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Stakeholders and public should use 20 specific health indicators

WASHINGTON 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. 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 report says.

The indictors are intended for the health section of a new Web site that the nonprofit State of the USA Inc. (SUSA) 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.

"This report takes an important step of capturing the health of the American people with a few key indicators," said committee chair George J. Isham, medical director and chief health officer, HealthPartners Inc., Bloomington, Minn. "Given the gap between the relatively low performance and high costs of our health care system, data that is readily accessible on the Internet will be of great value in devising strategies to close this gap. We believe this set of measures, as deployed by the State of the USA project, can help move the nation toward better health."

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


Contact: Christine Stencel
National Academy of Sciences

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