Surveillance Overview

Purpose

HRQOL surveillance supports the core functions of public health—assessment, policy development and assurance. As an assessment function, HRQOL surveillance is used to identify unmet population health needs including recognizing trends, disparities, and determinants of health in the population. HRQOL surveillance data can be used to inform decision making, and program and policy development. To assure that the population is benefiting from public health programs, HRQOL surveillance data can be used for program evaluation. A compact set of HRQOL measures including a summary measure of unhealthy days have been developed and validated for population health surveillance and have been widely used since 1993.

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Data Sources

HRQOL surveillance data are now viewed as a health resource for the U.S. population for effective decision making in public health. The CDC Healthy Days measures are an acknowledged standard for population health surveillance by national and international groups. The four core Healthy Days questions have been asked of all participants in the Behavioral Risk Factor Surveillance System (BRFSS) from 1993 through 2009 (except in 2002 when only 20 states asked these questions). Since 2000, the Healthy Days measures have also been administered to respondents aged 12 years or older in the National Health and Nutrition Examination Survey (NHANES). These measures are now accepted as standards in the United States and have been used in other countries including Canada, Sweden, and Italy. In recent years, the Healthy Days data from the BRFSS have also been regularly included in several national, state, and community “health report cards.” Many of these reports are available online.

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What are the main advantages of the Healthy Days measures and population data?

• Relate directly to the Healthy People 2010 and 2020 goals
• Reflect known demographic and socioeconomic disparities and health patterns
• Reflect the burden of physical and mental illness and disability
• Are validated against other established measures (e.g., MOS Short Form 36)
• Predict short-term mortality, hospitalizations, and physician visits
• Provide new insights into health behaviors
• Indicate important new policy-relevant disparities and trends
• Provide a focus for comprehensive community health programs
• Provide comparable population data from 1993 onward
• Are simple to measure, calculate, interpret, and add to other assessments

As knowledge builds about HRQOL surveillance and its potential uses, the Healthy Days measures and accumulating population data give states and communities a unique nationwide standard for identifying and tracking perceived unmet health needs and disparities. Focusing on HRQOL will help health agencies bridge artificial distinctions between physical and mental health and spur collaboration with a wider circle of health partners toward shared goals.

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Contributions to Public Health

Several recent CDC studies have reported increasing numbers of physically and mentally unhealthy days in the United States between 1993 and 2001 (CDC HRQOL Surveillance Summary 2005 [PDF - 219KB]). These studies highlight the benefit of ongoing monitoring of HRQOL and its correlates in the U.S. and the need for population health experts to continue to refine and validate HRQOL and functional status measures. The Healthy Days measures and accumulating population data offer considerable promise as part of a public health paradigm that looks at health as a broad multidimensional construct, comprising both physical and mental well-being.

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