Section Six

As demonstrated by the review of models and candidate sets of indicators in this report, many approaches are possible for developing leading health indicators which underscore progress and/or problems on key dimensions of the national health agenda. Not all approaches, however, are likely to achieve the goal of extending the reach of Healthy People beyond the health community to opinion leaders, the public, and non-health professionals. Factors that will influence the successful implementation of leading health indicators are likely to include 1) the publics understanding of the indicators, 2) perceived importance of the health issues, 3) availability of a reliable data source, 4) robustness of the indicators over time, and 5) relevance and utility to Healthy Peoples goals.

Public Understanding of the Indicators

If the peoples attention is to be drawn to the factors most important to the health prospects of their communities and themselves, and if support is to be mobilized for efforts to address those factors, the indicators chosen to reflect those factors must be both understandable and appealing. The notion of understandability, of course, may itself be somewhat ethereal. Based on its review of current indicator sets, the working group has observed that public understanding of indicators involves more than language. Words are important, and steeping the message in science or medical vernacular will not facilitate its accessibility. In addition to the clarity and simplicity of the words chosen to characterize a problem are issues such as perception of personal relevance of the problem, awareness of actions that can be taken to address it, availability of resources, sense of the possible for individual action, and the likelihood that results might be seen in the near-term.

Importance of the Health Issue

Part and parcel of the issue of understandability is the issue of priority. Clearly, identifying the important requires prudence of choice. Although many factors affect health status, and many programs are mounted to address health improvement (not to mention the many contributing organizations who take on one or another aspect of an issue), care must be used in selecting a list which is not so long as to immediately distance the target audience. Ultimately, importance must be determined not only by the foremost criteria of data and science--what the numbers reveal about impact and remedy--but also by public perception of the important. A set of indicators will maintain its interest and credibility only as long as the public perceives it as in synchrony with its interests.

Reliability of Data Sources

As numerical embodiments of vital life events, the data chosen must be faithful to the experiences they reflect, must be from sources that are perceived as independent and credible, and must be available over time. Other considerations of importance include the possibility of generating comparable data at the subnational and subgroup level for a variety of racial and ethnic groups and for the purpose of enhancing understanding of the distribution of the problems and better targeting interventions.

Robustness Over Time

One of the central assumptions underlying the selection of a set of indicators to serve as regularly collected and reported summaries of health progress and prospects is that the regular reporting process on the agreed-upon dimensions will have an inherent value for educating the public about important issues. The process of expectation and repetition has in itself educational value. This suggests that the indicator set chosen must be robust--that is, there must be at least a reasonable expectation that a sizable core of the indicator set will remain relevant for a long period of time while also offering some capacity to change the set at the margins in response to new knowledge and changing conditions.

Relevance to Program

It is assumed that the indicator set identified will be fully integrated into, and supportive of, the Healthy People 2010 initiative--that it will serve as a flagship for the full set of objectives. But, in addition, for the indicators to hold the potential of maximum impact, they must also be directly relevant to program directions and policies. Although throughout the land there are myriad programs and policies to which these sets must be relevant, at a minimum their utility to Federal program decisionmaking is vital. Their durability over time is dependent on their effectiveness as useful tools for tailoring program


McGinnis JM and Lee PR. Healthy People 2000 at Mid Decade. JAMA. 273 (14), April 12, 1995, 1123-1129.

Public Health Service. Healthy People: Surgeon General's Report on Health Promotion and Disease Prevention. Washington, D.C.: U.S. Department of Health and Human Services, 1979.


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