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Expectations and Desired Outcomes of the 2nd Meeting

Dr. Fielding explained that the focus of the meeting would be to hear progress updates from all chairs of the Secretary's Advisory Committee's subcommittees; to discuss how best to integrate the subcommittees' work; and to discuss and propose agenda items for the next in-person meeting of the Secretary’s Advisory Committee (scheduled for June 5 and 6, 2008 in Arlington, VA).

Reports of Progress from Subcommittees

Subcommittee on User Questions and Needs
Subcommittee Chair: Douglas Evans, PhD, RTI International

Dr. Evans explained that the subcommittee has met twice, and has drafted a list of target audiences for information about and from Healthy People 2020. In their discussions, the group has proposed a departure from previous iterations of Healthy People by suggesting that Healthy People 2020 could also include the general public as an intended audience. This would raise questions about whether more extensive segmentation needed in order to reach such a broad audience.

As they considered the informational needs of audiences listed, they drew a distinction between those who are active seekers of information from or about Healthy People 2020, and those who may need to know more about the initiative. The subcommittee discussed the need for targeted messages and products to reach specific audiences and segments, as well as potential barriers to reaching them. There were some unresolved issues, including whether a unifying theme or brand image for Healthy People can be used to reach out to audiences in an effort to raise awareness. How should target audiences and their needs be prioritized? Dr. Evans concluded that the subcommittee plans to develop a more robust conceptual model for segmenting audiences and needs.

Subcommittee on Developmental Stages, Life Stages, and Health Outcomes
Subcommittee Chair: Patrick Remington, MD, MPH, University of Wisconsin Population Health Institute

The subcommittee considered a life-span approach to be critical to population health improvement, improved length and quality of life, and reduced health disparities. Members noted that Healthy People 2010 did not reflect the importance of life course (except for a maternal and child health focus area), but this should be a visible priority for 2020. Dr. Remington said the group had looked at various examples, including obesity. There is evidence that pre-natal developments influence early childhood health (e.g., adiposity, growth trajectories). Later adult diseases are determined largely by the time that people become adults, but continued influences are important, such as inactivity, nutrition, and smoking. Currently, little attention is focused "upstream" on early life course.

Dr. Remington presented a logic model for population health improvement across the life course (see Appendix 1). It includes a modification of the two overarching goals from Healthy People 2010 (improved health outcomes and health equity). The determinants approach shows that healthy development across the life course not only influences outcomes (disease, disability, and injury rates) but also behaviors. "Life course," is shown at the bottom, indicating that exposure to health programs, policies, and systems early in life affects later outcomes. The model could also show how life stages (e.g. infant health, child health) are affected by health determinants. The subcommittee discussed the model as being a fairly simplistic approach; it’s easy to understand, but bi-directional interactions between some determinants may be needed. The metrics for healthy life course development are also important. Dr. Fielding suggested putting this model on the agenda for June’s meeting as an item for discussion and finalization.

Subcommittee on Health Equity and Disparities
Subcommittee Chair: Ronald Manderscheid, PhD, SRA International

The subcommittee decided to sort out key issues on definitions of health: disparity, inequity, equity, equality, and quality. They want to be able to communicate clearly about these issues to the health field. Members view health equity and disparities as vital issues for Healthy People 2020. They reviewed the core literature on health equity, and posted it on the SharePoint Extranet (a Web-based tool for internal use by members of the Committee). They also prepared criteria considerations for a definition of health equity, and began work on an actual definition (see Appendix 2).

The subcommittee feels it is important, once the draft definition has been completed, to work with federal agencies with interests in this area—principally the Office of Minority Health (OMH) and the Centers for Disease Control and Prevention (CDC). They want to ensure that they reach consensus with these agencies, and also within the Secretary’s Advisory Committee. Dr. Manderscheid highlighted key criteria for a definition of health equity, and offered a progress update on the current version of the draft definition. Dr. Fielding noted that the definitional issues (not only health equity, but also disparities, equality, etc.) should be addressed in the agenda for the June meeting.