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?1. Midcourse Status of the Leading Health Indicators Selected Findings More Information Footnotes Suggested Citation

HEALTHY PEOPLE 2020 MIDCOURSE REVIEW

IV?3 IV?4 IV?4 IV?4 IV?8 IV?8 IV?10

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HEALTHY PEOPLE 2020 MIDCOURSE REVIEW

Contents--Continued

Table IV?1. Leading Health Indicators

Table IV?2. Midcourse Progress for Leading Health Indicators

Table IV?3. Midcourse Health Disparities for Population-based Leading Health Indicators

Map IV?1. Adults (50?75 years) Who Received Colorectal Cancer Screening Based on Most Recent Guidelines, by State: 2014

Map IV?2. All Infant (< 1 year) Deaths, by State: 2013

Map IV?3. Total Preterm Live Births (< 37 completed weeks of gestation), by State: 2013

Map IV?4. Adults (18+ years) Who Met Guidelines for Aerobic and Muscle-strengthening Physical Activity, by State: 2013

Map IV?5. Adult (20+ years) Obesity Based on Self-reported Weight and Height, by State: 2013

Map IV?6. Knowledge of Serostatus Among HIV-positive Persons (13+ years), by State: 2012

Map IV?7. Students Who Graduated From High School 4 Years After Starting 9th Grade, by State: 2012?2013

Map IV?8. Adults (18+ years) Who Engaged in Binge Drinking in the Past 30 Days, by State: 2010?2013

Map IV?9. Adult (18+ years) Cigarette Smoking, by State: 2013

Map IV?10. Adolescent (grades 9?12) Cigarette Smoking in the Past 30 Days, by State: 2013

IV?11 IV?14 IV?17 IV?23 IV?24 IV?25 IV?26 IV?27 IV?28 IV?29 IV?30 IV?31 IV?32

HEALTHY PEOPLE 2020 MIDCOURSE REVIEW

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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?2020 "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

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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--involving drugs, alcohol, or both--is 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?1. Midcourse Status of Leading Health Indicators

Total Objectives: 26

Measurable Objectives: 26 Getting worse 11.5% (n = 3)

DevelopmMenetaasl urable 50.0% 100.0% (n = 2) (n = 26)

Little or no detectable

change 26.9% (n = 7)

Target met or exceeded

30.8% (n = 8)

Im proving 30.8% (n = 8)

All 26 of the Leading Health Indicators were measurable Healthy People 2020 objectives15,16 at midcourse (Figure IV?1, Table IV?1). The midcourse status of these objectives (Table IV?2) was as follows:

8 objectives had met or exceeded their 2020 targets,17

8 objectives were improving,18

7 objectives had demonstrated little or no detectable change,19 and

3 objectives were getting worse.20

Selected Findings

Access to Health Services

The proportion of persons under age 65 with medical insurance (AHS-1.1) increased from 83.2% in 2008 to 86.7% in 2014, moving toward the 2020 target (Table IV?2). ? 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?3).

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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?2).

? 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?3). The disparity by geographic location was not statistically significant.

Clinical Preventive Services

The age-adjusted proportion of adults aged 50?75 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?2).

? In 2014, the age-adjusted proportion of adults aged 50?75 who received a colorectal cancer screening based on the most recent guidelines varied by state (Map IV?1).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?75 who had received a colorectal cancer screening based on the most recent guidelines (C-16, Table IV?3). 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?2008 to 48.9% in 2009?2012, moving toward the 2020 target (Table IV?2).

? In 2009?2012, 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?3). The disparities by education and family income were not statistically significant.

Between 2005?2008 and 2009?2012, 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?2).

? In 2009?2012, 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%

(D-5.1, Table IV?3). The disparities by education, family income, and disability status were not statistically significant.

The percentage of children aged 19?35 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?2).

? In 2014, there were statistically significant disparities by sex, mother's education, and family income in the percentage of children aged 19?35 months who received the recommended doses of DTaP, polio, MMR, Hib, HepB, varicella, and PCV (IID-8, Table IV?3). 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?2008 to 982,186,972 in 2012?2014, exceeding the 2020 target (Table IV?2).

The proportion of children aged 3?11 years who were exposed to secondhand smoke (TU-11.1) decreased from 52.2% in 2005?2008 to 41.3% in 2009?2012, exceeding the 2020 target (Table IV?2).

? In 2009?2012, there were statistically significant disparities by race and ethnicity and family income in the proportion of children aged 3?11 years exposed to secondhand smoke (TU-11.1, Table IV?3). 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?2).

? 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?3).

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?2).

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