Use of Summary Measures in the US Healthy People and

Healthiest Nation Initiatives

Richard J. KleinUS Centers for Disease Control and Prevention

National Center for Health Statistics

Healthy People 2010

Goal 1: Increase Quality and Years of Healthy Life

“No single measure can adequately incorporate all aspects of health and mortality. A set of summary measures including both mortality and various aspects of morbidity or health that can be calculated from existing or collectable data should be proposed for Healthy People 2010”

Molla, et al2003

Goal 2: Eliminate Health Disparities

Measuring Healthy Life Expectancies, HP 2010

Expected years free of activity limitation Any limitation in activity, or need for special equipment due to physical, mental, or

emotional problems.

Expected years in good or better health Global assessment question: “excellent, very good, good, fair, or poor”.

Expected years free of selected chronic diseases

Arthritis, asthma, cancer, diabetes, heart disease, high blood pressure, kidney disease, or stroke.

Expected years of life Free of activity limitation

In good or better health Free of selected chronic diseases

Years from birth

Note: The categories white and black do not include persons of Hispanic origin

0

10

20

30

40

50

60

70

80

90

Total Women Men White Black

Life Expectancy and Expected Years of Healthy Life from Birth, 2001-02

0

5

10

15

20

25

Total Women Men White Black

Years from age 65

Expected years of life Free of activity limitation

In good or better health Free of selected chronic diseases

Note: The categories white and black do not include persons of Hispanic origin

Life Expectancy and Expected Years of Healthy Life from Age 65, 2001-02

Progress toward Quality and Years of Healthy Life

Life expectancy continues to improve for all population groups

Between 1999-2000 to 2001-2002, expected years in good or better health and expected years free of activity limitations increased slightly; expected years free of selected chronic conditions decreased

Women continue to have longer life expectancy than men; however women live a greater proportion of life in unhealthy states

Blacks have a shorter life expectancy than Whites; Blacks also live a greater proportion of life in unhealthy states compared to Whites

Healthy People 2010 Final Review

Update HLE calculations At birth At age 65

Incorporate international comparisons with OECD nations

Calculate individual contributions of health conditions on overall summary measure of Expected Years Free of Select Chronic Conditions

Future Directions

Develop additional domains/measures Mental health Health behaviors/determinants Multi-state/transitions

Improve understanding and interpretation/behavior of measures

Improve international comparability

Healthy People 2020

Healthy People 2020:Phase I - 2008

Vision

Mission

Overarching Goals

Two-prong Organizing Framework Behaviors/Determinants Health Status/Outcomes

Healthy People 2020 Vision

A society in which all people

live long, healthy lives

Healthy People 2020 Mission

To improve health through strengthening policy and practice, Healthy People will:

Identify nationwide health improvement priorities;

Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress;

Provide measurable objectives and goals that can be used at the national, state, and local levels;

Engage multiple sectors to take actions that are driven by the best available evidence and knowledge;

Identify critical research and data collection needs.

Healthy People 2020 Goals

Eliminate preventable disease, disability, injury, and premature death.

Achieve health equity, eliminate disparities, and improve the health of all groups.

Create social and physical environments that promote good health for all.

Promote healthy development and healthy behaviors across every stage of life.

Healthy People 2020

Global measures of health

Elimination of health disparities

Defining health equity

Healthy People 2020:Phase II - 2009

Develop Topic Areas

Develop Specific Objectives

Apply an interconnected organizing framework based on determinants of health

Refine summary measures of health for: Healthy life expectancies Disparities

The Challenge

US spends a higher % of GDP – and more per capita - on healthcare than any nation in the world – but ranks behind most developed countries in many metrics of health

Major disparities observed in LE between most and least advantaged US populations

Paradox: Great majority of US population considers themselves to be in good health

Alliance for the Healthiest Nation

Self-Perceived Health (Rated as Good or Better)

0 10 20 30 40 50 60 70 80 90 100

Poland

Italy

Spain

Finland

Luxembourg

Austria

France

United Kingdom

Netherlands

Ireland

United States

Source: OECD Health Data 2008

Percent

Life Expectancy by Healthcare Expenditure

Life Expectancy by Income per Capita

Infant Mortality Rates, 2005

US Whites

US Blacks 13.7

US TOTAL

Births (per 1,000 women) Ages 15-19, 2003

US Total

Alliance for the Healthiest Nation We Must Shift the Conversation

A FOCUS ON HEALTHCARE

A FOCUS ON HEALTH AND WELL-BEING

Health is not an outcome, it is a resource. It is what we need to achieve our ultimate goals - watching our children get married, completing a marathon, being able to enjoy life to the fullest, so that we are not just being well, but becoming well-beings.

TO

Alliance for the Healthiest Nation focuses on partnering with leading organizations to spark a nationwide movement to make the United States a “healthiest nation.”

CDC Healthiest Nation Indexes

Community-level Index

Employer Index

Individual Index

http://www.cdc.gov/nchs/hphome.htm

http://www.healthiestnation.org/