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Dr. Abby King, chair of the Ad Hoc Group on Social Determinants, sought input on the operational questions Dr. Marmot’s presentation had raised. The purpose of the Ad Hoc Group was to develop and operationalize specific examples of social determinants are and how they can be included and embedded in local, regional, and national actions around different topic areas. Members of the group have been asked to submit examples that can be used as a basis for this group’s work. It is easier to obtain examples that address the built environment, because much has been done in this area related to physical activity, nutrition, and weight. NORC has assisted in identifying concrete examples that are low cost, feasible, and do not require legislative action from different reports, including the NACCHO report on Health Inequities.

Dr. King was pleased to hear of Dr. Marmot’s local-level efforts in London. She suggested it might be useful to consider strategies Sir Marmot will highlight in his report in February 2010. Dr. King noted Dr. Marmot’s use of the term “we;” it sounded like he himself was meeting with local and federal decision-makers. She thought it would be helpful if the Ad Hoc group could gain understanding of how his group is organized, and how they plan to use the report to maximize results.

Dr. Douglas Evans, Chair of the Subcommittee on Strategic Communications, said his group had met twice in the last few months and would meet again in January. The Subcommittee identified two types of strategies: those that ODPHP can realistically implement t on their own, and those where partnerships will be required The Subcommittee has done some further analysis of the audience matrix. They expanded the matrix to define communication channels, mechanisms for outreach, and what some objectives and outcomes of those communications would be. Dr. Evans noted that the Subcommittee could look at how people think about social determinants, and how Healthy People can use those frames of reference. There is some research occurring in relation to this topic now. If Healthy People is to change the way people think and act about the social determinants, the issue must be framed in ways that will be understood and will motivate change.

Dr. David Meltzer, Chair of the Subcommittee on Priorities, said his group had met once, and would schedule additional meetings. The group was working on fine-tuning a priority-setting approach, developing specific examples with measures such as population and preventable burden, and then presenting them in an article that can be distributed to the public. The Subcommittee will consider how to integrate its work with that of the social determinants group. It is challenging to think about how to develop measures of population effects of social determinants. Members discussed how to incorporate the work of the Priorities Committee into the policy process, recommending that the Secretary engage the Domestic Policy Council in identifying national priorities, since leadership from other parts of government is needed to address social determinants.

Ms. Eva Moya, Co-Chair of the Subcommittee on Implementation, addressed three key issues. First, the Subcommittee continues to struggle to make implementation recommendations within a context of limited resources. Second, they wish to offer clear guidance for local public health agencies, health departments and other core users on what realistic actions can be taken, in a time of economic retrenchment. Third, it is important to look at continuous quality improvement approaches. Ms. Moya discussed the need for consistent reference to Healthy People in HHS funding opportunities and the language used by HHS. Implementation guidance must be practical for health departments, especially at a time when they are struggling with diminishing resources. The subcommittee reorganized its recommendations to be more cost-sensitive so that users have guidance on ways that they can take action in times of economic retrenchment.

Dr. Ronald Manderscheid, chair of the Subcommittee on Data and IT, said his group has completed two phases of work, and is now moving onto phase three. First, they will develop a framework for the information technology for the U.S. public health infrastructure and, second, they will develop an outline and framework for the Healthy People 2020. Based on today’s discussion, Dr. Manderscheid suggested that the subcommittee consult with ODPHP for guidance on how they can help with the relational database.

VII. Next Steps

Dr. Kumanyika thanked the subcommittee chairs for their updates and asked RADM Slade-Sawyer to comment on anything else that ODPHP should be addressing. RADM Slade-Sawyer noted that time is limited and the Committee should stay focused on the most important items. Dr. Kumanyika suggested creating a timeline for submission of the subcommittees’ recommendations so that they can be voted on and approved in a timely manner. She suggested that by the next public meeting, the subcommittees should have recommendations that are ready to be voted on. RADM Slade-Sawyer indicated March 2010 would be a good time for the next meeting. The meeting was adjourned.

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