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Dr. Fielding agreed that it is important to highlight the greatest opportunities, given current knowledge and techniques. As part of the prioritization effort, a set of criteria is needed for how those are chosen. Dr. Meltzer said that tools are used to inform priorities, so our goal is to establish first a set of tools to help us think about what is important, and then to apply those tools to decide what becomes important. He added that there are multiple decisions at multiple levels, the tools are often poor, and the data are insufficient. Looking at earlier Healthy People processes, large lists of issues were identified, but they were not narrowed down, and decisions were not made about what matters most. He expressed doubt that this Committee would be able to do any better in terms of deciding what matters most. However, he hoped that the Committee could describe a set of "tools" that could be used to enable more informed choices about what matters most in the next decade.

Dr. Fielding suggested that it should be possible to come up with a set of overarching priorities based on preventable burden, available interventions, and similar criteria. Since social environmental and physical environmental factors impact health; shouldn’t these be highlighted? Dr. Meltzer said felt that, given the lack of resources or time, this group would have difficulty drilling down deeply to decide what is important and what is less important. Dr. Fielding thought it should be possible to establish the criteria for priorities, and/or evidence.

Dr. Kumanyika preferred the term "principles" to tools; others agreed. Dr. Remington mentioned that principles for population health improvement are different from how public health agencies are currently organized. There’s a delicate balance between creating a document that supports public health agencies, and yet provides the principles for the actions that are most important to undertake. The priorities are often set at the local level. The 2020 plan should be equally useful in completely different communities—urban and rural. They need principles they can apply for achieving overall goals, and then simple tools that they can apply to decide what’s most important for their area.

Dr. Kumanyika asked whether others agreed with her that they are seeking a set of overall health objectives for the nation. Dr. Fielding agreed. Others were concerned that our priorities now may be very different from priorities over time. Flexibility is important. Dr. King liked the idea of principles because this approach is flexible enough to capture changes in the future. Dr. Fielding asked the subcommittee chairs how much support they need to move forward on these issues. He asked them to contact Karen Harris ( with questions about staff support for compiling materials and finalizing work for the June meeting.

Non-Federal Partnerships

Committee members felt that public health can’t address issues of this magnitude without the involvement of federal agencies from other sectors. Ms. Blakey mentioned that currently, only HHS representatives are taking part in the federal committee that is steering the development effort (the Federal Interagency Workgroup, or FIW). However, an FIW subgroup is developing criteria for Non-HHS federal partners, such as the departments of transportation, education, and agriculture. This approach would be a departure from previous Healthy People iterations. The FIW has not yet formally engaged these agencies, but would like to do so in the fall of 2008. Dr. Fielding suggested inviting these agencies to the table sooner. Having agencies take with "observer status," for the June meeting with formal representation at the Secretary’s Advisory Committee meeting in the fall, might be a viable option. Ms. Blakey said that reaching out informally for the June meeting was a great idea.

Other Issues for the June Agenda

Dr. Fielding said it will be a challenge to integrate the work of the subcommittees, and that this will be critical to the discussion in June. A suggestion was raised that subcommittees could meet in-person prior to the June meeting, but this was left to the discretion of subcommittee chairs.

Dr. Kumanyika suggested having a presentation from a representative of a state or city health department that had had experience with going outside public health sector to address social determinants, if time permits. Dr. Fielding suggested that he knows a county health official who may be able to do a brief session; he could also speak to this issue. Another option could be a representative from the Philadelphia health department. It was agreed that this would be discussed further offline.

Dr. Evans suggested that the Committee should seek information from the regional groups about user needs. