Subcommittee on Action Steps and Evidence. Dr. Steven Teutsch, co-chair of Subcommittee on Action Steps and Evidence along with Dr. Fielding, led discussion of the Report on Evidence-Based Clinical and Public Health Initiatives. Dr. Teutsch explained that the report was developed in response to an HHS request for guidance on what criteria should be used to select “evidence-based” or “knowledge-based” actions that could be taken to achieve the Healthy People 2020 objectives.
The report, Evidence-Based Clinical and Public Health Initiative: Generating and Applying the Evidence, summarizes the ideas of two separate groups of experts that convened over the course of a year to discuss evidence-based practice in public health, challenges in assessing evidence in support of public health interventions, and existing resources for evidence-based public health practice. The memo, Recommendations of the Subcommittee on Action Steps and Evidence, responds directly to questions posed by HHS about how to help Healthy People users bring evidence to bear in their decision-making. It provides a hierarchy of evidence, and presents concrete examples of how that hierarchy can be applied to inform decisions. Dr. Teutsch then explained the key principles that are outlined in the memo, including levels of evidence within the hierarchy. Dr. Fielding added that the central point made in the documents is that one should use evidence-based interventions when possible, but when the evidence is not available then the alternative hierarchy of evidence can be used.
A member noted that the literature on transitioning from evidence-based public health theory to practice is minimal. He said the report made a relatively complicated subject easy to understand. He inquired about plans to disseminate of this report, as well as other documents that have been produced by the Committee, to the practice community. Dr. Fielding explained that once the Committee votes to approve the documents, they are transmitted to the Secretary; they enter the public domain 30 days after they have been transmitted. He asked ODPHP about opportunities to disseminate the Committee’s reports. RADM Slade-Sawyer replied that ODPHP would be willing to work with the Committee to discuss dissemination of their work. Dr. Teutsch noted that many of the ideas presented in the report reflect the work of Subcommittee members, including Ross Brownson, Alice Ammerman, and others. Their work is posted on their Web sites.
A Committee member asked how the hierarchy of evidence could be used to evaluate issues related to addressing social determinants of health and eliminating health inequities (e.g., a Health in All Policies approach and Health Impact Assessments [HIA]). In the U.S. these are fairly new concepts, but they are getting a lot of support around the globe. Dr. Teutsch replied that as progress is made in reviewing complex intersectoral interventions, there will be more reliance on forms of evidence such as HIA. Dr. Fielding added that efforts that Robert Wood Johnson and Pew have undertaken will help to catalyze the growth of HIA.
- Dr. Fielding entertained a motion to approve the two documents produced by the Subcommittee on Action Steps and Evidence. Committee member Patrick Remington made a motion to approve the report, and member Ronald Manderscheid seconded the motion. All members who were present voted unanimously to approve the Subcommittee’s documents.
Subcommittee on Implementation. Ms. Eva Moya and Dr. Adewale Troutman, co-chairs of the Subcommittee on Implementation, led discussion on the Subcommittee’s work on Recommendations for Implementing Healthy People 2020. This work was carried out nearly a year ago, but no formal vote to approve the document was ever held. Dr Troutman said the recommendations were developed in answer to an HHS request for guidance on how to move from the framework to action, and how to provide Healthy People users with the tools and guidance they need. He provided an overview of the subcommittee’s work to develop the recommendations. Eva Moya briefly walked the members through the specific recommendations listed in the document. It consists of a set of five immediate recommendations to be implemented within the first year of launching Healthy People, as well as a set of longer-term recommendations, which the subcommittee suggests should be initiated within the first five years of the launch.
A Committee member suggested adding a sentence or two to link the work of the CHDI to the proposed Healthy People interactive Web site (one of the five recommendations for immediate action). Dr Fielding said that, based on Mr. Park’s presentation, he was under the impression that the Healthy People Web site would be a part of the CHDI and would therefore not need to link to it. Carter Blakey of ODPHP confirmed that Healthy People would be one of the “apps” on the CHDI, while the Healthy People data would be stored in the Indicators Warehouse that is part of the CHDI.