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V.  Healthy People 2020 Priority Setting Recommendations

Dr. Abby King, Co-Chair of the Subcommittee on Priorities, gave an overview of her group's recent work. The Subcommittee felt strongly that priorities should be set at multiple levels (national, regional, state, and local) and be communicated publicly. There are a number of criteria that can be used to set priorities. Elements that are particularly germane include preventable burden, ease of implementation, cost-effectiveness, and health equity. Prioritizing objectives should occur in two domains: those focused on improving health (e.g., through prevention/treatment), and those influencing underlying social and environmental determinants of health. A set of national "priority objectives" should be identified and should be considered and addressed by every level of government. Priority objectives should consist of a balanced portfolio of short- and long-term issues related to systems, disease, and determinants.

The Subcommittee had said that Healthy People 2020 should re-establish a set of leading health indicators that can be used to track general progress related to priority objectives and other objectives. Leading health indicators are outcomes and are issues that should be tracked to measure progress in a certain domain. Previously established sets of health indicators, such as the leading health indicators, actual causes of death, State Health rankings, or State of the USA indicators, could be used. Dr. King requested feedback.

Upon his return, Dr. Fielding said leading health indicators need not be limited to health, but could include social and economic factors. Social and economic determinants offer a way to engage stakeholders from a variety of backgrounds in collaborative efforts. A Committee member added the role of data collection systems in gathering the data to support such efforts should be examined. The Committee discussed the fact that leading health indicators do not necessarily relate to priority objectives, although they may overlap. Determining which objectives are "priorities" may prove to be politically challenging.

RADM Slade-Sawyer commented that one way to address political challenges could be to say that these are national priorities, but priorities at the local level may look different. Dr. Kumanyika said it is important to have national priorities, but that the Advisory Committee may not be the correct body to set them. Others agreed with this stance. The Committee could talk about the role of DHHS or the FIW in setting such priorities. There are some areas where special efforts are needed to move the nation to the next level of progress, where perhaps the Federal government should do something visionary to move things along.

Dr. Fielding remarked that the word "priorities" might be problematic. Dr. Kumanyika suggested using the phrase, "areas of special emphasis" rather than "priorities." A Committee member said this approach was attempted in Wisconsin and was not successful. Community-members did not buy into the state priorities. Dr. Fielding noted the sensitivity of priority-setting with regard to the danger of disenfranchising some stakeholders. The other possibility to explore is that there might be a way to state priorities that are not disease or condition specific, such as those that are implied in the Committee's Phase I report (e.g., social or environmental determinants). Dr. Fielding asked the Subcommittee on Priorities to continue working on the questions of whether national priorities should be set and how they should relate to indicators.

RADM Slade-Sawyer noted in the past, Healthy People stakeholders have expressed confusion about where they should begin. She asked whether the Committee was saying that priorities should not be set due to the risk of leaving someone out. How should burden and amelioration be factored into decision-making? The Committee discussed these issues further, explaining that priority should be given to cross-cutting areas that have not received enough attention. Policies should be considered as potential interventions, not just additional resources for programs. Also, priority should be given to implementing evidence-based strategies that have been proven effective. It was agreed that the Subcommittee would reconvene to clarify the distinctions between core indicators and priority objectives, and to articulate a process for developing these.

Expert Presentation: The Alliance to Make US Healthiest

John Clymer, Senior Advisor to the Alliance to Make US Healthiest, presented his perspective on implementation of Healthy People. The Alliance fosters public and private collaboration to spark innovative actions and connect individuals to a national movement. Conceived by public health leaders, it is intended to move the U.S. from its ranking as 37th healthiest nation in the world to the "healthiest nation." The mission of the Alliance to Make US Healthiest is to provide leadership and facilitate actions by organizations and individuals that encourage or sustain health and well-being.

Just as Healthy People focuses on providing clear objectives and allowing diverse groups to combine efforts, the Alliance focuses on supporting individuals and organizational efforts that make it easier to adopt lifestyle choices to positively influence our nation's health. The Alliance will draw upon Healthy People goals and objectives and the leading indicators of health to choose a set of goals that will galvanize and resonate with the public. The Alliance's board had endorsed the decision to use the year 2020 as the end-date for their goals. Mr. Clymer presented screen shots of the alliance Web site via www.healthiestnation.org External Web Site Policy. He stressed that the nation must expand the current conversation from a focus on healthcare reform to creating health and well-being and promoting health equity throughout the nation.

VI.  Next Steps

Dr. Fielding would like feedback on how the Advisory Committee can help to make recommendations related to implementation of evidence-based practices in Healthy People. He thanked the Committee members and members of the public for their participation in an extremely productive meeting.

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