 (men) or more drinks on one occasion and/or consuming
more than an average of 1 (women) or 2 (men) drinks per day during the past 30 days
• Nutrition — percent of adults eating a good diet as indicated by a score of 80 or more on the Healthy Eating Index
• Obesity — percent of adults with a body mass index of 30 or more
• Condom Use — proportion of youth in grades 9 through 12 who are sexually active and do not use condoms, placing them at risk
for sexually transmitted infections

Health Systems
• Health Care Expenditures — per capita health care spending
• Insurance Coverage — percentage of adults without health coverage via insurance or entitlement
• Unmet Medical, Dental, and Prescription Drug Needs — percent of non-institutionalized people who did not receive or
delayed receiving needed medical services, dental services, or prescription drugs during the previous year
• Preventive Services — percent of adults who are up-to-date with age-appropriate screening services and flu vaccination
• Preventable Hospitalizations — hospitalization rate for ambulatory care-sensitive conditions
• Childhood Immunization — percent of children between 19 and 35 months old who are up-to-date with recommended immunizations

The study was sponsored by State of the USA Inc., the F.B. Heron Foundation, and William and Flora Hewlett Foundation. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. A committee roster follows.

INSTITUTE OF MEDICINE - Board on Population Health and Public Health Practice - COMMITTEE ON THE STATE OF THE USA HEALTH INDICATORS
GEORGE J. ISHAM, M.D., M.S. (CHAIR) Medical Director and Chief Health Officer Health Partners Inc. Bloomington, Minn.
RON BIALEK, M.P.P. President Public Health Foundation Washington, D.C.
NORMAN M. BRADBURN, PH.D. Tiffany and Margaret Blake Distinguished Service Professor Emeritus; and Senior Fellow National Opinion Research Center University of Chicago Chicago
CAROLINE FICHTENBERG, PH.D. Chief Epidemiologist Baltimore City Health Department Baltimore
JESSIE GRUMAN, PH.D. Executive Director Center for the Advancement of Health Washington, D.C.
DAVID HOLTGRAVE, PH.D. Professor and Chair Department of Health, Behavior, and Society Bloomberg School of Public Health Johns Hopkins University Baltimore
CARA V. JAMES, PH.D. Senior Policy Analyst Henry J. Kaiser Family Foundation Washington, D.C.
DAVID A. KINDIG, M.D., PH.D. Professor Emeritus of Population Health Sciences, and Emeritus Vice Chancellor for Health Sciences School of Medicine University of Wisconsin Madison
LISA LANG, M.P.P. Head National Information Center on Health Services Research and Health Care Technology, and Assistant Director Health Services Research Information, National Library of Medicine Bethesda, Md.
DAVID R. NERENZ, PH.D. Director of Outcomes Research Neuroscience Institute, and Director Center for Health Services Research Henry Ford Health System Detroit
JAMES D. RESCHOVSKY, PH.D. Senior Health Researcher Center for Studying Health System Change Washington, D.C.
STEVEN M. TEUTSCH, M.D., PH.D. Executive Director U.S. Outcomes Research Merck and Co. Inc. West Point, Pa.
DAVID R. WILLIAMS, PH.D., M.P.H. Florence & Laura Norman Professor of Public Health, and Professor of African and African American Studies and of Sociology Department of Society, Human Development, and Health School of Public Health Harvard University Boston
ALAN M. ZASLAVSKY, PH.D. Professor of Statistics Department of Health Care Policy Harvard Medical School Boston
INSTITUTE OF MEDICINE STAFF LYLA HERNANDEZ, M.P.H. Study Director --- http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12534