Transcript Healthy People 2010 Progress Reviews

Measuring Years of Healthy Life:
Use of Summary Measures in
The Healthy People Initiative
Ritu Tuteja, MPH
National Center for Health Statistics
History of Healthy People
Timeline of major developments
1979
Surgeon General’s report
1980
Promoting Health, Preventing Disease
1987
Healthy People Consortium
1990
Healthy People 2000
1995
Healthy People 2000 Midcourse Review
2000
Healthy People 2010
2001
Healthy People 2000 Final Review
2006
Healthy People 2010 Midcourse Review
2008
2009
Healthy People 2020 Development & Regional Meetings
Release of Framework and Draft Objectives
2010
Healthy People 2020 Released
2011
Healthy People 2010 Final Review
Promoting Health, Preventing Disease1990 Health Objectives for the Nation


Health status goals by age
Longevity goals considered
only mortality/life
expectancy
Age Group
1990 Goal
Healthy Infants
(below age 1)
35% Fewer Deaths
Healthy Children
(age 1-14)
20% Fewer Deaths
Healthy
Adolescents/
Young Adults (age
15-24)
20% Fewer Deaths
Healthy Adults (age
25-64)
25% Fewer Deaths
Healthy Older
Adults (age 65+)
20% Fewer Sick
Days
Healthy People 2000

Goal 1: Increase the Span of Healthy Life for
Americans

Goal 2: Reduce Health Disparities Among
Americans

Goal 3: Achieve Access to Preventive Services
for All Americans
Healthy People 2010

Goal 1:
Increase Quality and Years of Healthy Life

Goal 2:
Eliminate Health Disparities
Healthy People 2020

Goal 1: Attain High Quality, Longer Lives Free of
Preventable Disease, Disability, Injury and
Premature Death

Goal 2: Achieve Health Equity, Eliminate
Disparities, and Improve the Health of all Groups

Goal 3: Create Social and Physical Environments
that Promote Good Health for All

Goal 4: Promote Quality of Life, Healthy
Development and Healthy Behaviors across All
Life Stages
Healthy People 2020

1200+ Objectives

40 Topic Areas
HP2020 Topic Areas
 Access
to Health Services
 Adolescent Health
 Arthritis, Osteoporosis & Chronic Back Conditions
 Blood Disorders and Blood Safety
 Cancer
 Chronic Kidney Diseases
 Diabetes
 Disability and Secondary Conditions
 Early and Middle Childhood
 Educational And Community-Based Programs
 Environmental Health
 Family Planning
 Food Safety
 Genomics
 Global Health
 Health Communication and Health IT
 Healthcare-Associated Infections
 Hearing and Other Sensory or Communication
Disorders
Heart Disease and Stroke
 HIV
 Immunization and Infectious Diseases
 Injury and Violence Prevention
 Maternal, Infant and Child Health
 Medical Product Safety
 Mental Health and Mental Disorders
 Nutrition and Weight Status
 Occupational Safety and Health
 Older Adults
 Oral Health
 Physical Activity and Fitness
 Public Health Infrastructure
 Quality of Life and Well-Being
 Respiratory Diseases
 Sexually Transmitted Diseases
 Social Determinants Of Health
 Substance Abuse
Tobacco Use
Vision

HP2020 Topic Areas

Access to Health Services


Adolescent Health
Arthritis, Osteoporosis & Chronic Back Conditions

Blood Disorders and Blood Safety
Cancer
 Chronic Kidney Diseases
 Diabetes
 Disability and Secondary Conditions


Early and Middle Childhood
Educational And Community-Based Programs
 Environmental Health
 Family Planning
 Food Safety

Genomics
 Global Health


Health Communication and Health IT
Healthcare-Associated Infections
 Hearing and Other Sensory or
Communication Disorders

Heart Disease and Stroke
 HIV
 Immunization and Infectious Diseases
 Injury and Violence Prevention
 Maternal, Infant and Child Health
 Medical Product Safety
 Mental Health and Mental Disorders
 Nutrition and Weight Status
 Occupational Safety and Health


Older Adults
Oral Health
 Physical Activity and Fitness
 Public Health Infrastructure


Quality of Life and Well-Being
Respiratory Diseases
 Sexually Transmitted Diseases


Social Determinants Of Health
Substance Abuse
Tobacco Use
 Vision

HP2020 Topic Areas

Access to Health Services
 Adolescent

Health
Arthritis, Osteoporosis & Chronic Back Conditions

Blood Disorders and Blood Safety
Cancer
 Chronic Kidney Diseases
 Diabetes
 Disability and Secondary Conditions


Early and Middle Childhood
Educational And Community-Based Programs
 Environmental Health
 Family Planning
 Food Safety




Genomics
Global Health
Health Communication and Health IT
Healthcare-Associated Infections
 Hearing and Other Sensory or
Communication Disorders

Heart Disease and Stroke
 HIV
 Immunization and Infectious Diseases
 Injury and Violence Prevention
 Maternal, Infant and Child Health
 Medical Product Safety
 Mental Health and Mental Disorders
 Nutrition and Weight Status
 Occupational Safety and Health


Older Adults
Oral Health
 Physical Activity and Fitness
 Public Health Infrastructure


Quality of Life and Well-Being
Respiratory Diseases
 Sexually Transmitted Diseases


Social Determinants Of Health
Substance Abuse
Tobacco Use
 Vision

Healthy People 2020
Public Meetings
October
22nd - Kansas City, Kansas
November
7th – Philadelphia, Pennsylvania
November
20th – Seattle, Washington
Online Public Comment starting October 30th
Healthy People 2010
Final Review
Measuring Healthy Life
Expectancies, HP 2010

Expected years in good or better health
 Global assessment question: “excellent, very good, good, fair, or poor”.

