Well-being In the Nation
A multi-sector measurement framework for population and community
health and well-being advanced by the National Committee on Vital and
What we will cover today
1. What is the Well-Being In the Nation
(WIN) Measurement Framework/measures?
1. How was it developed?
2. How can it help me in my work?
What is the Well-Being In the Nation
The Well-Being In the Nation (WIN) Measurement Framework offers a set
of common measures to assess and improve population and community
health and well-being across sectors.
It is intended to help people address all of the drivers of health, well-
being and equity together. This includes measures for the social
determinants of health.
The framework is divided into three elements: core measures, leading
indicators, and a full flexible set of measures.
The framework was developed by the National Committee on Vital and
Health Statistics; measure development was facilitated by 100 Million
Healthier Lives, with input from 100+ people and organizations
About the National Committee on Vital and
National Committee on Vital and Health
Statistics (NCVHS) is a Federal Advisory
Committee – reports to secretary of HHS
Goal was to identify multi-sector
measures to support population and
community health and wellbeing and
address social determinants of health
Report from January 2017
Accompanying letter w/
recommendations to HHS Secretary (May
Who: An unprecedented collaboration of change
agents pursuing an unprecedented result:
100 million people living healthier lives by 2020
Vision: to fundamentally transform the way we
think and act to improve health, wellbeing and
Equity is the price of admission.
Convened by the Institute for Healthcare
Improvement as a partnership.
About 100 Million Healthier Lives
1850+ members and partners across sectors
in all 50 states, 200+ communities and 30+
Aim & Key Considerations
1. Arrive at measure set(s) aligned with NCVHS Framework domains
to create a measurement ecosystem for wellbeing:
• Parsimonious set of core measures at national level
• Expandable menu of measures for use at local, community level
2. Achieve a balance between standard, widely-used measures and
those that may be promising/currently used in fewer places at
this time (or even gaps in the field/opportunities for
development), but have the potential to be highly useful
3. Include a breadth of experts, including across sectors and those
who implement measurement on multiple levels, including
Key features of the approach we took
1. Co-design: Identify who would be using it and how (use cases) and engage metrics
experts and implementers together in the process of metrics identification.
2. Continuous testing with communities and others groups of implementers as the
framework implementation approach was being developed and measures were
selected to see if they resonated and were useful.
3. A focus on creating a living library of measures that helps us learn together what
works rather than creating “a definitive set” of measures “for all time”.
4. A focus on what brings us together rather than how we might slice the world
differently; a willingness to engage in public-private partnership.
5. A mix of leading indicators and lagging indicators that meets the needs of different
sectors—as well as common ones many can align around.
2018: Modified Delphi Process – 100+ organizations
across sectors participating along with communities
Cycle 1: What’s missing?
• Process: Participants were invited to suggest additions to the list of candidate metrics being considered.
• Output: Complete metrics list compiled
Cycle 2: Prioritization
• Process: In each domain participants were asked to prioritize 10 metrics for each the National and
Community measures based on the measure’s importance, value/usefulness, and usability to stakeholders
• Output: Candidate metrics lists for each domain at each National and Community levels were reduce to
~20 most selected measures
Cycle 3: Evaluation
• Process: In each domain participants were asked to prioritize 5 metrics for each the National and
Community measures, then evaluate their importance, feasibility, usability and value on a scale of 1 (least)
to 3 (most)
Cycle 4: Multisector expert validation and community testing
Cycle 5: Alignment with related measurement initiatives, such as Healthy People 2030
Well-being In the Nation (WIN) Measurement
Framework (NCVHS Framework)
• Well-being of people
• Well-being of places
• 12 domains and associated
subdomains related to determinants of
health (upstream, midstream, downstream)
3.Full flexible set (developmental measures)
• 12 domains and associated subdomains
Wellbeing In the Nation (WIN) Core
1. Wellbeing of people
• People reported wellbeing
• Life expectancy
2. Wellbeing of places
• Healthy communities index (USNWR/CHRR)
• Child poverty
• Differences in subjective wellbeing
• Years of potential life gained
• Income inequality, graduation rates
• Differences by demographic variables (race,
place, gender, educational level, language, etc)
People reported well-being
Relate to morbidity,
Useful for risk
Work across sectors
% people thriving
% people suffering
% people with hope
Leading Indicators and Full Flexible Set –
Measures related to domains below
3.Food and Agriculture
11.Wellbeing of people
Data availability, importance,
as well as priority to different
determined whether measure
was chosen a leading indicator
What you can use these measures to do
Identify measures for national initiatives that can be applied
across a wide variety of communities.
Monitor the health, well-being, and equity of a population over
Understand and drive improvements in health, well-being, and
Understand health, well-being, and equity in population segments.
Compare the health and well-being of communities through the
development of an index.
1. US News & World Report
2. American Heart Association
3. National Councils on Aging
4. HERO (Employers)
5. Health systems - Kaiser Permanente, Health
6. States – Delaware, New York, California
7. Federal agencies – Veterans Administration
8. Public health agencies – Association of State
and Territorial Health Officials
9. Funders – Wellbeing Trust, Robert Wood
Johnson Foundation, Cargill Foundation
10. Wellbeing Legacy partners
11. Technology groups: Community Commons,
12. Other measurement efforts – CityHealth
Dashboard, USNWR, Healthy Places Index,
13. Other sectors: Housing (Enterprise), CDFIs
(Build Healthy Places Network),
Transportation, Business, Media
14. 100 Million Healthier Lives partners – IHI,
DASH, Empath, SCALE communities,
In coordination with Healthy People 2030
Drill down to place based data 15
Interactive tools to help you see the data - www.winmeasures.org