Measuring Years of Healthy Life: Use of Summary Measures in The Healthy People Initiative Ritu Tuteja, MPH National Center for Health Statistics

History of Healthy People Timeline of major developments 1979 Surgeon General’s report 1980 Promoting Health, Preventing Disease 1987 Healthy People Consortium 1990 Healthy People Healthy People 2000 Midcourse Review 2000 Healthy People Healthy People 2000 Final Review 2006 Healthy People 2010 Midcourse Review 2008 Healthy People 2020 Development & Regional Meetings 2009 Release of Framework and Draft Objectives 2010 Healthy People 2020 Released 2011 Healthy People 2010 Final Review

Promoting Health, Preventing Disease Health Objectives for the Nation Health status goals by age Longevity goals considered only mortality/life expectancy Age Group1990 Goal Healthy Infants (below age 1) 35% Fewer Deaths Healthy Children (age 1-14) 20% Fewer Deaths Healthy Adolescents/ Young Adults (age 15-24) 20% Fewer Deaths Healthy Adults (age 25-64) 25% Fewer Deaths Healthy Older Adults (age 65+) 20% Fewer Sick Days

Healthy People 2000 Goal 1: Increase the Span of Healthy Life for Americans Goal 2: Reduce Health Disparities Among Americans Goal 3: Achieve Access to Preventive Services for All Americans

Healthy People 2010 Goal 1: Increase Quality and Years of Healthy Life Goal 2: Eliminate Health Disparities

Healthy People 2020 Goal 1: Attain High Quality, Longer Lives Free of Preventable Disease, Disability, Injury and Premature Death Goal 2: Achieve Health Equity, Eliminate Disparities, and Improve the Health of all Groups Goal 3: Create Social and Physical Environments that Promote Good Health for All Goal 4: Promote Quality of Life, Healthy Development and Healthy Behaviors across All Life Stages

1200+ Objectives 40 Topic Areas Healthy People 2020

Access to Health Services Adolescent Health Arthritis, Osteoporosis & Chronic Back Conditions Blood Disorders and Blood Safety Cancer Chronic Kidney Diseases Diabetes Disability and Secondary Conditions Early and Middle Childhood Educational And Community-Based Programs Environmental Health Family Planning Food Safety Genomics Global Health Health Communication and Health IT Healthcare-Associated Infections Hearing and Other Sensory or Communication Disorders Heart Disease and Stroke HIV Immunization and Infectious Diseases Injury and Violence Prevention Maternal, Infant and Child Health Medical Product Safety Mental Health and Mental Disorders Nutrition and Weight Status Occupational Safety and Health Older Adults Oral Health Physical Activity and Fitness Public Health Infrastructure Quality of Life and Well-Being Respiratory Diseases Sexually Transmitted Diseases Social Determinants Of Health Substance Abuse Tobacco Use Vision HP2020 Topic Areas

Access to Health Services Adolescent Health Arthritis, Osteoporosis & Chronic Back Conditions Blood Disorders and Blood Safety Cancer Chronic Kidney Diseases Diabetes Disability and Secondary Conditions Early and Middle Childhood Educational And Community-Based Programs Environmental Health Family Planning Food Safety Genomics Global Health Health Communication and Health IT Healthcare-Associated Infections Hearing and Other Sensory or Communication Disorders Heart Disease and Stroke HIV Immunization and Infectious Diseases Injury and Violence Prevention Maternal, Infant and Child Health Medical Product Safety Mental Health and Mental Disorders Nutrition and Weight Status Occupational Safety and Health Older Adults Oral Health Physical Activity and Fitness Public Health Infrastructure Quality of Life and Well-Being Respiratory Diseases Sexually Transmitted Diseases Social Determinants Of Health Substance Abuse Tobacco Use Vision HP2020 Topic Areas

Access to Health Services Adolescent Health Arthritis, Osteoporosis & Chronic Back Conditions Blood Disorders and Blood Safety Cancer Chronic Kidney Diseases Diabetes Disability and Secondary Conditions Early and Middle Childhood Educational And Community-Based Programs Environmental Health Family Planning Food Safety Genomics Global Health Health Communication and Health IT Healthcare-Associated Infections Hearing and Other Sensory or Communication Disorders Heart Disease and Stroke HIV Immunization and Infectious Diseases Injury and Violence Prevention Maternal, Infant and Child Health Medical Product Safety Mental Health and Mental Disorders Nutrition and Weight Status Occupational Safety and Health Older Adults Oral Health Physical Activity and Fitness Public Health Infrastructure Quality of Life and Well-Being Respiratory Diseases Sexually Transmitted Diseases Social Determinants Of Health Substance Abuse Tobacco Use Vision HP2020 Topic Areas