Expected years free of activity limitation
 Any limitation in activity, or need for special equipment due to physical, mental, or
emotional problems.

Expected years free of selected chronic
diseases
 Arthritis, asthma, cancer, diabetes, heart disease, high blood pressure, kidney
disease, or stroke.
Life Expectancy and Expected Years
of Healthy Life from Birth, 2004
90
80
70
60
50
40
30
20
10
0
Expected years of life
Free of activity limitation
In good or better health
Free of selected chronic diseases
Years from birth
Total
Women
Men
White
Black
Life Expectancy and Expected Years
of Healthy Life from Birth, 2004
90
80
70
60
50
40
30
20
10
0
Expected years of life
Free of activity limitation
In good or better health
Free of selected chronic diseases
Years from birth
Total
Women
Men
Note: The categories white and black do not include persons of Hispanic origin
White
Black
Life Expectancy and Expected Years
of Healthy Life from Birth, 2004
90
80
70
60
50
40
30
20
10
0
Expected years of life
Free of activity limitation
In good or better health
Free of selected chronic diseases
Years from birth
Total
Women
Men
Note: The categories white and black do not include persons of Hispanic origin
White
Black
Life Expectancy and Expected Years of
Healthy Life from Age 65, 2004
20
18
16
14
12
10
8
6
4
2
0
Expected years of life
Free of activity limitation
In good or better health
Free of selected chronic diseases
Years from age 65
Total
Women
Men
White
Black
Life Expectancy and Expected Years of
Healthy Life from Age 65, 2004
25
Expected years of life
Free of activity limitation
In good or better health
Free of selected chronic diseases
Years from age 65
20
15
10
5
0
Total
Women
Men
Note: The categories white and black do not include persons of Hispanic origin
White
Black
Life Expectancy and Expected Years of
Healthy Life from Age 65, 2004
25
Expected years of life
Free of activity limitation
In good or better health
Free of selected chronic diseases
Years from age 65
20
15
10
5
0
Total
Women
Men
Note: The categories white and black do not include persons of Hispanic origin
White
Black
Progress toward Quality and
Years of Healthy Life

Life expectancy continues to improve for all
population groups

Between 1999 and 2004, 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; women live a greater proportion of their lives in
healthy states than men (from age 65)

Blacks have a shorter life expectancy than Whites;
Blacks also live a greater proportion of life in
unhealthy states compared to Whites
Current Methodology
US Life Tables

Mortality-US Life Tables
Under 85 years of age-Vital Statistics/Census
 85 years + - Medicare Data


Vital Statistics/Census
Age
misreporting-overstatement
More prevalent in Census population than in Vital Statistics

Medicare
Proof
of age requirement for enrollment
99 percent of deaths to Americans age 65 and older
Medicare vs. Vital Statistics Data
0.40
White male,
Medicare
White male, Vital
Statistics
White female,
Medicare
White female, Vital
Statistics
0.35
0.30
q(x)
0.25
0.20
0.15
0.10
0.05
0.00
60
65
70
United States Life Tables, 2005 (forthcoming)
75
80
Age
85
90
95
100
Medicare vs. Vital Statistics Data
0.30
Black male,
Medicare
Black male,
Vital Statistics
Black female,
Medicare
0.25
q(x)
0.20
Black female,
Vital Statistics
0.15
0.10
0.05
0.00
60
65
70
United States Life Tables, 2005 (forthcoming)
75
80
Age
85
90
95
100
Newly revised Methodology for
US Life Tables

Probability of Dying-Ages 66-94:
Combined Vital Statistics and Medicare Data
-Contribution of Medicare increases with age

Probability of Dying-Ages 95-100:
Exclusively Medicare
Newly revised Methodology for
US Life Tables
Decrease
in Life Expectancy for all groups
At Birth
At Age 65
Old
New
Difference
Old
New
Difference
Total
77.8
77.4
0.4
Total
18.7
18.2
0.5
Males
75.2
74.9
0.3
Males
17.2
16.8
0.4
Females
80.4
79.9
0.5
Females
20.0
19.5
0.5
Change in Rankings:
Life Expectancy
Males
 At
Birth: 22nd to 23rd
Age
65: 11th to 16th
Females
 At
Birth: 24th to 24th
Age
65: 17th to 20th
Implications for the Years of Healthy Life Measures
OECD Health Data 2009- Year 2005 life expectancy data
Future Directions

Develop additional domains/measures

Improve international comparability

Improve understanding and
interpretation/behavior of measures
http://www.cdc.gov/nchs/hphome.htm