226 objectives and these were then published in a second document, Promoting Health/Preventing Disease: Objectives for the Nation (U.S. Department of Health and Human Services, 1980). The overriding premise for that report was the need for improvement of the health of all people in the U.S. during the decade of 1980 to 1990 through the implementation of intervention plans by governmental bodies and private sector agencies at the national, state, local, and community levels.

Evaluation of progress toward achieving the 226 objectives outlined in Promoting Health/Preventing Disease: Objectives for the Nation relied on periodic progress reviews and a midcourse review. Both reviews included discussions of the progress that had been made toward achievement of each of the objectives and the five overarching goals, analysis of shortfalls and problems associated with implementation of the interventions, and suggestions for modifications to the specific language of objectives or the methods of intervention. Five periodic progress reviews and the midcourse review were completed by 1996 (National Center for Health Statistics, 1992, 1994, 1995, 1996, 1997). A final report summarized the progress that had been made in achieving the five overarching goals as well as each of the 226 objectives (Journal of the American Medical Association, 1992). That final review revealed that among the five overarching goals, positive changes had been achieved for infants, children, and adults whereas the goals for adolescents and the elderly had not been met. Of equal importance, this final report set the stage for development and modification of goals and objectives for the next decade of the Healthy People including the years from 1990 to 2000.

Healthy People 2000

The development of priority areas and objectives for the decade from 1990 to 2000 was enhanced by lessons learned during the first decade of Healthy People. Several significant changes were incorporated into the Healthy People 2000 plan as a result of those lessons (U.S. Department of Health and Human Services, 1991). Specifically, the five age-based mortality and morbidity reduction goals were replaced by the following three goals:

    1.  

    increase the span of healthy life for Americans,

    2.  

    reduce health disparities among Americans, and

    3.  

    provide access to preventive health services for all Americans.

In addition, the original 15 strategic areas were expanded, renamed, and reorganized to include 22 priority areas. The entire national public health community was invited to contribute to the process of determining the priority areas, objectives, and targets for Healthy People 2000. The total number of objectives increased to 319. Of greater significance was the inclusion of subobjectives to ensure that efforts to reach special population groups in the United States were emphasized, with a particular focus on reduction in disparities of health status and disease outcomes. Special targets were set for population groups at heightened risk of morbidity and mortality from disease including people in certain racial and ethnic minority groups and disabled people.

Another innovation that emerged during planning efforts for Healthy People 2000 was the identification of a smaller set of 47 "sentinel" indicators selected from among the full set of 319 objectives. These sentinel indicators were thought to provide a succinct measure of the health of the general population and special populations. These 47 indicators were similar in purpose to the five overarching goals established for the first decade of Healthy People. These sentinel indicators were conceptually linked to the goals, priority areas, objectives and subobjectives of Healthy People 2000. The intent was for sentinel indicators to monitor



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