A New Scorecard for Progress in Sexual Health

Moving away from a focus on risk of disease to a more positive, holistic, and health-promoting approach to sexual health is key to improving health outcomes, according to a new study led by a researcher from Columbia University Mailman School of Public Health. The study, which proposes indicators to assess broad progress in sexual health outcomes, appears in the open-access journal Frontiers in Public Health.

Rates of sexually transmitted infections (STIs) have increased substantially throughout the COVID-19 pandemic, aided by delays in treatment and surveillance. STIs are the most reported infectious diseases in the United States; reproductive tract cancers affect hundreds of thousands of people annually; and almost half of all pregnancies are unintended. Adverse health outcomes are costly, with the direct medical costs of STIs estimated at $16 billion annually, and the estimated annual costs of unintended pregnancies at $9 billion.

Within the United States, public health researchers have largely focused on sexual health challenges like these one at a time. Yet many of these outcomes occur in the same individuals and subpopulations, creating syndemics (overlapping epidemics of two or more health-related issues) stemming from social conditions like poverty, stigma, and structural violence. However, in recent years, other countries have moved towards a more holistic approach to evaluating sexual health outcomes, aligned with the World Health Organization definition of sexual health, which the researchers used as a framework for their study.

The research team worked with experts from the Centers for Disease Control and Prevention (CDC) to identify key sexual health indicators to measure long-term outcomes, focused on the general population, and aligned with existing government goals. Indicators were selected that fit into one of four objectives: 1) increasing knowledge, communication, and respectful attitudes towards sexual health; 2) increasing healthy, responsible, and respectful sexual behaviors and relationships; 3) increasing use of high-quality educational, clinical, and other preventative services to improve sexual health; and 4) decreasing adverse health outcomes.

The study identifies 23 indicators tied to these objectives. They write that their efforts were more successful at identifying indicators for traditional public health measures like clinical services and adverse outcomes (example: new HIV infections among adolescents and adults) and less so for measures of attitudes and relationships related to sexual health (example: percentage of people who report being very happy in marriage).

The researchers envision these core sexual health indicators would be published in the form of an index that is publicly available and updated frequently. These sexual health indicators could be used for ongoing monitoring, and to guide related research, programming, and policy development to help promote sexual health in coming years. They hope that proposed indicators will be reviewed and revised overtime to ensure usefulness.

“While there have been calls for a more positive, holistic focus on sexual health, this paper takes those calls a step further and nails down the importance of measurement,” says study author Jessie V. Ford, PhD, assistant professor of sociomedical sciences at Columbia Mailman School. “Imagine if the U.S. had a publicly available scorecard where we could easily track our sexual health. It would help us think about where to celebrate our wins and where to make changes and invest resources. We envision this paper as a sort of baseline upon which to build even better measures and surveillance in the future.”

The study’s co-authors are Megan B. Ivankovich from the Population Reference Bureau and Eli Coleman from the University of Minnesota Twin Cities’ Institute for Sexual and Gender Health.

Megan B. Ivankovich was employed by the Population Reference Bureau, but the other study authors declare no conflict of interest.