A set of core concepts guides the National Health Security Preparedness Index development and use. These principles emerged from collaborative work with stakeholders and reflect ideas critical to the future development and use of the Index.

On Health Security as reflected by the NHSPI:

1. Our nation’s health security is influenced by many factors.

• The Index reflects the social, environmental, governmental, and economic dimensions of health security.
• The Index addresses important health security capabilities in key areas such as public health, healthcare delivery, environmental and occupational health, countermeasure management, incident and information management, and community planning and engagement.
• To reflect the many factors that contribute to health security, the Index combines measures from more than 60 sources. These measures come from national household surveys, medical records, safety inspection results, and surveys of health agencies and facilities.

2. Responsibility for our nation’s health security is shared across public and private sectors and includes all who work together to prepare for, respond to, and recover from health security threats.

• The Index structure emphasizes the shared responsibility and interdependencies of individuals, organizations, and sectors.
• Improving health security requires that individuals, organizations, and sectors work together.
• The Index measures the health security of the nation by collectively measuring the health security levels of states. State-level data are the most consistently available across the nation, and, in some cases, represent a composite of local-level data.

3. The Index measures health security as a preparedness activity and incorporates the broad definition of preparedness outlined in Presidential Policy Directive 8 (PPD-8).

• Measures reflect activities across the full preparedness planning cycle: prevent, protect, mitigate, respond, and recover.
• The Index consists of pre-event preparedness measures including structures, processes, and outcomes.

4. The Index incorporates the concepts of disaster risk reduction and primary prevention as fundamental to advancing and sustaining health security.

• In addition to response and recovery capabilities, the Index reflects activities aimed at reducing exposure to risks and minimizing vulnerability to the health consequences of disasters.
• The Index illustrates how strong response systems are built upon and influenced by the strength of everyday systems.

On Index Development:

5. The Index continues to provide an assessment of health security that can be used to identify strengths and challenges that inform quality improvement.

• The Index is the most comprehensive look at health security available to date.
• The Index reveals strengths as well as vulnerabilities in the protections needed to keep people safe and healthy in the face of disasters, and it tracks how these protections vary across the United States and change over time.
• The Index can be used to support quality improvement, inform resource and policy decisions, enhance collaborations, strengthen shared responsibility, and advance the science of measuring health security.

6. The Index is built on public-use data; it does not add data collection burdens to practitioners.

• Hundreds of data sources are examined to produce the Index.
• Each year, new measures are solicited and considered for inclusion in the Index. Factors in measure selection include the timeliness, reliability, and sustainability of the data source.
• Consistent with other long-standing indices (e.g., Consumer Price Index, Well-Being Index), the Index will continue to develop and incorporate additional and/or better measures and data sources over time.

7. The Index aligns with existing national health security capabilities and frameworks.

• The Index supports the full preparedness cycle outlined in the National Preparedness Goal: prevent, protect, mitigate, respond, and recover.
• The Index includes and extends beyond public health and healthcare preparedness capabilities.
• The Index mission aligns with the National Health Security Strategy vision: prepared, protected, resilient.

8. The Index aims to accurately and fully reflect health security of states and the nation.

• Measures are evaluated against National Quality Forum criteria and for their relevance to national health security.
• Measures are included whether or not (1) all states meet the measure or (2) meeting the measure is under the direct control of one or more non-governmental or community entities.
• Individual measures are weighted according to their importance to health security. Measure weights are decided by an expert panel that evaluates measures based on their importance to health security capacities and capabilities represented in each Index subdomain and domain.

9. Index development is a transparent process that includes continuous improvement, stakeholder involvement, and real-world experience.

• The first release of the Index in 2013 was based on the practical experience and model development knowledge of a multidisciplinary steering committee, workgroups, and task forces representing more than 35 organizations and 100 individuals.
• Each year, feedback from national, state, and local health security partners is received during formal review processes and incorporated into the Index model.
• The project office convenes expert advisory panels, think tanks, and other events to solicit additional input and feedback from Index stakeholders and other subject matter experts.

On Index Use:

10. Well-organized groupings of information provide a more meaningful picture than a simple sum of the parts.

• Individual indicators provide limited information. It is the group of measures that best describes a sub-domain, the group of sub-domains that create the picture of a domain, and the group of domains that describe state health security.
• Aggregating state indices reflects the health security status of the nation.

11. The Index is a call to advance the science of measuring health security.

• Target values for a measure ideally come from scientific study and practice. However, only a few such targets can be identified from the literature. Where literature and scientific data do not exist, target values are defined as those of the highest performing state, excluding outliers.