The Phase I Report of the Recommendations for the Framework and Format of Healthy People 2020 identifies a vision and mission statement, and an ecological action model that emphasizes life and developmental stages. In many ways it is similar to Healthy People 2010 with its vision of a society in which all people live long, healthy lives. The Phase I report acknowledges that clustering life stages is not always age-determined, and envisions allowing users to track objectives by user-defined groups as related to issues such as parental disparity, obesity, or growth. The criteria for identifying these objectives will be in the Phase 2 report.
The Phase I report sums up the history behind Healthy People, and sets the foundation with the intent of being clear, communicative and transparent. Three mechanisms were used to gather input for the Phase I report: a public comment Web site, six regional meetings across the United States between March and May of 2008, and oral comments to the advisory group at one of its in-person meetings. The report also has a well-referenced glossary.
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Chart courtesy of Healthy People Phase I Report |
There are at least three areas that could be clarified or improved in the Healthy People 2020 process and report.
1. Need to evaluate selected aspects of Healthy People 2010 to better understand how objectives are and are not achieved.
On page 17 of the report, it reads: Although no comprehensive evaluation of the Healthy People initiative has been conducted, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Office of Disease Prevention and Health Promotion (ODPHP) launched a study in 2002 to examine how Healthy People 2010 was being used. The study's overall conclusions were that Healthy People 2010 is a visible, practical tool that is being used by public health agencies at the state and regional levels. Barriers to usage were also identified, including a lack of implementation tools that could be used to achieve the objectives, and resource constraints. In Appendix 7, the lack of a comprehensive evaluation of Healthy People 2010 was not identified as a challenge, hence no proposed approach for Healthy People 2020 is addressed. A thoughtfully conducted evaluation for selected issue areas that meets pre-determined criteria would be an invaluable resource.
2. Seek more clarity on how public health and medicine can work together.
The primary focus of Healthy People 2020 is primary prevention and health promotion, while its secondary focus is health care. It is unclear what opportunities there are to bridge the work between primary prevention, health promotion and health care because the boundaries in communities are not always distinct. How will the Agency for Healthcare Research and Quality’s (AHRQ) 14 Prevention Quality Indicators be complemented by objectives in Healthy People 2020? PQIs can be used with hospital discharge data to indicate ambulatory care-sensitive conditions resulting in hospital admissions that could have been avoided, at least in part, through high-quality primary or outpatient care.
3. Identifying secondary audiences may undermine the community engagement process.
While it is very helpful to understand who the primary and secondary audiences are, how useful is it to explicitly identify a secondary audience? Would it be sufficient to just state the primary audience with the understanding that other audiences are secondary? Does identifying secondary audiences, make those in this sub-group feel like second-class citizens and undermine their engagement?
Comments related to Healthy People 2020 can be posted at http://www.healthypeople.gov/HP2020/comments/default.asp. Also, the CHPPD Section is working to organize a Web conference tentatively scheduled for Wednesday, April 1, 3:00 - 4:00 p.m. EST, and we invite you to participate. Please hold the date, and updates will be posted at http://www.chppd.org.
By Priti Irani, MS CHPPD Chair, pri01@health.state.ny.us