Use of Summary Measures in the US Healthy People and Healthiest Nation Initiatives Richard J. Klein US 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 al 2003 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 healthFree 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,

Years from age 65 Expected years of lifeFree 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,

Progress toward Quality and Years of Healthy Life Life expectancy continues to improve for all population groups Between to , 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 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 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) 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