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IV. Committeee Discussion

Dr. Kumanyika thanked the Subcommittee for all of their hard work and developing the LHI recommendations. She then opened up the floor for questions and comments from the Committee members.

Dr. Troutman commended the Subcommittee on their great work in crafting the recommendations. He does note that he continues to query himself over the feasibility of measuring the social determinants of health and cites the problem of intricately connected factors. He also mentioned the notion of geography of opportunity neighborhoods and its impact on populations and how this can be included in the measure of social determinants. Dr. Manderscheid responded that the Committee can include a recommendation to HHS that they continue developing measures and objectives for the social determinants of health. This way, the Committee will be providing a proposal (i.e., Social Determinants indicator) and making a recommendation for further HHS work. Dr. Manderscheid also added that the Economic Hardship Index accounts for geography of opportunity neighborhoods and is organized by county and community. Dr. Kumanyika added that the Committee’s recommendations do not preclude more work on measuring social determinants through Healthy People 2020.

Dr. Felitti asked whether the concept of “family” could be incorporated in the Social Determinants topic area. He noted that some of the most destructive forces in the developmental stages of life are within one’s own family; however, a taboo against exploring the inner workings of families still exists. Dr. Manderscheid responded by saying that several options exist for this addition. “Family” could be added to the Social Determinants indicator but could also be incorporated in Foundational Health Measures by recommending that HHS conduct work in family issues. A Committee member stated that Social Determinants is currently written in a global context and should stay as listed. Dr. Manderscheid agreed, saying that developmental issues around family will be addressed in the Foundational Health Measures.

A Committee member raised an objection to the wording of bullet point C under Healthy and Active Lifestyle. He proposed a change from “reduce food insecurity” to “improve food security” to eliminate the double negative and state it in the affirmative. Dr. Manderscheid responded that the Subcommittee was employing language from Healthy People 2020 and that this change in wording can be made as a friendly amendment. Dr. Kumanyika recommended phrasing the rewording as a comment; others agreed.

A Committee member noted that the Environmental Determinants indicator includes the built environment which engenders concerns such as the context of housing. However, the objectives under this topic do not necessarily relate to the built environment. Dr. Manderscheid responded that the Committee can recommend that HHS provide a more comprehensive framework to address the built environment through the Foundation Health Measures. Dr. Kumanyika added that current coverage of the topic is lacking. A Committee member further noted that HHS should hone in on the area of Social Determinants, as this is the most critical area of personal and community health that has yet to be adequately addressed. Dr. Manderscheid said the initiative that the Secretary talked about recently on health disparities connects strongly to LHIs.Ms. Blakey added that part of that initiative dealt with data collection of minority population groups that are currently underrepresented in national data surveys. There was a follow-up conference that addressed LGBT populations, and the National Center for Health Statistics will look at sexual orientation in their surveys. NORC will send out details on the data collection initiative for minority groups.

Next, Dr. Kumanyika asked for the members’ reactions to the LHI Subcommittee’s second and third recommendations. There were no comments for the second recommendation on how the multi-measure health indices differ from the overarching measure of health. For the third recommendation, the overarching measure of health, a Committee member stated that it is difficult to envision what an overarching measure of health is going to look like. The Committee member asked whether the Subcommittee is recommending work to be done on a measure similar to the Physical Quality of Life Index. He also inquired about the specific factors to be included in the measure so that it may encompass an overarching measure of health. In response, Dr. Manderscheid stated that several factors will comprise this measure, including health related quality of life and well-being, social/economic/environmental determinants, and health disparities. The question posed to HHS is how to meaningfully combine these different factors to create one overarching measure. He also noted the importance of this recommendation, given that so few resources are currently are devoted to this area. A Committee member added that HHS should reflect on the Health Equity Index developed over a decade ago, given its inclusion of social determinants.

Another Committee member suggested that the Prosperity Index may also be an important tool in the implementation of this recommendation. She asked HHS about the existence of a global Healthy People working group on LHIs. Ms. Blakey responded affirmatively, saying that the group may want to take on this task. Dr. Kumanyika acknowledged the challenges of creating an overarching measure of health, citing the area of quality of life/happiness/positive health which is all very controversial to define. She noted that the Committee’s recommendation will serve to stimulate work on this highly important topic.