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Policy Implications

What are the research and policy implications of HRQOL surveillance?

Extensive research using the Healthy Days measures has shown their value for population surveillance and program planning and evaluation. The Healthy Days measures consistently reflect population differences in educational level, household income, employment status, marital status, chronic diseases, and disability, and they correlate with broader community health status indicators such as the proportion of births to adolescents, and levels of disability. The Healthy Days measures offer diverse communities and groups a meaningful indicator that they can easily calculate and use to identify burden of impaired physical or mental health that can guide healthy public policy and collaboration with community partners.

The Healthy Days measures assess the burden of physical and mental health problems in a manner that is not disease-specific. Therefore, health planners Elderly people swimmingand legislators can use the measures and resulting data to help allocate resources among competing health programs based on several criteria including the burden of impaired HRQOL in a specific group Because of their sensitivity to broad influences such as seasonal patterns and time trends, the Healthy Days measures are also likely to be useful in detecting the impact of major population-based policies or interventions.

In support of the use of these measures, the Institute of Medicine (IOM) State of the USA Health Indictors: Letter Report (IOM 2008) recommended that 20 indicators be used to track population health in the US, including both physically and mentally unhealthy days.

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Why is HRQOL surveillance important for Healthy People 2020?

Healthy People 2020, developed with leadership of the Department of Health and Human Services (DHHS), is the nation’s prevention agenda with a scorecard to assess progress toward meeting goals (DHHS 2009). It is a road map that states, communities, professional organizations, and others can use to help increase life expectancy and enhance population health. Two of the four overarching goals for Healthy People 2020 are directly related to quality of life: 1) Attain high quality, longer lives free of preventable disease, disability, injury, and premature death and 2) Promote quality of life, healthy development and healthy behaviors across all life stages. By continuously tracking population HRQOL in national and state surveillance systems, the Healthy Days measures will monitor the nation’s and states’ progress toward meeting these quality of life goals. Doing so will help to assure that the net progress in achieving targets set by the Healthy People objectives in specific focus areas is not offset by unanticipated new diseases, barriers, or health problems. A third overarching goal for Healthy People 2020 is to eliminate health disparities among segments of the population. Data from the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES) on socioeconomic and demographic characteristics and the Healthy Days measures have been used to quantify perceived physical and mental health disparities among population subgroups based on gender, race or ethnicity, education, income, and place of residence.

How can the Healthy Days measures support epidemiologic and prevention research?

The validity, brevity, and comparability of the Healthy Days measures make them ideal additions to existing and new survey instruments to enhance opportunities for epidemiologic and prevention research.

The addition of the core Healthy Days measures to the NHANES, beginning in 2000, has supported public health prevention goals. NHANES measures the national burden of preventable disease, injuries, and disabilities. It provides valuable new insights into the relationship between HRQOL and clinically-measured health characteristics and conditions such as blood pressure, physical strength and endurance, oral health, and mental health (

Moreover, the addition of the HRQOL questions to the NHANES survey has been important because this survey is nationally representative and is linked with other national surveys and health outcomes. NHANES Healthy Days data allows researchers to validate people’s self-reports through comparison with the NHANES objective measures of physical health and blood tests for interviewed subjects. NHANES studies of the levels of reported unhealthy days and activity limitation days in relation to measured body mass index and physical endurance, as well as to reported nutritional and physical activity patterns, can provide research-based messages to support related health communication objectives. The addition of the Healthy Days questions to NHANES has also extended the HRQOL surveillance to adolescents as well as adults and has yielded important information on the nature and extent of health disparities among geographic and socio-demographic groups.

How can an HRQOL surveillance support community mobilization?

The Healthy Days measures have been used effectively to help identify health problems of vulnerable groups and to justify additional funding for addressing disparities among these groups. The measures are also valuable for population health assessment and as community health indicators. For example, both the DHHS Community Health Status Indictors project and the University of Wisconsin’s Mobilizing Action Toward Community Health (MATCH) project have included the Healthy Days measures in their community- and county-level health rankings to monitor and improve population health over time.

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