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Leading health indicators about your health and well-being

February 2, 2012
by Ron Manderscheid, PhD
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Behavioral Healthcare is Well Represented

Assigned the task of leading a Subcommittee to make recommendations about which topics should become Healthy People 2020 Leading Health Indicators (LHIs, for short) causes one to pause and reflect.

We expected that the U.S. Department of Health and Human Services will report on these LHIs for the next 10 years. We also expected that these LHIs will foster considerable interest and program development around the topics selected. Finally, we believed that the LHIs need to motivate you and your community to improve health. Clearly, this was a very daunting assignment!

Some of the major considerations that come to mind are:

  • Should we focus only on those things that will impact one’s health in the future versus reporting on one’s current health status?
  • How far should we go upstream to include those factors in our social and physical environment that influence our health?
  • How should disparities and life stages be included?
  • What about data availability?

After wrestling with these topics in the Secretary’s Advisory Group and in the Subcommittee, we devised the following logic: One’s future health can be predicted from one’s social and physical determinants of health, one’s behaviors and current health, the prevention and care services one receives, and one’s life stage. Addressing these factors today can change one’s future health status.

Walking this logic down into specific health topics leads to the following twelve LHI topics:

Social Determinants of Health

Environmental Determinants: Natural and Built Environment

Healthy and Active Lifestyle

Mental Health

Tobacco Use

Substance Abuse (other than tobacco)

Injury and Violence

Responsible Sexual Behavior

Maternal, Infant, and Child Health

Oral Health

Clinical Preventive Services

Access to Care Services

These are the topics that the Subcommittee and the Secretary’s Advisory Committee have recommended to the Secretary.

How very exciting! We can view the LHIs in the same way one views an orchestra. It takes a full orchestra to produce a symphony. A single instrument will not accomplish this. Similarly, it takes a broad range of LHI factors to produce good health. In this sense, this model provides a way to put the whole person back together, and should be helpful in increasing both resiliency and recovery for persons with behavioral health conditions. The approach is very person centered.

For those of us from the behavioral healthcare fields, this LHI work clearly reaffirms many of the things that we are trying to accomplish, which we know are very important for persons with mental and substance use conditions: the necessity of linking mental health, substance use, and primary care as we move forward with the Affordable Care Act;  the importance of recovery and wellness actions to future health; and the essential nature of whole health, i.e., viewing the whole person in context.

HHS Assistant Secretary for Health Dr. Howard Koh announced the LHIs at the Annual National Meeting of the American Public Health Association on October 31.I hope that you will vigorously support the implementation of these LHIs in the field. We need them to motivate community action and to promote excellence. You need them for your own good health too!  


Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid



Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...

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