Leading Health Indicators

CHAPTER IV

Leading Health Indicators

Lead Agencies

Agency for Healthcare Research and Quality

Centers for Disease Control and Prevention

Food and Drug Administration

Health Resources and Services Administration

Indian Health Service

National Institutes of Health

Office of Adolescent Health, Office of the Assistant Secretary for Health,

Office of the Secretary

Office of Population Affairs, Office of the Assistant Secretary for Health,

Office of the Secretary

President¡¯s Council on Fitness, Sports, & Nutrition

Substance Abuse and Mental Health Services Administration

Contents

Background

Status of Leading Health Indicators

Figure IV¨C1. Midcourse Status of the Leading Health Indicators

Selected Findings

More Information

Footnotes

Suggested Citation

HEALTHY PEOPLE 2020 MIDCOURSE REVIEW

IV¨C3

IV¨C4

IV¨C4

IV¨C4

IV¨C8

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IV¨C10

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HEALTHY PEOPLE 2020 MIDCOURSE REVIEW

Contents¡ªContinued

Table IV¨C1. Leading Health Indicators

Table IV¨C2. Midcourse Progress for Leading Health Indicators

Table IV¨C3. Midcourse Health Disparities for Population-based

Leading Health Indicators

Map IV¨C1. Adults (50¨C75 years) Who Received Colorectal Cancer Screening Based on

Most Recent Guidelines, by State: 2014

Map IV¨C2. All Infant (< 1 year) Deaths, by State: 2013

Map IV¨C3. Total Preterm Live Births (< 37 completed weeks of gestation),

by State: 2013

Map IV¨C4. Adults (18+ years) Who Met Guidelines for Aerobic and

Muscle-strengthening Physical Activity, by State: 2013

Map IV¨C5. Adult (20+ years) Obesity Based on Self-reported Weight and Height,

by State: 2013

Map IV¨C6. Knowledge of Serostatus Among HIV-positive Persons (13+ years),

by State: 2012

Map IV¨C7. Students Who Graduated From High School 4 Years After

Starting 9th Grade, by State: 2012¨C2013

Map IV¨C8. Adults (18+ years) Who Engaged in Binge Drinking in the Past 30 Days,

by State: 2010¨C2013

Map IV¨C9. Adult (18+ years) Cigarette Smoking, by State: 2013

Map IV¨C10. Adolescent (grades 9¨C12) Cigarette Smoking in the Past 30 Days,

by State: 2013

HEALTHY PEOPLE 2020 MIDCOURSE REVIEW

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IV¨C17

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IV¨C25

IV¨C26

IV¨C27

IV¨C28

IV¨C29

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Chapter IV ? Leading Health Indicators

IV¨C3

Background

For four decades, Healthy People has provided a

comprehensive set of 10-year national goals and

objectives for improving the health of all Americans.

Healthy People 2020, the most recent iteration, tracks the

country¡¯s health through more than 1,200 objectives that

span 42 topic areas.

The Leading Health Indicators are a select subset of 26

Healthy People 2020 objectives chosen to communicate

high-priority health issues and challenges. They address

determinants of health that promote quality of life,

healthy behaviors, and healthy development across all

life stages. The indicators are used to assess the health

of the country, facilitate collaboration across sectors, and

motivate action to improve health at the national, state,

and community levels.

The Leading Health Indicators were selected and

organized using a ¡°Health Determinants and Health

Outcomes by Life Stages¡± conceptual framework. This

approach was intended to draw attention to both

individual and societal determinants that affect the

public¡¯s health and contribute to health disparities from

infancy through old age, thereby highlighting strategic

opportunities to promote health and improve quality of

life for all Americans. The selection process was led by

the Healthy People 2020 Federal Interagency Workgroup

(FIW). In selecting the indicators, the FIW took into

consideration recommendations from the Institute of

Medicine of the National Academy of Sciences and the

Secretary¡¯s Advisory Committee on National Health

Promotion and Disease Prevention Objectives for

2020. For more information on the development and

framework see ¡°More Information¡± below.

Leading Health Indicator Topics

The Leading Health Indicators are organized into 12

topics. These topics are described briefly below, and

references are provided for readers interested in further

information about their public health significance.

