Foundation Health Measures

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Global, cross-cutting summary measures of population health have been included in Healthy People since the initiative’s second decade.^1,2,3

In Healthy People 2020, the cross-cutting summary measures are called Foundation Health Measures. Such measures have been a cornerstone of Healthy People because they reflect the impact of actions and interventions implemented to achieve the Healthy People objectives and goals. The measures are used to monitor improvement in population health in the broadest sense.

In 2016, the Foundation Health Measures were reorganized into a succinct number of broad, global measures of health in a coherent, visible, and conceptually-consistent manner. Two tiers of Foundation Health Measures are currently included in Healthy People 2020 (Table 1). The first tier includes 3 measures of healthy life expectancy that combine life expectancy with selected summary measures of health.⁴

The first tier measures are ordered to form a hierarchy, with an indicator of participation in society—activity limitation—at the top, followed by a measure of disability, and, finally, a measure of respondent-assessed health. The second tier of Foundation Health Measures disaggregates the measures of healthy life expectancy into their component parts, namely: life expectancy; activity limitation; disability; and respondent-assessed health.⁵

Table 1. Healthy People 2020 Foundation Health Measures

Tier 1 Foundation Health Measures: Healthy Life Expectancy

Healthy life expectancy is the average number of healthy years a person can expect to live if age-specific death rates and age-specific morbidity rates remain the same throughout his or her lifetime. Thus, healthy life expectancy is a snapshot of current death and illness patterns, illustrating the long-range implications of the prevailing age-specific death and illness rates. The measure is comparable across different populations and time periods.

Healthy People 2020 tracks healthy life expectancy using 3 measures, each of which is evaluated at birth and at age 65 (Table 1):

• Expected years of life free of activity limitation
• Expected years of life free of disability
• Expected years of life in good or better health

Tier 2 Foundation Health Measures: Summary Mortality and Population Health Measures

The Tier 2 Foundation Health Measures disaggregate the measures of healthy life expectancy into their component parts, namely: life expectancy; activity limitation; disability; and respondent-assessed health (Table 1). For comparability with the Tier 1 healthy life expectancy measures, Tier 2 life expectancy is evaluated at birth and at age 65. Similarly, the summary population health measures (activity limitation, disability, and respondent-assessed health) are evaluated for all ages and for adults aged 65 and over.

Life Expectancy

Life expectancy is a summary mortality measure often used to describe the overall health status of a population. Life expectancy is defined as the average number of years a population of a certain age would be expected to live, given a set of age-specific death rates in a given year.

Activity Limitation

Activity limitation refers to a long-term reduction in a person’s ability to perform his or her usual activities, including:⁵

• Requiring the help of other people with personal care or routine needs
• Playing and going to school (for children and youth)
• Working (for adults)
• Remembering
• Any other activity that he or she cannot do or participate in because of a physical, mental, or emotional problem.

Disability

The term disability describes people at risk of a limitation in their ability to fully participate in society. People are identified as having a disability through a set of 6 standardized questions developed for the American Community Survey (ACS). These questions ask if a person has difficulty in any of these 6 domains of functioning:⁶

• Hearing
• Seeing
• Concentrating
• Remembering or making decisions
• Walking or climbing stairs
• Dressing or bathing
• Doing errands alone

Respondent-Assessed Health Status

Respondent-assessed health status is a measure of how a person perceives his or her health. It is assessed by a single question that asks a respondent to rate his or her health as “excellent,” “very good,” “good,” “fair,” or “poor.”⁷

Selected Findings

Healthy Life Expectancy at Birth

In 2014, compared to the life expectancy at birth of 78.8 years, persons could expect to live an average of:

• 68.1 years (86.4%) free of activity limitation (FHM-1.1)
• 66.0 years (83.7%) free of disability (FHM-1.2)
• 70.4 years (89.3%) in good or better health (FHM-1.3)

Healthy Life Expectancy at Age 65

In 2014, compared to the life expectancy at age 65 of 19.3 years, persons could expect to live an average of:

• 13.5 years (69.9%) free of activity limitation (FHM-2.1)
• 11.1 years (57.5%) free of disability (FHM-2.2)
• 15.0 years (77.7%) in good or better health (FHM-2.3)

Life Expectancy

In 2014, life expectancy:

• At birth (FHM-3) was 76.4 years for men and 81.2 years for women
• At age 65 (FHM-4) was 18.0 years for men and 20.5 years for women

Summary Health Measures:

In 2014, the percentage (age-adjusted) of individuals with:

• Activity limitation was 11.3% for all ages (FHM-5.1) and 29.2% among persons aged 65 years and over (FHM-5.2).
• Disability was 12.9% for all ages (FHM-6.1) and 41.0% among persons aged 65 years and over (FHM-6.2).
• Poor or fair health was 8.9% for all ages (FHM-7.1) and 22.1% among persons aged 65 years and over (FHM-7.2).

To see the previous version of Healthy People 2020 Foundation Health Measures, please visit the Foundation Health Measures archive.

Footnotes

1 Department of Health and Human Services. Public Health Service. (2001). Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: Government Printing Office.

2 Erickson P., Wilson R., Shannon I. Years of Healthy Life. Healthy People 2000 Statistical Notes No. 7. Hyattsville, MD: National Center for Health Statistics. 1995.

3 The initiative’s first decade, Healthy People 1990, included five broad “health goals” that reflected the importance of enhancing life in each of the five major life stages: infants; children; adolescents and young adults; adults; and older adults. These health goals were monitored primarily using mortality measures; see: Department of Health, Education, and Welfare. Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention. Public Health Service. Washington, DC: U.S. Government Printing Office. 1979. These original five goals were retained in future Healthy People decades; however, changes in how health was conceptualized and measured resulted in new summary measures of health being used in subsequent decades.

4 Madans JH and JD Weeks. A Framework for Monitoring Progress Using Summary Measures of Health. Journal of Aging and Health. 28(7): 1299-1314. 2016.

5 Since the 1997 National Health Interview Survey (NHIS), activity limitation has been assessed by asking respondents about their (or a family member’s) limitations in: activities of daily living, such as eating, bathing/showering, dressing, getting in and out of bed, or using the toilet; instrumental activities of daily living, such as using the telephone, doing housework, preparing meals, shopping, or managing money; playing, going to school, or working; remembering; and any other activity that they (or their family member) cannot do because of a physical, mental, or emotional problem.

6 Since 2008, the National Health Interview Survey (NHIS) has included disability questions as part of an effort to develop and implement a standardized set of questions across multiple surveys in multiple countries. The American Community Survey (ACS) disability questions were adopted in 2011 by the U.S. Department of Health and Human Services (HHS) as the standard set of disability questions to be included on all HHS national surveys, including NHIS. The six ACS questions assess any serious difficulties with hearing; seeing; concentrating, remembering, or making decisions; walking or climbing stairs; dressing or bathing; and doing errands alone. Respondents who report any of these difficulties are considered to have a disability. See: http://aspe.hhs.gov/datacncl/standards/ACA/4302/index.shtml.

7 In the National Health Interview Survey (NHIS), respondent-assessed health status has been assessed from the single question “Would you say [your/ALIAS’s] health in general is excellent, very good, good, fair, or poor?” Health status may be assessed and reported by the respondent for himself or herself, or on behalf of a family member living in the same household.