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Details of the Top-Down Procedure

Drawing from more than a dozen sets of measures (for a complete version of the brief overview see Table 2-2) and in some cases, additional sources, committee members first generated a list of Leading Health Indicator (LHI) contenders based on each member’s proposed indicators to inform the development of a high-level, parsimonious set. Two rounds of consolidating or collapsing similar items followed, and reduced the longer list of candidates to one that represented the committee’s consensus of candidate LHIs.

In the process of selecting the first set of candidate LHIs for consideration, the top-down procedure employed a staff-developed, web-based polling form (developed using a web-based platform), which each member independently completed to ensure an efficient process and to avoid members influencing each other’s thinking at an early stage. The form included a series of checks members were asked to make, reflecting key considerations required to ensure LHIs would adhere to all selection criteria and reflect Healthy People 2030 (HP2030) principles. During this part of the work, committee members applied Phase 0 and Phase 1 LHI selection criteria to each LHI contender (see Table 2-1). For each candidate, committee members were asked to complete the following fields (see Appendix D for the form used):

1. Source of the suggested measure (e.g., America’s Health Rankings, Centers for Disease Control and Prevention Winnable Battles)
2. Does the measure meet HP2030 objective criteria
3. Does the measure meet LHI selection criteria (Phase 0 and 1, with Phase 2 to be applied later to the full set; see Table 2-1)

4. Which of the four broad categories outlined in the committee’s first report—life stages; public health and health care systems; social, physical, and economic determinants; or health states—does the measure fit in? The committee used this information as an additional way to ensure balance of measures
5. Which of the HP2030 Framework concepts (17 items; see Figure 1-1) does the measure map to?
   • Health and Well-Being Across the Lifespan: physical, mental, social dimensions of health; access to quality public health and clinical care systems (the committee separated the latter into four sub-level concepts: access to public health system, quality of public health system, access to health care, quality of health care) (seven items)
   • Cultivating Healthier Environments: physical, social, economic (three items)
   • Closing Gaps: health disparities, health equity, health literacy (three items)
   • Increasing Knowledge and Action: shared responsibility across sectors; public health successes; evidence-based laws, policies, and practices; objectives and data (four items)

Using the curated list of more than a dozen measure sets (see Table 2-2 for the high-level overview) each committee member was asked to identify 15 measures that would be eligible to be considered as a candidate LHI. The committee produced a pooled set of 115 LHI candidates. As foreseen, there were overlaps in LHI contenders produced by the committee, so the staff reviewed the list of 115 and condensed similar topics and measures, ultimately rendering a list of 45 distinct items. Next, the committee undertook a collective consensus process (several meetings discussing each LHI, alignment with selection criteria, and relevant literature) to further narrow the list, ultimately yielding the 34 LHIs presented in this report.

The resulting list of LHI candidates was heterogeneous, an assortment of complete measures (e.g., “life expectancy at birth”), broad topics with no specific measure (e.g., “education”), and multiple measures for the same topic listed together (e.g., for education, “either fourth grade reading proficiency or educational spending”). Staff collapsed the items submitted based on similarity, such as measures that were the same but worded differently or referred to the same topic, to yield a shorter list of 45 items.

The committee then deliberated in several rounds to arrive at consensus on the 34 LHI candidates to put forward. The committee arbitrarily considered that number would be appropriate in order to reflect the breadth of key priorities while advancing an achievable agenda toward

health. At each step in the top-down process, the committee continually applied the three-phase LHI selection criteria (see Table 2-1), both explicitly during LHI selection (e.g., during the use of the polling tool) as well as throughout committee deliberations. Thus, the working assumption was that most candidates would meet the criteria. However, related considerations (e.g., “Does this LHI meet the ‘public health burden’ criterion?” and “What is known about interventions to address it?”) operated throughout the deliberations, even before the committee moved on to the step of discussing the merits of each candidate LHI.

THE RESULTS OF THE TOP-DOWN PROCEDURE

As noted already, committee members were asked to contribute their suggestions toward a draft list of LHIs through a process that integrated a range of considerations and “checks.” The result was a list of 34 LHIs, which are listed and discussed in the next chapter.

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