Access to Health Services. Barriers to accessing health

services, such as lack of availability, high cost, and lack

of medical insurance, lead to unmet health care needs,

delays in receiving needed care, inability to obtain

preventive services, and preventable hospitalizations.1

Clinical Preventive Services. Services such as routine

disease screening and scheduled immunizations prevent

illnesses and detect diseases in their earlier, more

treatable stages, reducing the risk of illness, disability,

early death, and medical care costs.2

Environmental Quality. Approximately one-quarter

of the global disease burden is due to modifiable

environmental factors, which include exposure to toxic

substances and hazardous wastes in the air, water, soil,

and food.3

Injury and Violence. Intentional and unintentional

injuries are critical public health concerns in the United

States. They include homicide; intimate partner,

sexual, and school violence; child abuse and neglect;

suicide; motor vehicle crashes; and unintentional drug

overdoses.4

Maternal, Infant, and Child Health. Addressing the

health needs of women before, during, and after

pregnancy helps to improve not only their health but

also their children¡¯s health. Healthy birth outcomes and

early identification and treatment of health conditions

among infants can prevent death or disability and enable

children to reach their full potential.5

Mental Health. Mental health is a component of a

person¡¯s well-being, healthy family and interpersonal

relationships, and the ability to live a full and productive

life. Mental health disorders have a serious impact on

physical health and are associated with the prevalence,

progression, and outcome of chronic diseases such as

diabetes, heart disease, and cancer.6

Nutrition, Physical Activity, and Obesity. Good nutrition,

physical activity, and a healthy body weight can help

decrease the risk of developing serious health conditions,

such as high blood pressure, high cholesterol, diabetes,

heart disease, stroke, and cancer. In addition, to manage

existing health conditions to improve quality of life,

the 2015¨C2020 ¡°Dietary Guidelines for Americans¡±

emphasize following a healthy eating pattern, engaging in

regular physical activity, and achieving and maintaining a

healthy weight.7

Oral Health. Oral diseases include dental caries (cavities),

periodontal (gum) disease, cleft lip and palate, oral and

facial pain, and oral and pharyngeal (mouth and throat)

cancers. Oral diseases, particularly gum disease, have

been linked to chronic diseases such as diabetes, heart

disease, and stroke. Many oral diseases can be prevented

with regular dental care.8

Reproductive and Sexual Health. Reproductive and

sexual health covers a broad range of health needs from

adolescence forward, including the reproductive system,

sexually transmitted diseases (STDs), HIV, and fertility.

Untreated STDs can lead to serious long-term health

IV¨C4

HEALTHY PEOPLE 2020 MIDCOURSE REVIEW

consequences, especially for adolescent girls and young

women. These include reproductive health problems and

infertility, fetal and perinatal health problems, cancer, and

further sexual transmission of HIV and other STDs.9

Social Determinants. Individual and population health

are affected by a range of personal, social, economic,

and environmental factors. For example, access to parks

and safe sidewalks is associated with physical activity

in adults, and education is associated with improved

health and quality of life and health-promoting behaviors.

Although education is the Leading Health Indicator for

this topic, many Healthy People 2020 objectives address

social determinants as a means of improving population

health.9

Substance Abuse. Substance abuse¡ªinvolving drugs,

alcohol, or both¡ªis associated with a wide range

of detrimental social conditions, including family

disruptions, financial problems, lost productivity, failure

in school, domestic violence, child abuse, and crime.

Substance abuse contributes to a number of negative

health outcomes and public health problems, including

cardiovascular conditions, pregnancy complications,

teen pregnancy, HIV/AIDS, STDs, motor vehicle crashes,

homicide, and suicide.10,11

Tobacco. Tobacco use is the leading cause of preventable

disease, disability, and death in the United States. More

deaths are caused each year by tobacco use than from

HIV, illegal drug use, alcohol use, motor vehicle injuries,

suicides, and homicides combined. Tobacco use causes

several forms of cancer, heart disease, stroke, lung

diseases, pregnancy complications, gum disease, and

vision problems.12,13

Status of Leading Health Indicators

Figure IV¨C1. Midcourse Status of Leading Health Indicators

Total Objectives: 26

Measurable Objectives: 26

Getting worse 11.5% (n = 3)

Little or no

detectable

change

26.9% (n = 7)

Measurable

Developmental

50.0% 100.0%

(n = 2) (n = 26)

Target met or

exceeded

30.8% (n = 8)

Improving

30.8% (n = 8)

All 26 of the Leading Health Indicators were measurable

Healthy People 2020 objectives15,16 at midcourse

(Figure IV¨C1, Table IV¨C1). The midcourse status of these

objectives (Table IV¨C2) was as follows:

Selected Findings

? 8 objectives had met or exceeded their 2020 targets,

? The proportion of persons under age 65 with medical

17

? 8 objectives were improving,

18

? 7 objectives had demonstrated little or no detectable

change,19 and

? 3 objectives were getting worse.20

Access to Health Services

insurance (AHS-1.1) increased from 83.2% in 2008 to

86.7% in 2014, moving toward the 2020 target (Table

IV¨C2).