Healthy People 2020 Public Meetings October 22 nd - Kansas City, Kansas November 7 th – Philadelphia, Pennsylvania November 20 th – Seattle, Washington Online Public Comment starting October 30th

Healthy People 2010 Final Review

Measuring Healthy Life Expectancies, HP 2010 Expected years in good or better health Global assessment question: “excellent, very good, good, fair, or poor”. Expected years free of activity limitation Any limitation in activity, or need for special equipment due to physical, mental, or emotional problems. Expected years free of selected chronic diseases Arthritis, asthma, cancer, diabetes, heart disease, high blood pressure, kidney disease, or stroke.

Life Expectancy and Expected Years of Healthy Life from Birth, 2004 Expected years of lifeFree of activity limitation In good or better health Free of selected chronic diseases Years from birth

Life Expectancy and Expected Years of Healthy Life from Birth, 2004 Expected years of lifeFree 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

Life Expectancy and Expected Years of Healthy Life from Birth, 2004 Expected years of lifeFree 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

Life Expectancy and Expected Years of Healthy Life from Age 65, 2004 Expected years of lifeFree of activity limitation In good or better health Free of selected chronic diseases Years from age 65

Life Expectancy and Expected Years of Healthy Life from Age 65, 2004 Expected years of lifeFree of activity limitation In good or better health Free of selected chronic diseases Years from age 65 Note: The categories white and black do not include persons of Hispanic origin

Life Expectancy and Expected Years of Healthy Life from Age 65, 2004 Expected years of lifeFree of activity limitation In good or better health Free of selected chronic diseases Years from age 65 Note: The categories white and black do not include persons of Hispanic origin

Progress toward Quality and Years of Healthy Life Life expectancy continues to improve for all population groups Between 1999 and 2004, 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; women live a greater proportion of their lives in healthy states than men (from age 65) Blacks have a shorter life expectancy than Whites; Blacks also live a greater proportion of life in unhealthy states compared to Whites

Limitations of HP 2010 Healthy Life Expectancies Excludes institutionalized populations Health status is respondent-reported  Overall health status  Activity limitations  Chronic conditions Uses cross-sectional prevalence data

Mortality-US Life Tables Under 85 years of age-Vital Statistics/Census 85 years + - Medicare Data Vital Statistics/Census Age misreporting-overstatement More prevalent in Census population than in Vital Statistics Medicare Proof of age requirement for enrollment 99 percent of deaths to Americans age 65 and older Current Methodology US Life Tables

Medicare vs. Vital Statistics Data United States Life Tables, 2005 (forthcoming)

Medicare vs. Vital Statistics Data United States Life Tables, 2005 (forthcoming)

Probability of Dying-Ages 66-94: Combined Vital Statistics and Medicare Data -Contribution of Medicare increases with age Probability of Dying-Ages : Exclusively Medicare Newly revised Methodology for US Life Tables

Decrease in Life Expectancy for all groups At Birth OldNewDifference Total Males Females At Age 65 OldNewDifference Total Males Females

Change in Rankings: Life Expectancy Females At Birth: 24 th to 24 th Age 65: 17 th to 20 th Males At Birth: 22 nd to 23 rd Age 65: 11 th to 16 th Implications for the Years of Healthy Life Measures OECD Health Data Year 2005 life expectancy data

Future Directions Develop additional domains/measures Improve international comparability Improve understanding and interpretation/behavior of measures

State of the USA (SUSA) Mobilizing Action Toward Community Health (MATCH) Beyond Healthy People

20 Key Health Indicators Health of the Nation Efficiency & Efficacy of US Health Systems SUSA

Health Outcomes -- LE at birth/65, infant mortality, Injury-related mortality, self-reported health status, physical and mental unhealthy days, chronic disease prevalence, serious psychological distress Health Related Behaviors -- Smoking, physical activity, excessive drinking, nutrition, obesity, condom use health-care expenditure, insurance coverage Health Systems Performance -- Health-care expenditure, insurance coverage SUSA

Community Health Indicators Community Health Index MATCH

Wisconsin County Health Rankings Published annually since 2003 Modeled after America’s Health Rankings Focuses on both health outcomes and health determinants Compilation of publicly available data for WI counties Includes individual and summary measures and ranks the ‘health’ of Wisconsin’s 72 counties

The Wisconsin Model of Population Health

MATCH County Health Rankings for all 50 states Release