Navajo Family Social Distancing with Covid-19 Masks outside their home in Monument Valley Arizonaa
Navajo Family Social Distancing with Covid-19 Masks outside their home in Monument Valley Arizonaa

Action Framework: Measuring Health Outcomes

When the nation makes progress in the Action Areas, we expect health in our nation to improve significantly for everyone. But progress will take time and persistence. It calls for new norms and expectations, expanded knowledge and capacities, and innovative practices. It requires sectors to work with new partners—spreading and sustaining new approaches.

So how will we know that our efforts in building a Culture of Health are effective? We measure outcomes such as individual and community well-being, how chronic disease is being managed, and how much healthcare costs are reduced over time.


    By measuring well-being among individuals and communities, we can expand the definition of health beyond healthcare or absence of disease to how people are thriving in every aspect of life.

    Well-being includes people's physical, mental, and social health, and the opportunities they have to create meaningful futures. It considers basic needs like food, housing, education, employment, and income. It includes social and emotional needs like sense of purpose, safety, belonging, social connection, and life satisfaction. And it is tightly linked with the well-being of our communities, our environment, and our planet.


    • 6.9 out of 10

      The average life satisfaction score for adults (15+ years) in the U.S. in 2015-2017.

    Many factors identified in the four Action Areas contribute to how people view their overall health and well-being, including the fulfillment of basic needs as well as physical needs. Meeting people's emotional needs—such as safety, life satisfaction, and work-life balance, is another healthy outcome associated with quality of life.

    SOURCE: Better Life Index, Organization for Economic Cooperation and Development, 2015-2017

    METHODS NOTE: OECD reported a one-year average life satisfaction score for each country until 2013. For the most recently reported scores, OECD transitioned to reporting a three-year average (2014-2016, 2015-2017).

    • 1,414,162 sentenced prisoners in the U.S., in 2018.

    Incarceration negatively impacts the health of not only prisoners, but also their families and communities. Prisoners are in poorer health than the general U.S. population, and ex-prisoners returning to communities often bring a host of unmet health needs.

    A reduction in the number of people incarcerated could lead to better health outcomes for individuals and communities across populations. Reducing incarceration has strong implications for improving equity, as minorities are disproportionately likely to be arrested, convicted, and face harsher sentences. A decrease in incarceration rates may also reflect overall improvements in community conditions, such as poverty reduction, access to health services, and fair educational opportunities.

    SOURCES: Bureau of Justice Statistics, 2018


    Improving health and well-being requires addressing health issues as early as possible.

    A growing area of research is focused on the relationship between childhood trauma—such as domestic violence, substance abuse, and neglect—and the risk of physical and mental illness in adulthood. This is often referred to as toxic stress. Adverse childhood experiences (ACEs) are one of the key indicators to track childhood trauma. In addition, a large and rising number of people in America suffer from one or more chronic diseases. Measuring the prevalence of disability related to chronic disease is an important way to track this urgent challenge.


    • 42% of U.S. children had one or more adverse childhood experiences (ACES) in 2018

    Children who experience trauma, such as neglect or physical, verbal, or sexual abuse, can suffer health and social consequences long into adulthood. Adverse childhood experiences (ACEs) are linked to mental illness, chronic health conditions, and premature death. The physical, social, and economic environment in which children live, and the shared societal values on health and well-being, can contribute to whether or not children are exposed to these negative events.

    SOURCE: Combined National Survey of Children’s Health, Health Resources and Services Administration, 2017-2018

    • 32,103,228 Total number disability-adjusted life years (DALYS) in the U.S., for the top 10 chronic diseases in 2017.

    A large and growing number of people in America suffer from one or more chronic diseases. Measuring the impact and burden of chronic disease—and monitoring the disparities that exist—highlights whether all individuals are able to live the healthiest life possible.

    SOURCES: The Global Burden of Disease, Institute for Health Metrics and Evaluation, 2000, 2005, 2010 and 2015, 2017


    When health and well-being improve, health care costs will go down.

    Growing health care costs are placing a significant burden on all sectors of American society. The United States spends more per capita on health care than similar countries, yet we have significantly poorer health outcomes. Progress across the Action Framework is intended to reduce health care costs while improving health and well-being throughout the course of people’s lives.


    • 19% On average, American households paid 19% of their income toward health care costs in 2016.

    The United States spends over $3 trillion on health care each year. Families bear the burden of these high costs, not only through insurance premiums and out-of-pocket expenses, but also through taxes to support health care.

    SOURCES: National Health Expenditure Data, 2016; Current Population Survey, 2016

    Having routine access to high-quality care throughout one’s life is key to good health and can also reduce the occurrence of preventable hospitalizations. Also, managing people with a chronic or acute illness through their primary care provider can promote better health and reduce costs associated with visiting an emergency department or being admitted to a hospital.

    SOURCES: Healthcare Cost and Utilization Project, 2015

    • $66,176 The average total health expenditures in Medicare beneficiaries' last year of life in 2017.

    This measure monitors the medical choices made by and for people in their last year of life—with an eye toward time spent in clinical settings versus at home. End-of-life care expenditures also reflect costs associated with the burden of chronic disease, as well as the higher costs associated with acute care facilities.

    SOURCES: Medicare Master Beneficiary Summary File (MBSF), 2017

More Ways We Track A Culture of Health

From studying our Sentinel Communities to diving deep into projects like County Health Rankings, these are the tools we use to track our progress as we Build a Culture of Health.

A Navajo woman standing by the gate of her home, with a faraway look in her eyes wondering if life will ever be back to normal, Covid19

National Progress: Sentinel Communities

Learn about the transformative activities underway in communities around the country.

Father playing with daughter in kitchen

National Progress: American Health Values

Learn about the survey that explores views about the importance of health in personal life, creating healthy communities and health as a priority for the U.S. government.

Creative 10 year old child using blue chalk to draw on wall in back garden at home with her father and brother watching, having fun and concentrating, freedom, childhood

Culture of Health Progress Report

See our most current report on the progress we’re making toward building a Culture of Health.

Measurement Tools and Resources