Healthy People: Three Decades Of National Health Goals National Center for Health Statistics Edward J. Sondik Director Richard J. Klein Office of Analysis

Healthy PeopleHealthy People::Three Decades OfThree Decades Of

National Health Goals National Health Goals

National Center for Health Statistics

Edward J. SondikEdward J. SondikDirectorDirector

Richard J. KleinRichard J. KleinOffice of Analysis and EpidemiologyOffice of Analysis and Epidemiology

Edward J. SondikEdward J. SondikDirectorDirector

Richard J. KleinRichard J. KleinOffice of Analysis and EpidemiologyOffice of Analysis and Epidemiology

Healthy PeopleHealthy People::Three Decades OfThree Decades Of

National Health Goals National Health Goals

What is What is Healthy PeopleHealthy People??

What is What is Healthy PeopleHealthy People??

•National disease prevention and health promotion initiative

•Quantified health indicators

• Targets for each indicator Objectives

• Two broad overarching national goals

Healthy PeopleHealthy People 2010 2010Overarching Goals Overarching Goals

• Increase quality and years of healthy life

• Eliminate health disparities

Examples of ObjectivesExamples of Objectives

•Reduce the proportion of nonsmokers exposed to environmental tobacco smoke. (Baseline 65%, 2010 target 45%)

•Increase the proportion of persons with a usual primary care provider. (Baseline 77%, 2010 target 85%)

Overweight and Obesity

Baseline data> 1988–94

Tobacco UseBaseline data> 1990–99

Mental HealthAdults with depression who received treatment

Baseline data 1994–97

Access to Health CareBaseline data 1997 and 1998

Implications of Implications of Healthy PeopleHealthy People for for National Indicators National Indicators

• Topics

•Role of government

•Involvement of the public and health professionals

•Healthy People infrastucture

•Twin overall focus on goals and disparities

•Role of data

•Impact – effects of the program

History:History:Who Initiated Who Initiated Healthy Healthy

PeoplePeople??• Initiated by the Surgeon General’s

Report on Health Promotion and Disease Prevention (1979)

• Contributions from •Federal, State, and local agencies •Academic centers•Providers•Voluntary health associations•The public

Philosophy:Philosophy:Goals, Indicators, and TargetsGoals, Indicators, and Targets

• Science-based

• Indicators with targets = Objectives

•Includes two over-arching goals

•Measurement!

• Public reviews (reports and papers)

•Aggressive use of the web

• Consensus process for development

Conceptual Framework:Conceptual Framework:Linkage Between Linkage Between

Objectives and GoalsObjectives and Goals

•Health: measured by

•Presence or absence of disease

•Quality of life

•Length of life

• Influenced by risk factors, interventions, non-health factors

Determinants of Health



HistoryHistoryHealthy PeopleHealthy People Editions Editions

• Three Healthy People initiatives

•Objectives for:•1990 •2000 •2010

• Each iteration increased in scope and complexity

HistoryHistoryHealthy PeopleHealthy People Editions Editions

• Three Healthy People initiatives

•Objectives for:•1990 (226 objectives)•2000 (312 objectives)•2010 (467 objectives)

• Each iteration increased in scope and complexity

Minimum Dataset per Minimum Dataset per ObjectiveObjective

•Race (5 categories)

• Ethnicity (2 categories)

•Gender

• Socioeconomic status

•Education (3 levels)

•Family income (3 levels)

Implications of Implications of Healthy PeopleHealthy People for for National Indicators National Indicators

• Topics


•Involvement of the public and health professionals


•Twin overall focus on goals and disparities

•Role of data

•Impact – effects of the program

Implications of Implications of Healthy PeopleHealthy People for for National IndicatorsNational Indicators


• Involvement of the public and health professionals

•Science-based objectives are critical

•Government is essential to initiating and managing the program

•The public, health professionals and all levels of government are partners and customers



•Extensive, high level support by government

•Deputy Assistant Secretary for Health manages the program

•28 Federal teams manage objectives

•National Consortium

Healthy People Consortium Healthy People Consortium

•Over 400 private and national membership organizations, State and Territorial, environmental, substance abuse and mental health departments all using the Healthy People 2010 objectives

•Listserv/website

•Annual Meetings

•Newsletter

•Independent contributions from members:•Tools •Intervention experience


•Healthy People infrastucture (more)

•190 data sources

•Data warehouse under the National Center for Health Statistics (Federal Statistical Agency)

•New data sources for Developmental Objectives

•State and local data

• Technical guidebook on the statistics used for HP2010

• Provides details on how the objectives are measured

• Discusses major statistical issues that affect interpretation of data


•Healthy People infrastucture (more)

•Research and development•Analytic methods

–Measuring progress–Evaluating disparities–Small area estimates from National data and multiple data sources


•Assessing impact

Use by

Federal agencies

State and local agencies

Private and voluntary agencies

The public

Federal UsesFederal Uses

•Represents the Nation’s disease prevention, health promotion goals

•Used to build partnerships

•Has spawned derivative programs: A framework and an indicator set for other health initiatives

• Identified topics in need of intervention research and action

State and Local UsesState and Local Uses•Nearly all States had specific goals and

objectives modeled after Healthy People 2000

• 23 States have specific goals and objectives modeled after Healthy People 2010•Some select all indicators•Other adopt select areas and objectives

• Framework for local health initiatives

•Data improvements

Use By the PublicUse By the Public

•Health coalition building

• Introduces a common vocabulary

• Increasing focus on prevention

•Data and information for health decisions

•Use by the media

Healthy PeopleHealthy People Lessons Learned Lessons Learned

• Science-based framework

• Credible data

•High level support

• Consensus-based measures

• Customer-driven and supported ongoing process

•Accessible information

Impact – Progress to DateImpact – Progress to Date2010 Objectives2010 Objectives

• Progress Quotient = Most recent value - Baseline Target value - Baseline

Progress to Date % of Measures

Achieved Target 6.5Moving Towards Target 32.3No Change 4.9Moving Away from Target 14.6

Cannot Assess: Baseline data only 41.8100.0

Documents

Healthy People: Three Decades Of National Health Goals National Center for Health Statistics Edward J. Sondik Director Richard J. Klein Office of Analysis