Appendix A

Leading Health Indicators (* See Appendix B for specific objectives.)

Physical Activity

Regular physical activity throughout life is important for maintaining a healthy body, enhancing psychological well-being, and preventing premature death. Regular physical activity decreases the risk of death from heart disease, lowers the risk of developing diabetes, and is associated with a decreased risk of colon cancer. Regular physical activity helps prevent high blood pressure and plays a role in decreasing existing high blood pressure. (Objectives 22-2, 22-7*)
Public Health Priority: Promote daily physical activity.

Overweight and Obesity

Overweight and obesity raise the risk of illness from high blood pressure, high cholesterol, type 2 diabetes, heart disease and stroke, gallbladder disease, arthritis, sleep disturbances and problems breathing, and endometrial, breast, prostate, and colon cancers. Obese individuals may also suffer from social stigmatization, discrimination, and lowered self-esteem. (Objectives 19-2, 19-3c*)
Public Health Priority: Promote good nutrition and healthier weights.

Tobacco Use

Cigarette smoking is the single most preventable cause of disease and death in the United States. Smoking results in more deaths each year in the United States than AIDS, alcohol, cocaine, heroin, homicide, suicide, motor vehicle crashes, and fires - combined. Smoking is a major risk factor for heart disease, stroke, lung cancer, and chronic lung diseases. Smoking during pregnancy can result in miscarriages, premature delivery, and sudden infant death syndrome. Environmental tobacco smoke (ETS) increases the risk of heart disease and significant lung condition, especially asthma and bronchitis in children. ETS is responsible for an estimated 3,000 lung cancer deaths each year among adult nonsmokers. (Objectives 27-3b, 27-la*)
Public Health Priority: Prevent and reduce tobacco use.

Substance Abuse

Alcohol and illicit drug use are associated many of this country's most serious problems, including child and spousal abuse; sexually transmitted diseases including HIV infection; teen pregnancy; school failure; motor vehicle crashes; rising health care costs; low worker productivity; and homelessness. Alcohol and illicit drug use also can result in substantial disruptions in family, work, and personal life. (Objectives 26-10a, 26-10c, 26-11c*)
Public Health Priority: Prevent and reduce substance abuse.

Responsible Sexual Behavior

Unintended pregnancies and sexually transmitted diseases (STDs), including infection with the human immunodeficiency virus (HIV) that causes AIDS, can result from unprotected sexual behaviors. Abstinence is the only method of complete protection. Condoms, if used correctly and consistently, can help prevent both unintended pregnancy and STDs. (Objectives 25-11, 13-6*)
Public Health Priority: Promote responsible sexual behavior, including abstinence.

Mental Health

Mental health is a state of successful mental functioning, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity. Mental health is indispensable to personal well-being, family and interpersonal relationships, and one's contribution to society. Approximately 20 percent of the U.S. population are affected by mental illness during a given year; no one is immune. Of all mental illnesses, depression is the most common disorder. More than 19 million adults in the United States suffer from depression. Major depression is the leading cause of disability and is the cause of more than two-thirds of suicides each year. (Objective 18-9b*)
Public Health Priority: Promote mental health and well-being.

Injury and Violence

More than 400 Americans die each day due primarily to motor vehicle crashes, firearms, poisonings, suffocation, falls, fires, and drowning. The risk of injury is so great that most persons sustain a significant injury at some time during their lives. (Objectives 15-15, 15-32*)
Public Health Priority: Promote safety and reduce violence.

Environmental Quality

An estimated 25 percent of preventable illnesses worldwide can be attributed to poor environmental quality. In the United States, air pollution alone is estimated to be associated with 50,000 premature deaths and an estimated $40 billion to $50 billion in health-related costs annually. Two indicators of air quality are ozone (outdoor) and environmental tobacco smoke (indoor). (Objectives 8-1a, 27-10*)
Public Health Priority: Promote healthy environments.


Vaccines are among the greatest public health achievements of the 20th century. Immunizations can prevent disability and death from infectious diseases for individuals and can help control the 
spread of infections within communities. Immunizations against influenza and pneumococcal disease can prevent serious illness and death. Pneumonia and influenza deaths together constitute the 6th leading cause of death in the United States. (Objectives 14-24, 14-29a, b*)
Public Health Priority: Prevent infectious disease through immunization.

Access to Health Care

Strong predictors of access to quality health care include having health insurance, a higher income level, and a regular primary care provider or other source of ongoing health care. Persons with health insurance are more likely to have a specific source of care and to have received appropriate preventive care. (Objectives 1-1, 1-4a, 16-6a*)
Public Health Priority: Increase access to quality health care.


Appendix B

This appendix presents selected Healthy People 2010 objectives that may be of special interest to healthy community coalitions. (A "developmental" objective does not yet have a data system or data set available for measuring how the Nation is doing on that objective. Efforts are underway to develop such data systems and data sets.)


