V. Healthy People 2020 Criteria for Evidence-based Strategies
Dr. Fielding explained that he and Dr. Steven Teutsch, an Ad Hoc group member, had incorporated the Committee's feedback from the July 10, 2009, meeting into a revised version of the Evidence-based Strategies report. The report was then circulated back to the Committee for feedback so that final recommendations could be made. Dr. Fielding thanked Steven Teutsch, Ned Calonge, Mike McGinnis, and Tracy Orleans for their contributions to the report. He emphasized that the criteria for evidence based strategies should not drive priorities, although it is probably one of the issues that should be taken into account. Before opening the floor for discussion, Dr. Fielding noted that the report addresses three basic questions:
- How should decisions be made about linking Healthy People objectives with evidence-based interventions?
- What should be done when there is insufficient evidence to identify effective interventions?
- And what guidance could be provided to users about what needs to be done?
A Committee member expressed concern that, given the size and complexity of the potential target audience, it would be a challenge to engage everyone at every level. When programs and policies are implemented in communities, the issues are very complex. One possible way to address this would be to consider possible uses of social networking to communicate about effective interventions.
Another member asked how Healthy People 2020 evidence-based practices should be coordinated with the health reform legislation. This legislation is defining criteria for evidence-based practices in clinical prevention and health promotion interventions. Dr. Fielding said there must be a clear mandate for the Community and Clinical Guides to continue their work. He invited Dr. Teutsch, who was present on the phone, to comment. Dr. Teutsch said much of comparative effectiveness research doesn't address population health interventions as fully as one would like. He stressed that it is important to bring this issue to people's attention.
Members should come to an agreement on the level of certainty that is needed, and what magnitude of effect, before it can be said that a particular strategy is worthwhile to pursue. Dr. Fielding noted that the Committee should review the report to ensure consistency and include any additional opportunities that may come from the legislation. As a final note, Dr. Kumanyika added that the report should include a disclaimer noting that standards of evidence will differ depending on health intervention.
- Dr. Fielding requested a motion to approve the report on selecting evidence-based actions. All members who were present voted to approve; none were opposed.
VI. Healthy People 2020 Priorities
Dr. David Meltzer, Chair of the Subcommittee on Priorities, gave an overview of the group's recent activities. During their July 10 meeting, Committee members had decided to explore two areas for priority-setting: 1) the gap between evidence and practice for each health area, and 2) the overarching Federal investment in areas that would have a pervasive effect. The latter would encompass the "3-four-50" approach (i.e., three risk factors affecting four chronic diseases that cause 50 percent of all mortality) and the idea of cross-cutting social determinants. Priorities could be chosen based on the "know-do" gap (i.e., thinking about what we know could be accomplished, based on the evidence, and comparing that to where we actually are now). Another approach would be to consider what effectively reduces the frequency and/or severity of the burden.
Since July, the Subcommittee had met twice and had developed a 3-pronged approach to priority-setting. This would involve setting priorities at three levels: 1) the FIW could use a quantitative algorithm to set priorities within topic areas; 2) certain pervasive health behaviors could be identified and targeted in order to address a spectrum of health issues (the 3-four-50 approach); and 3) a Health in All Policies approach could be used to address determinants in the social and physical environment by addressing some of the causes of health disparities.