Appendix D

Criteria for Selecting a Set of Leading Health Indicators¹

Healthy People 2030 comprises three types of objectives—core, developmental, and research. The Leading Health Indicators (LHIs) for Healthy People 2030 will be drawn from the core objectives because core objectives are defined as having valid, reliable, and timely data sources, as well as evidence-based interventions through which their targets can be met. The Committee proposes a set of criteria for selecting Healthy People 2030 LHIs that are informed by the Healthy People 2030 Framework, including the vision, mission, foundational principles, overarching goals, and plan of action.

PHASE 1

All core objectives should be assessed across the following four criteria:

1. Public health burden—relative significance to the health and well-being of the nation;
2. Magnitude of the health disparity and the degree to which health equity would be achieved if the target were met;
3. The degree to which the objective is a sentinel or bellwether; and
4. Actionability of the objective.

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¹ SOURCE: The Secretary’s Advisory Committee report Recommendations for the Leading Health Indicators.

Rationale

In phase 1, four criteria are applied to the core objectives. The first criterion, public health burden, is classically indicated by important metrics such as excess morbidity and mortality. Conversely, however, indicators may at first glance be viewed as having low public health burden (e.g., low levels of selected infectious diseases) owing to current practice (e.g., vaccinations). For this reason, public health burden must also be assessed by whether it would be significant if current practice were not continued. Public health burden directly supports the mission of Healthy People 2030, which is to “promote, strengthen, and evaluate the nation’s efforts to improve the health and well-being of all people.”

The second criterion focuses on the magnitude of the health disparity and the degree to which health equity would be achieved if the LHI target were met. It directly supports the overarching goal to “eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.”

The third criterion emphasizes the role of the LHIs in serving as a sentinel and bellwether for the state of the nation’s health and as a warning or harbinger of threats. This criterion supports the Healthy People 2030 plan of action to “provide data that can drive targeted actions to address regions and populations with poor health or at high risk for poor health in the future.”

Actionability, the final criterion, is multifaceted. It takes into account the state of available and actionable evidence, and the ability to improve health and well-being at a cost that is considered a good value. Actionability is informed by the foundational principle that “promoting and achieving the nation’s health and well-being is a shared responsibility that is distributed across the national, state, tribal, and community levels, including the public, private, and not-for-profit sectors,” and the plan of action to develop and make available “affordable means of health promotion, disease prevention, and treatment.”

Description of Application

Phase 1 is a focused assessment that applies a set of four criteria to each core objective in Healthy People 2030. A quantitative approach helps identify the initial set of potential LHI candidates. All core objectives would be assessed according to each criterion on a scale of 1 (not important) to 10 (very important). A cumulative score would be calculated across the four criteria, ranging from 4 (least important) to 40 (most important). Those core objectives with the highest ranked scores would be considered as candidates for the pool of possible LHIs for Healthy People 2030.

PHASE 2

The pool of possible LHIs that emerges from phase 1 would then be subjected to an additional set of criteria before the final LHIs for Healthy People 2030 are selected. The phase 2 criteria should be applied with the important assumption that the LHIs are to be viewed as a group. Individuals who apply these criteria to select the LHIs should assure the following:

• The LHIs represent a balanced portfolio or cohesive set of indicators of health and well-being across the life span.
• The LHIs are balanced between common, upstream root causes of poor health and well-being and measures of high-priority health states.
• The LHIs are amenable to policy, environmental, and systems interventions at the local, state, tribal, and national levels.
• The LHIs are understandable and will resonate with diverse stakeholders to drive action.

Rationale

Considerations for phase 2 reinforce the foundational principles upon which Healthy People 2030 is based. They also reflect the Healthy People 2030 vision—“a society in which all people can achieve their full potential for health and well-being across the life span”—with the intent of attaining lives free of preventable disease, disability, injury, and premature death. Achievement of balance between upstream root causes and measures of high-priority health states in the final set of the LHIs can be guided by the foundational principle that “healthy physical, social, and economic environments strengthen the potential to achieve health and well-being.” The final two criteria in phase 2 emphasize the importance that the LHIs as a set resonate with diverse stakeholders who must take action. This notion is specified in the foundational principle “promoting and achieving the nation’s health and well-being is a shared responsibility that is distributed across the national, state, tribal, and community levels, including the public, private, and not-for-profit sectors,” and the centrality of Healthy People 2030 as “a component of decision making and policy formulation across all sectors.”

Description of Application

Unlike the core objectives, the LHIs do not exist in isolation from one another. Therefore, an additional assessment of the LHIs as a group is

warranted. In this second phase, those who apply the additional criteria listed above would then evaluate the proposed set of the LHIs as a whole. As various sets of potential LHIs are constructed during this phase, it is likely and indeed recommended that iterative movement between phase 1 and phase 2 take place until the final set of the LHIs is selected. For example, it is possible that what emerges from the initial phase 1 process may not adequately balance the upstream root causes of poor health and well-being and measures of high-priority health states. It is also possible that the set would not resonate sufficiently across stakeholders to drive action.