Performance indicators and health promition targets

This paper discusses the usefulness of performance indicators in health promotion. Health promotion and target-setting in health have both risen to the fore in the light of the Health of the Nation White Paper. This coupled with increasing pressure on all sectors of health care to demonstrate their “value-for-money” have meant that health promotion activities are being scrutinised as never before. Performance indicators have been one suggested means of ensuring movement towards Health of the Nation targets and value-for-money in health promotion. The paper outlines the uses to which performance indicators have been put elsewhere in the NHS and argues that they are unlikely to be directly transferrable to health promotion. Criteria for successful performance indicators in health promotion are outlined. However, it is doubtful whether these criteria will be fulfilled to any useful extent at present. The theory of health promotion is characterised by many different views of what is an appropriate outcome measure of any health promotion intervention and therefore what will be an appropriate performance indicator. Consensus in theory is needed before any consensus on what is most suitable to measure is reached. In addition, any outcomes from health promotion, by its very nature, are likely to become apparent only over long periods of time, if at all. This reduces the likelihood of attribution and the feasibility of assigning responsibility for meeting targets. Nonetheless, there is some scope for performance indicators in health promotion and their use as an internal management tool and as mechanisms for reaching external micro and macro level health-related targets is discussed. A collection of suggested macro performance indicators from the Health Education Authority are evaluated according to the criteria developed earlier. It is argued that at present these do not qualify as performance indicators, although they are certainly useful as monitoring tools. The paper concludes with priorities for further research in this area. Despite the emphasis on target-setting brought about by the Health of the Nation, knowledge and expertise in performance indicators for health promotion is lacking. This is a matter of urgent concern. There are many complex conceptual and practical problems which will influence the future role and choice of performance indicators in health promotion. These range from the fundamental, differing views about the definition of health education and health promotion, to the practical, a lack of knowledge at the community level about how to start looking for indicators, and the technical, a lack of clear responsibility for meeting macro-level targets.