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II.  Desired Outcomes of the Meeting

Dr. Fielding, Chair of the Advisory Committee, outlined the desired outcomes of the meeting. He commented that extensive subcommittee discussions had taken place since the May 15, 2009 meeting. Today's discussion would be an opportunity to integrate this work into a cohesive whole, discuss whether refinements are needed, and prepare to approve the documents at the August 2009 meeting. Issues to be discussed included: finalization of Data & IT recommendations, criteria for identifying evidence-based strategies, implementation strategy recommendations, and the work of the Priorities Subcommittee. Dr. Fielding noted that nearly every issue that they discuss from this point forward will be one of implementation. He introduced Shiriki Kumanyika, Committee Vice-Chair, to lead that discussion.

III.  Healthy People 2020 Implementation Strategies

Dr. Kumanyika noted that she would moderate the discussion after Eva Moya, Subcommittee Co-Chair, had presented introductory slides. The Implementation Subcommittee, which includes key players at the state- and local-levels and representatives of the business community, has sought to answer questions related to what Healthy People 2020 should do, and how it should ensure accountability. She noted that the subcommittee was focused on users' needs for tools, aids, and guidance.

Ms. Moya provided an overview of the Subcommittee's discussions of action-oriented implementation strategies within a social determinants-oriented framework. The Subcommittee organized their recommendations around four general themes: action orientation; infrastructure for accountability; incentives for engaging and participating in Healthy People; and investing adequate resources at the state and local levels. This last element includes providing tools, resources, and guidance for users. The Subcommittee's draft document presents recommendations for activities and actions that should be carried out within the immediate- (i.e., the first year of the decade) and the long-term (i.e., might not be initiated until later). Ms. Moya walked the members through the specific recommendations in the document. Dr. Kumanyika requested feedback from the Committee about whether or not the recommendations were complete." They discussed several revisions that pertain to "immediate-term recommendations," summarized below.

Dr. Fielding said that physical determinants should be emphasized in addition to social determinants, as the two elements are complementary and have import for health issues. An accountability infrastructure should be in place at all levels of government. Federal level efforts should be coordinated with the Office of Personnel Management, which is responsible for the Federal workforce. Dr. Fielding mentioned that, although states are the primary partners of the Federal government, local health departments should not be overlooked. Local agencies have a major role in implementation efforts.

Members of the Committee discussed the need for more hands-on technical assistance and resources (e.g. webinars, conferences, call centers, online curricula, and smart assistance) to support implementation efforts at the local level, especially for large local health departments. These resources should be linked to the interactive Web site. The interactive Web site should be a major priority for resources, because the potential exists for it to create an online community including far more people than could be reached through individual technical assistance.

The Committee also recommended revisions regarding the longer-term recommendations. For example, it would be beneficial to create a tool that helps users at the state or local level cross-walk their current activities with the Healthy People 2020 action strategies; this would enable them to see how their activities align with Healthy People, and identify areas that they are not currently addressing. It would be useful to provide a toolkit to help states develop their own objective targets and data-tracking methods. An online curriculum (e.g., distance learning) could be created to give users general understanding of Healthy People and how they can obtain technical assistance. Completion of this course could serve as a measure of competency by offering some sort of certification on the basic components of Healthy People 2020.

When using an "Health in All Policies" approach, attention should be paid to measuring how health outcomes are affected by efforts to address the social determinants of health. As an interdisciplinary body, the Federal Interagency Workgroup (FIW) can play a key role in operationalizing cross-cutting elements of Healthy People 2020 (e.g., those that relate to physical and social environments and extend beyond the field of health). FIW members are from various agencies and organizations, so this group could be valuable for implementing a "Health in All Policies" approach.

Dr Fielding said that depending on the state, more than one Healthy People State Coordinator may be needed; the number of coordinators should be scaled by population. Coordinators may also be needed to direct implementation at the local level. States are primary partners for the Federal Healthy People efforts, but local health departments—particularly large ones—are also critical. Partnerships that are leveraged in the public sector are important, but the private sector should also be mentioned. Public/private partnerships would draw a larger network of interest. Non-health related companies should be motivated to get involved in Healthy People 2020 by using arguments about economic productivity and the overall economy.