Leading Health Indicators for Healthy People 2010: First Interim Report (1998)

Attention was directed toward the third generation of Healthy People even before Healthy People 2000 Review: 1997 (National Center for Health Statistics, 1997) was completed. The context in which the Healthy People 2010 effort has been developed built upon the strengths of previous efforts, especially those activities undertaken for the year 2000 plan, and also incorporated a number of innovative strategies. The selection of goals, enabling goals, focus areas and objectives for Healthy People 2010 relied heavily on results from the annual and biannual data reviews, and the midcourse review made a particular contribution to decisions to modify Healthy People 2010. Thus, the primary methodology to Healthy People 2010 will follow a dynamic process in which changes to the plan will occur in response to data collected during the decade. In addition to changes prompted by the data, it is expected that scientific advances, especially those in the areas of preventive health, communication, vaccines, pharmaceuticals, and improved data sources, will contribute to changes in the practice of medicine and, consequently, changes in Healthy People 2010. Such changes will also reflect health care reform and the changing demographic profile of the U.S. population that will evolve during the interval from 2000 to 2010.

Efforts to develop the priority areas and their concomitant objectives are predicted to be enhanced from those of the year 2000 initiative by a variety of factors including a broadened science base, especially in the area of health promotion and disease prevention; enhanced surveillance and data systems; a heightened awareness of health promotion and disease prevention among traditional health care agencies complemented by the activities of the general public and community groups; an emphasis on monitoring the quality of health care services; changes in epidemiologic knowledge about disease risk factors and methods of effective intervention; and finally, through the decade, alterations in population demographics and access to health care services.

In recognition of the potential complexity of maintaining and expanding the Healthy People process in response to these diverse forces, efforts to develop the content of Healthy People 2010 have been already begun. As early as September 5, 1996, the Secretary's Council on National Disease Prevention and Health Promotion Objectives for 2010 was established. One of the first

public actions of this council was to conduct focus groups with Healthy People Consortium members, including both public and private agencies and organizations. In addition, a meeting of the Healthy People Consortium was convened on November 15, 1996, which resulted in the publication Building the Prevention Agenda for 2010: Lessons Learned (U.S. Department of Health and Human Services, 1996). Activities heightened in 1997, with the Secretary's first briefing on objectives for 2010 occurring on January 22, 1997 followed by a meeting with the Secretary's council on April 21, 1997, to discuss in greater detail the objectives for 2010. In July 1997 a focus group report on the utility of Healthy People 2000 was published (U.S. Department of Health and Human Services, 1997a). Shortly thereafter, in September 1997, a notice was published in the Federal Register to call for comments on the framework for the objectives for 2010 and the proposal of objectives (Federal Register, 1997). This resulted in the receipt of almost 700 comments from private consumers of health services, Healthy People Consortium members, members of the U.S. Congress, agencies of state and local governments, health care agencies, and other diverse organizations. The Healthy People Consortium met again on November 7, 1997, in Indianapolis, Indiana to discuss in detail the specific issue of reducing health disparities and how far the nation has come in doing so.

Work groups in each of the 22 priority areas discussed relevant objectives, and the issues and the content of these discussions were included in the record of public comments. Activities continued through 1997 and 1998, including meetings of work groups consisting of members from lead and collaborative organizations to determine the specific objectives that should be included, new objectives that should be developed, objectives that were no longer considered relevant and that should be deleted. It was anticipated that the first draft of objectives would be available for internal review by March 1998, presented to the Secretary's council meeting in April 1998, and published as the first draft of content for Healthy People 2010 in the Federal Register by October 1998 to elicit a second round of public comments. In addition, ODPHP plans to conduct regional meetings and small group discussion sessions with interested and target populations during the period from October through December 1998.

Simultaneously, a meeting of the Healthy People 2010 Consortium will occur in November 1998 to coincide with the annual meeting of the American Public Health Association in Washington, D.C. Finally, by December 1998 three meetings of the IOM Committee on Leading Health Indicators for Healthy People 2010 will have occurred and reports for phases one and two of the IOM project will have been generated.

Activities that will support the development of Healthy People 2010 expected to continue through 1999, including another meeting of the Secretary's council in April 1999 and a meeting of the Healthy People 2010 Consortium in June 1999. Finalization of the specific objectives and development of companion documents are projected to occur through the remainder of 1999, with the release of Healthy People 2010 by the Secretary of Health and Human Services in January 2000.

At the time of preparation of the present report, the proposed framework for Healthy People 2010 was conceptualized around the vision of “Healthy People in Healthy Communities,” which emphasizes the fact that basic good health practices and health improvement begin with individuals, families, and communities with their associated organizations and services. Two vision goals have been defined for Healthy People 2010: (1) increase the number of years of healthy life for all Americans and (2) eliminate health disparities among Americans. In order to achieve the latter goal, all objectives and their targets of change will be identical for all population groups. Within the framework of the two vision goals, four enabling goals have been defined. The purpose of this second set of goals is to identify strategies that will support the achievement of the two overarching vision goals. Briefly, the four enabling goals are (1) promotion of healthy behaviors, (2) protection of health, (3) assurance of access to quality health care services, and (4) strengthening of community-based prevention efforts. The proposed framework for Healthy People 2010 moves from use of the term priority areas to focus areas in an effort to discourage the impression that a particular area of interest is of greater or lesser importance or a greater or lesser priority. The proposed focus areas fall under one of the four categories of enabling goals, and a set of quantitative objectives is associated with each of the focus areas. The plan for 2010 includes two new focus areas including (1) mental and physical impairment and disabilities and (2) the public health infrastructure, which includes objectives relevant to surveillance, data systems, training, and research. The proposed framework includes 20 focus areas and identifies special populations by the following: socioeconomic status, race or ethnicity, gender, age, or disability. A special population may consist of individuals with one or more of these characteristics.

Objectives formulated for each of the 20 focus areas fall into one of two categories: measurable or developmental. By definition, measurable objectives are intended to provide direction for action because they are supported by valid and reliable baseline data derived from established, nationally representative data systems. The baseline rate establishes the point from which a quantitative or numeric target, such as percent reduction, can be established. In contrast, developmental objectives are qualitative or descriptive in nature and generally, do not provide a numeric value as a target. Quantitative measurement systems are under development but not yet available for application. Qualitative objectives do however, provide a “vision” for a desired outcome or health status. Currently available surveillance systems and databases do not provide quantitative measures for these objectives. Inclusion of such objectives is expected to identify focus areas that are important and are also intended to motivate the development of national data systems through which they can be monitored. It is anticipated that 30 percent of the objectives for 2010 will be developmental in nature and will therefore lack an existing data set from which baseline data can be calculated and with which change can be monitored over time.

A unique component of the framework for Healthy People 2010 has been the specification of seven criteria considered necessary and essential for the development of objectives within each of the 20 focus areas. These seven criteria for Healthy People 2010 objectives include:

1. important and understandable to the general population and relate clearly to the vision, enabling goals, and focus areas of Healthy People 2010;

2. prevention oriented with an emphasis on health improvements that can be achieved through population-based and health service-based interventions;
3. action-oriented including suggestions for a set of interim steps requisite to achieving the proposed target by 2010;
4. useful and relevant to states, localities, and the private sector in a manner that activities targeted to community organizations such as schools, work sites, health settings, and churches are facilitated and encouraged;
5. measurable (or have the potential to become measurable during the decade) including a variety of measures such as health outcomes, behavioral and health service change, and community capacity;
6. stated in an affirmative tone; and
7. permit continuity and comparability of measurement with objectives defined for Healthy People 2000
8. supported by sound scientific evidence.