Guiding Principles

A set of core concepts guides NHSPI development and use. These principles emerged from collaborative work with stakeholders and reflect ideas critical to the future development and use of the NHSPI™.

On Health Security as reflected by the NHSPI:

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

  • Today: The 2014 Index includes measures pertaining mostly to public health and the healthcare system.
  • Future Direction: As data become available, the NHSPI will include measures that address:
    – additional sectors
    – overarching concepts (e.g., pre-event community status, federal contributions to state preparedness)

2. Responsibility for our nation’s health security is shared among the whole community, including all sectors and jurisdictions that work together to prepare for, respond to, and recover from health security threats.

  • Today:
    – The NHSPI structure emphasizes the shared responsibility and interdependencies of individuals, organizations, and sectors.
    – Improving health security requires the efforts of more than any one individual, organization, or sector.
    – The NHSPI looks at the health security of the nation by collectively measuring the preparedness of states. State-level data are the most consistently available across the nation and often include local-level data.
  • Future Direction:
    – The NHSPI long-term objective is to add measures that more fully demonstrate how each sector contributes to the overall state of health security and how these contributions are related.
    – Other geographic level versions (e.g., local, tribal, or territorial) may be explored, if data are available.

3. The NHSPI is a “preparedness” Index and uses the broad definition of preparedness outlined in Presidential Policy Directive 8 (PPD-8).

  • Today:
    – Measures reflect activities across the full preparedness planning cycle.
    – The NHSPI consists of pre-event preparedness measures including structures, processes, and outcomes.
  • Future Direction:
    – As additional sectors and concepts are built into the model, the NHSPI can demonstrate more fully the many factors that influence preparedness.

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

  • Today:
    – In addition to response and recovery capabilities, the NHSPI reflects activities aimed at reducing exposure to risks and vulnerability to the health consequences of disaster.
    – The NHSPI reflects the fact that strong response systems are built upon and influenced by the strength of everyday systems.
  • Future Direction:
    – Additional measures more fully capturing local, state, tribal, territorial, federal, and private sector risk reduction efforts will be sought.
    – Research identifying the specific activities most effective in reducing disaster risk and decreasing vulnerability will improve Index accuracy and usefulness.

On Index Development:

5. The Index should be practical and of greater use than what is currently available.

  • Today:
    – The NHSPI is the most comprehensive look at health security preparedness to date.
    – The NHSPI can be used to support quality improvement, inform resource and policy decisions, enhance collaborations, strengthen shared responsibility, and advance the science of measuring preparedness.
    – Accuracy and validity of measures is as per the source. No measure is perfect, and it is important to note the limitations of each measure. In some areas, significant gaps in measurement exist.
    – The NHSPI serves as a call for filling measure gaps and improving measures of preparedness.
  • Future Direction:
    – Trend data will become available to further support uses.
    – NHSPI results may one day be used as a predictor of response, recovery, and resilience (post-event community functioning).

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

  • Today:
    – Hundreds of data sources are examined to produce the NHSPI; the 194 measures selected for the 2014 NHSPI come from more than 65 sources.
    – Factors in measure selection include the reliability and sustainability of the data source.
  • Future Direction:
    – Consistent with other long-standing indices (e.g., Consumer Price Index, Well-Being Index), the NHSPI will continue to develop and incorporate additional and/or better measures over time.

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

  • Today:
    – The NHSPI supports the full preparedness cycle outlined in the National Preparedness Goal: prevent, protect, mitigate, respond, and recover.
    – The NHSPI includes and extends beyond public health preparedness and healthcare preparedness capabilities.
    – The NHSPI mission aligns with the National Health Security Strategy vision: prepared, protected, resilient.
  • Future Direction:
    – The NHSPI will continue to align and evolve with national frameworks.

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

  • Today:
    – Measures are evaluated against National Quality Forum criteria and relevance to national health security preparedness.
    – 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 community entities.
  • Future Direction:
    – Any measure that has bearing on health security and meets NHSPI selection criteria will be considered for inclusion in future versions.
    – An approach called “systems dynamic modeling” may be explored to more accurately reflect relationships between Index parts.

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

  • Today:
    – The NHSPI is 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.
    – Feedback from state and local public health, healthcare, and national association partners received during formal review processes is incorporated into the current NHSPI model.
  • Future Direction:
    – The NHSPI will continue to evolve, incorporating stakeholder input from the broader health security community.
    – Studies assessing the Index’s ability to predict response and recovery during future events can help validate its accuracy.
    – How and the extent to which practitioners and policymakers effectively use the NHSPI will validate its utility.

On Index Use:

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

  • Today:
    – 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 a state’s preparedness.
    – Aggregating state indices reflects the health security status of the nation.
    – All measures contribute equally to their sub-domain, all sub-domains contribute equally to their domain, and all domains weigh equally within the Index.
  • Future Direction:
    – Refinements to Index structure will incorporate additional domains and sub-domains that influence health security preparedness after identifying a sufficient grouping of measures.
    – Future versions of the Index may include weighting beyond that implicit to its structure.
    – Finding measures to sufficiently describe new areas will require identifying and accessing additional data sources and the expertise of new sector partners.

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

  • Today:
    – 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.
  • Future Direction:
    – The Index will have an associated research and development effort.
    – As the Index is used and the science of measuring preparedness advances, the NHSPI will include the following:
    *more science- and practice-based targets for existing measures
    *better measures and data collection systems
    *improved methodology
    *measures that most accurately predict strong performance during an event