Jan. 22, 2020

Healthy People 2030’s Leading Health Indicators Should Track Health Effects of Climate Change, Residential Segregation, Civic Engagement

WASHINGTON – Healthy People 2030 (HP2030) – which will set national objectives for improving the health of all Americans from 2020 to 2030 – should include in its Leading Health Indicators (LHIs) voting as a measure of civic engagement, the health effects of climate change, and indicators of racial and ethnic residential segregation, says a new report from the National Academies of Sciences, Engineering, and Medicine. Leading Health Indicators 2030: Advancing Health, Equity, and Well-Being recommends a set of 34 LHIs that the U.S. Department of Health and Human Services (HHS) should consider in the development of Healthy People 2030.

Launched in 1979, HHS’ Healthy People initiative is designed to identify the major health concerns facing the nation, set measurable objectives and goals for health promotion and disease prevention, and drive multiple sectors to take action. Many state, local, and tribal public health departments align their priorities with those outlined in Healthy People.

HP2030 contains 41 topics, 355 draft core objectives, and LHIs, a set of selected objectives to communicate high-priority health issues. It also outlines additional developmental objectives (high-priority issues with evidence-based interventions, but insufficient or no reliable baseline data) and research objectives. HP2030 is still being drafted by HHS, with final objectives expected in the spring of 2020 and the final LHIs to be released later in the year. 

In previous decades, Healthy People has focused on specific diseases and behaviors (such as diabetes or mean daily intake of vegetables). By contrast, the recommended LHIs for HP2030 focus more on the social and other circumstances that shape health, including poverty and neighborhood disinvestment.

“The committee’s proposed set of Leading Health Indicators reflects how people in the United States live their lives, shaped by policies and social factors. The set is well aligned with the HP2030 framework, and we hope the LHIs will be informative in the selection of the final set,” said George Isham, senior fellow at the HealthPartners Institute and chair of the committee that wrote the report. “With an appropriately balanced set of LHIs, Healthy People 2030 represents a tremendous opportunity to be more forward-looking and responsive to social, environmental, and economic factors that are intertwined with population health.”

The slate of 34 LHIs was informed by four selection criteria, which the committee recommended in an August 2019 report: public health burden and national importance; magnitude of disparity; sentinel or bellwether (signifiers of things to come); and actionability.

Missing LHIs for Consideration
Of the 34 proposed LHIs, 15 of them are not drawn from the HP2030 draft objectives. HHS should consider including them, the report says, because they better reflect HP2030’s central focus on health, equity, and well-being, as well as being responsive to selection criteria. These include:

LHIs for Additional Discussion
LHIs on tobacco, poverty, and education are included among the HP2030 draft core objectives, but deserve additional discussion, the report says. For example, under its objective to reduce adolescent use of tobacco products, HHS should clarify whether “tobacco products” includes e-cigarettes. Objectives on poverty reduction should be disaggregated by age group, with particular attention to child poverty. Finally, while there are several objectives related to increasing fourth grade reading proficiency and on-time high school graduation, the committee found that quality early childhood care and education (ECE) could be a developmental objective.

Developmental Objectives on Tracking Costs, Investments in Public Health and Health Care
The committee had hoped to propose an LHI on health care expenditures, such as tracking per capita spending, and an LHI on public health spending, but found no optimal measures.

Instead, the committee proposed three developmental objectives that would track the cost of a “market basket” of widely used pharmaceuticals compared with other high-income nations; health care system administrative costs; and per capita public health funding.

The study — undertaken by the Committee on Informing the Selection of Leading Health Indicators for Healthy People 2030 — was sponsored by the U.S. Department of Health and Human Services. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

Report Highlights

Stephanie Miceli, Media Relations Officer

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