6-12  (Developmental) Reduce the proportion of people with disabilities reporting environmental barriers to participation in home, school, work, or community activities.
7-9  (Developmental) Increase the proportion of hospitals and managed care organizations that provide community disease prevention and health promotion activities that address the priority health needs identified by their community.
7-11 Increase the proportion of local health departments that have established culturally appropriate and linguistically competent community health promotion and disease prevention programs.
8-28  (Developmental) Increase the number of local health departments or agencies that use data from surveillance of environmental risk factors as part of their vector control programs.
18-3  Reduce the proportion of homeless adults who have serious mental illness.
19-18  Increase food security among U.S. households and in so doing reduce hunger.
21-9  Increase the proportion of the U.S. population served by community water systems with optimally fluoridated water.
25-13 Increase the proportion of Tribal, State, and local sexually transmitted disease programs that routinely offer hepatitis B vaccines to all STD clients.
25-14  (Developmental) Increase the proportion of youth detention facilities and adult city or county jails that screen for common bacterial sexually transmitted diseases within 24 hours of admission and treat STDs (when necessary) before persons are released.
25-15  (Developmental) Increase the proportion of all local health departments that have contracts with managed care providers for the treatment of nonplan partners of patients with bacterial sexually transmitted diseases (gonorrhea, syphilis, and chlamydia).
26-23 (Developmental) Increase the number of communities using partnerships or coalition models to conduct comprehensive substance abuse prevention efforts.
27-13 Establish laws on smoke-free indoor air that prohibit smoking or limit it to separately ventilated areas in public places and worksites.

Access to Health Care
1-6 Reduce the proportion of families that experience difficulties or delays in obtaining health care or do not receive needed care for one or more family members.
3-12 Increase the proportion of adults who receive a colorectal cancer screening examination.
3-13 Increase the proportion of women aged 40 years and older who have received a mammogram within the preceding 2 years.
12-15 Increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 years.
14-24 Increase the proportion of young children and adolescents who receive all vaccines that have been recommended for universal administration for at least 5 years.
14-29 Increase the proportion of adults who are vaccinated annually against influenza and ever vaccinated against pneumococcal disease.
7-5 Increase the proportion of worksites that offer a comprehensive employee health promotion program to their employees.
8-17 (Developmental) Increase the number of office buildings that are managed using good indoor air quality practices.
10-6 (Developmental) Improve food employee behaviors and food preparation practices that directly relate to foodborne illnesses in retail food establishments.
20-2  Reduce work-related injuries resulting in medical treatment, lost time from work, or restricted work activity.
20-9  Increase the proportion of worksites employing 50 or more persons that provide programs to prevent or reduce employee stress.
20-11 (Developmental) Reduce new cases of work-related, noise-induced hearing loss.
22-13 Increase the proportion of worksites offering employer-sponsored physical activity and fitness programs.
23-1  (Developmental) Increase the proportion of Tribal, State, and local public health agencies that provide Internet and e-mail access for at least 75 percent of their employees and that teach employees to use the Internet and other electronic information systems to apply data and information to public health practice.
26-8 (Developmental) Reduce the cost of lost productivity in the workplace due to alcohol and drug use.
27-12 Increase the proportion of worksites with formal smoking policies that prohibit smoking or limit it to separately ventilated areas.
7-2 Increase the proportion of middle, junior high, and senior high schools that provide school health education to prevent health problems in the following areas: unintentional injury; violence; suicide; tobacco use and addiction; alcohol and other drug use; unintended pregnancy, HIV/AIDS, and STD infection; unhealthy dietary patterns; inadequate physical activity; and environmental health.
7-4 Increase the proportion of the Nation's elementary, middle, junior high, and senior high schools that have a nurse-to-student ratio of at least 1:750.
8-20 (Developmental) Increase the proportion of the Nation's primary and secondary schools that have official school policies ensuring the safety of students and staff from environmental hazards, such as chemicals in special classrooms, poor indoor air quality, asbestos, and exposure to pesticides.
14-23 Maintain vaccination coverage levels for children in licensed day care facilities and children in kindergarten through the first grade.
15-31  (Developmental) Increase the proportion of public and private schools that require use of appropriate head, face, eye, and mouth protection for students participating in school-sponsored physical activities.
19-15  (Developmental) Increase the proportion of children and adolescents aged 6 to 19 years whose intake of meals and snacks at schools contributes to good overall dietary quality.
22-8  Increase the proportion of the Nation's public and private schools that require daily physical education for all students.
22-10 Increase the proportion of adolescents who spend at least 50 percent of school physical education class time being physically active.
22-12 (Developmental) Increase the proportion of the Nation's public and private schools that provide access to their physical activity spaces and facilities for all persons outside of normal school hours (that is, before and after the school day, on weekends, and during summer and other vacations).
27-11 Increase smoke-free and tobacco-free environments in schools, including all school facilities, property, vehicles, and school events.
Environmental Health 
8-5 Increase the proportion of persons served by community water systems who receive a supply of drinking water that meets the regulations of the Safe Drinking Water Act.
8-11  Eliminate elevated blood lead levels in children.
8-12 Minimize the risks to human health and the environment posed by hazardous sites.
8-15  Increase recycling of municipal solid waste.
8-18 Increase the proportion of persons who live in homes tested for radon concentrations.
8-22 Increase the proportion of persons living in pre-1950s housing that has been tested for the presence of lead-based paint.

Health Communication
11-1 Increase the proportion of households with access to the Internet at home.
11-2 (Developmental) Improve the health literacy of persons with inadequate or marginal literacy skills.
11-3  (Developmental) Increase the proportion of health communication activities that include research and evaluation. 
11-4 (Developmental) Increase the proportion of health-related World Wide Web sites that disclose information that can be used to assess the quality of the site.
11-5  (Developmental) Increase the number of centers for excellence that seek to advance the research and practice of health communication. 
11-6  (Developmental) Increase the proportion of persons who report that their health care providers have satisfactory communication skills.
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