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Core, developmental, and research objectives comprise Healthy People 2030. Because core objectives are defined as having valid, reliable, and timely data sources, as well as evidence-based interventions through which their targets can be met, the Leading Health Indicators (LHIs) for Healthy People 2030 will be drawn from them. The Committee recommends a set of criteria for selecting Healthy People 2030 LHIs based on the Healthy People 2030 Framework, which includes the vision, mission, foundational principles, overarching goals, and plan of action.

PHASE 1 is the place to be.

All core objectives should be evaluated using the four criteria listed below:

1. The relative importance of public health to the nation’s health and well-being.

2. The magnitude of the health disparity, as well as the extent to which health equity would be achieved if the target were met;

3. The extent to which the objective serves as a sentinel or bellwether; and

4. The objective’s actionability.
Four criteria are applied to the core objectives in phase 1. The first criterion, public health burden, is traditionally represented by critical metrics such as excess morbidity and mortality. In contrast, indicators may appear to have a low public health burden (e.g., low levels of selected infectious diseases) due to current practice (e.g., vaccinations). As a result, the public health burden must also be assessed in terms of whether it would be significant if current practices were discontinued. The responsibility of public health directly supports Healthy People 2030’s mission to “promote, strengthen, and evaluate the nation’s efforts to improve the health and well-being of all people.”

The second criterion considers the health disparity’s magnitude and the extent to which health equity would be achieved if the LHI target were met. It contributes directly to the overarching goal of “eliminating health disparities, achieving health equity, and achieving health literacy in order to improve the health and well-being of all.”

The third criterion highlights the LHIs’ role as a sentinel and bellwether for the nation’s health, as well as a warning or herald of threats. This criterion contributes to the Healthy People 2030 plan of action by “providing data that can drive targeted actions to address regions and populations with poor health or at high risk of future poor health.”

The final criterion, actionability, is multifaceted. It considers the state of available and actionable evidence and the ability to improve health and well-being at a reasonable cost. The foundational principle that “promoting and achieving the nation’s health and well-being is a shared responsibility distributed across the national, state, tribal, and community levels, including the public, private, and not-for-profit sectors,” as well as the plan of action to develop and make available “affordable means of health promotion, disease prevention, and treatment,” inform actionability.
Application Description
Phase 1 is a focused assessment that applies four criteria to each of Healthy People 2030’s core objectives. A quantitative approach aids in the identification of the initial set of potential LHI candidates. All core objectives would be graded on a scale of 1 (not necessary) to 10 (very important) (very important). A total score would be calculated based on the four criteria, ranging from 4 (least important) to 40 (most important) (most important). Those core objectives with the highest scores would be considered potential LHIs for Healthy People 2030.

PHASE 2 is the place to be.
After phase 1, the pool of potential LHIs would be subjected to additional criteria before the final LHIs for Healthy People 2030 were chosen. The phase 2 criteria should be applied with the critical assumption that the LHIs will be viewed collectively. Individuals who use these criteria to select LHIs should make sure of the following:

The LHIs are a balanced portfolio or cohesive set of health and well-being indicators spanning life.
The LHIs strike a balance between common, upstream root causes of poor health and well-being and high-priority health state measures.
Policy, environmental, and system interventions are possible at the local, state, tribal, and national levels.
The LHIs are understandable and will elicit action from a wide range of stakeholders.
Considerations for phase 2 reinforce the fundamental principles on which Healthy People 2030 is founded. They also reflect the Healthy People 2030 vision, which aims to achieve “a society in which all people can achieve their full potential for health and well-being across the life span,” to live free of preventable disease, disability, injury, and premature death. The foundational principle that “healthy physical, social, and economic environments strengthen the potential to achieve health and well-being” can guide the achievement of balance between upstream root causes and measures of high-priority health states in the final LHIs. The last two criteria in phase 2 emphasize the importance of the LHIs, resonating with a diverse set of stakeholders who must act. This idea is encapsulated in the foundational principle that “promoting and achieving the nation’s health and well-being is a shared responsibility distributed across the national, state, tribal, and community levels, including the public, private, and not-for-profit sectors,” as well as the importance of Healthy People 2030 as “a component of decision making and policy formulation across all sectors.”

Application Description
The LHIs, unlike the core objectives, do not exist in isolation from one another. As a result, an additional assessment of the LHIs as a group is required. Those who apply the other criteria listed above would then evaluate the proposed LHIs in the second phase. Because different batches of potential LHIs are built during this phase, it is recommended that iterative movement between phases 1 and 2 occur until the final set of LHIs is chosen. It is possible, for example, that the initial phase 1 process does not adequately balance the upstream root causes of poor health and well-being and measures of high-priority health states. The set may also not resonate with enough stakeholders to elicit action.
A group of nursing students wanted to learn more about the health behaviors of adolescents in their community. They decided to have students at the local high school complete a questionnaire about their health behaviors. After the adolescents completed the questionnaire, the nursing students reviewed the responses and tallied the results. They discovered that over half of the adolescents who completed the questionnaire engaged in risky sexual behaviors. They reviewed the literature, which stated that sexually transmitted infection (STI) rates in this population are on the rise.

The nursing students decided to educate the adolescents about safe sexual practices and the prevention of STI transmission. The overall goal of the program was to decrease the number of adolescents engaged in risky sexual behaviors. The nursing students developed the following objectives and teaching strategies for this educational program:

To instill adolescents with an intrinsic motivation to become aware of their own risky sexual behavior through class discussions and cooperative learning exercises
To promote safe sexual practices with the adolescents through demonstration of appropriate safe sex practices and inquiry-guided instruction
To develop students’ positive sexual health behaviors through scenario-based case presentations and discussions
Review the Healthy People 2030 Leading Health Indicators (LHIs). Identify the LHI that best matches STIs and transmission through risky sexual behaviors.

Critique the objectives and teaching strategies used by the student nurses by responding to the following in a minimum of 175 words:

How do the objectives and teaching strategies address the identified LHI?
What action by the nursing students illustrates the planning phase of the health planning model? Refer to Figure 7.2 in Community Health Planning, Implementation, and Evaluation.
Which system level is primarily being addressed through the educational program? Refer to Box 7-2 in Community Health Planning, Implementation, and Evaluation.
What level of prevention is being applied by the educational program that the nursing students are providing? Refer to your textbook for levels of prevention.

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