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IV. HHS Update

Timeline of Development Activities for Healthy People 2020
RADM Penelope Slade-Sawyer, Deputy Assistant Secretary for Health (Disease Prevention and Health Promotion), provided an update on the timeline for HHS activities related to development of Healthy People 2020. The proposed topic areas and draft objectives were posted online for public comment from October 31, 2009 through December 31, 2009. The Federal Interagency Workgroup (FIW) was in the process of developing a target-setting methodology. HHS had several concurrent activities planned through April of 2010. The FIW would develop a narrative and specific measures to underpin all of Healthy People 2020. Simultaneously, the Topic Area Workgroups and the National Center for Health Statistics (NCHS) would partner to produce operational definitions that would be used to measure the objectives. HHS would also develop the “front matter” to Healthy People 2020. The Implementation Strategies Subgroup would continue to refine the guidance for selecting evidence-based interventions that will be linked to the objectives.

ODPHP and the NCHS would be using the Committee’s recommendations to develop the Healthy People 2020 relational database (scheduled through October, 2010). HHS Workgroups would review public comments and revise objectives between January and February, 2010. The FIW would consider the Workgroups’ proposed revisions between March and April of 2010. As objectives are finalized, their targets would be calculated using the baseline data and the target setting methodology. Between May and June 2010, Healthy People 2020 would go through HHS’ Departmental clearance. In July 2010, clearance comments would be considered, and changes would be made before the objectives were submitted for final Departmental approval of Healthy People 2020.

RADM Slade-Sawyer provided details of the process for sharing five hundred and fifty-seven (557) draft Healthy People objectives with the public, both at public meetings and online at the Healthy People 2020 Web site. Three public meetings took place (October 22, 2009, in Kansas City, Kansas; November 7, 2009, in Philadelphia, Pennsylvania; and November 20, 2009, in Seattle, Washington). Each meeting included opportunities for participants to provide oral testimony across the full set of draft Healthy People 2020 objectives. The majority of comments that were presented addressed specific issues, population groups, or other interest groups. A large number of comments reflected broad, cross-cutting interests, including the nature of health determinants and interventions, and the nature and structure of the Healthy People initiative itself. The Public Comment database for the proposed Healthy People 2020 objectives also opened on October 30, 2009 and would remain open through December 31, 2009.

RADM Slade-Sawyer discussed the FIW’s preliminary decisions about Target-Setting Methods. The Committee had recommended that target-setting methods for Healthy People 2020 be: 1) understandable and transparent; 2) based on data and projected trends; and 3) realistic, but representing a “reach” that is more than a continuation of the status quo. The FIW’s proposed recommendation is that, when the science and information are available, modeling, existing policies and laws, and consistency with other Federal targets/programs be used to set an objective’s target. When these are not available, 10 percent improvement would be used as the standard. This would make the target setting methodology transparent, simple, and easy to explain, while allowing utilization of available empirical findings from last decade. RADM Slade-Sawyer cautioned that this recommendation had not yet been submitted to the ASH for approval.

After providing an overview of FIW progress on objectives in specific topic areas, RADM Slade-Sawyer shared that the Secretary and the Assistant Secretary for Health were interested in including a set of Leading Health Indicators (LHIs) in Healthy People 2020. Like the Healthy People 2010 LHIs, this small set of objectives would enable focused efforts and facilitate public awareness. This list could include indicators that reflect social determinants of health. ODPHP asked for the Committee’s guidance in identifying criteria to select social determinant of health measures that would be added to the LHIs. RADM Slade-Sawyer opened the floor for Committee questions and discussion.

Target-setting. Dr. Fielding commented on the FIW recommendation that objectives be set using a standard level of 10 percent improvement. He acknowledged that sometimes there is not enough information available to inform target-setting. In such situations, 10 percent improvement may be an acceptable standard. However, the focus should be on interventions that we know are effective to reduce the burden of illness or injury. Objective targets should take interventions into account, indicating where we will be if we implement what may make it appear as though many objectives have been achieved.

Dr. Kumanyika added that the advantages to using this method are that it sounds like a simple, transparent approach. Yet a 10 percent improvement would represent a tremendous gain for some objectives, while for others it would be a trivial change. She asked if the FIW had considered stratifying the objectives, based on where they are now. Targets could be set at a higher level for certain objectives; if those targets are not met, they could be flagged for further analysis. Otherwise, it seems this approach lacks an element of aspiration. RADM responded that, while it does sound small, a ten percent improvement would not be achieved for about fifty percent of the objectives. She added that they were not trying to trivialize the targets, but to make the methods used for setting them transparent and consistent.

Leading Health Indicators (LHIs). A Committee member suggested that, in thinking about LHIs, the Committee should also consider indicators related to public understanding of social determinants of health, as well as those related to health information access and utilization. These would be critical factors in empowering people to take charge of their own health.