? In 2014, there were statistically significant

disparities by sex, race and ethnicity, education,

family income, disability status, and geographic

location in the proportion of persons under age 65

with medical insurance (AHS-1.1, Table IV¨C3).

Chapter IV ? Leading Health Indicators

? There was little or no detectable change (76.3% in

2007 and 76.5% in 2012) in the proportion of persons

with a usual primary care provider (AHS-3, Table

IV¨C2).

? In 2012, there were statistically significant

disparities by sex, race and ethnicity, education, and

family income in the proportion of persons with a

usual primary care provider (AHS-3, Table IV¨C3). The

disparity by geographic location was not statistically

significant.

Clinical Preventive Services

? The age-adjusted proportion of adults aged 50¨C75

who had received a colorectal cancer screening based

on the most recent guidelines (C-16) increased from

52.1% in 2008 to 58.2% in 2013, moving toward the

2020 target (Table IV¨C2).

? In 2014, the age-adjusted proportion of adults aged

50¨C75 who received a colorectal cancer screening

based on the most recent guidelines varied by state

(Map IV¨C1).21

? In 2013, there were statistically significant

disparities by race and ethnicity, education, family

income, disability status, and geographic location in

the age-adjusted proportion of adults aged 50¨C75

who had received a colorectal cancer screening

based on the most recent guidelines (C-16, Table

IV¨C3). The disparity by sex was not statistically

significant.

? The age-adjusted proportion of adults aged 18 and

over with hypertension whose blood pressure was

under control (HDS-12) increased from 43.7% in

2005¨C2008 to 48.9% in 2009¨C2012, moving toward the

2020 target (Table IV¨C2).

? In 2009¨C2012, there were statistically significant

disparities by sex, race and ethnicity, and disability

status in the age-adjusted proportion of adults with

hypertension whose blood pressure was under

control (HDS-12, Table IV¨C3). The disparities by

education and family income were not statistically

significant.

? Between 2005¨C2008 and 2009¨C2012, there was

little or no detectable change in the age-adjusted

proportion of adults aged 18 and over with diagnosed

diabetes whose A1c value was greater than 9%

(18.0% and 21.0%, respectively) (D-5.1, Table IV¨C2).

? In 2009¨C2012, there were statistically significant

disparities by sex and race and ethnicity in the

age-adjusted proportion of adults with diagnosed

diabetes whose A1c value was greater than 9%

IV¨C5

(D-5.1, Table IV¨C3). The disparities by education,

family income, and disability status were not

statistically significant.

? The percentage of children aged 19¨C35 months who

received the recommended doses of diphtheriatetanus-acellular pertussis (DTaP); polio; measles,

mumps, rubella (MMR); Haemophilus influenza B

(Hib); hepatitis B (HepB); varicella; and pneumococcal

conjugate vaccine (PCV) (IID-8) increased from 68.4%

in 2012 to 71.6% in 2014, moving toward the 2020

target (Table IV¨C2).

? In 2014, there were statistically significant

disparities by sex, mother¡¯s education, and family

income in the percentage of children aged 19¨C35

months who received the recommended doses

of DTaP, polio, MMR, Hib, HepB, varicella, and

PCV (IID-8, Table IV¨C3). The disparities by race

and ethnicity and geographic location were not

statistically significant.

Environmental Quality

? The number of days the Air Quality Index (AQI)

exceeded 100 (EH-1) decreased from 2,200,000,000

(weighted by population and AQI) in 2006¨C2008 to

982,186,972 in 2012¨C2014, exceeding the 2020 target

(Table IV¨C2).

? The proportion of children aged 3¨C11 years who were

exposed to secondhand smoke (TU-11.1) decreased

from 52.2% in 2005¨C2008 to 41.3% in 2009¨C2012,

exceeding the 2020 target (Table IV¨C2).

? In 2009¨C2012, there were statistically significant

disparities by race and ethnicity and family income

in the proportion of children aged 3¨C11 years

exposed to secondhand smoke (TU-11.1, Table

IV¨C3). The disparity by sex was not statistically

significant.

Injury and Violence

? The age-adjusted rate of injury deaths (IVP-1.1) per

100,000 population decreased from 59.7 in 2007 to

58.8 in 2013, moving toward the 2020 target

(Table IV¨C2).

? In 2013, there were statistically significant

disparities by sex, race and ethnicity, and

geographic location in the age-adjusted rate of

injury deaths (IVP-1.1, Table IV¨C3).

? The age-adjusted rate of homicides (IVP-29) per

100,000 population decreased from 6.1 in 2007 to 5.2

in 2013, exceeding the 2020 target (Table IV¨C2).

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