they must collect the data necessary to document the effectiveness of those interventions.

One of the constraints of the PPG process, as currently formulated, is that the performance objectives must be judged capable of realization within 5 years. Yet many important public health objectives, such as lowered incidence of cancer and HIV infection, cannot be achieved over this short time period. However, it would be unwise to divert resources from those objectives simply because demonstrable results cannot be expected in the 5-year period. The panel recommends that DHHS and the states consider negotiating some items in their performance agreements that allow for longer term goals if relevant risk behaviors and process data can be used to measure progress toward the desired health outcomes.

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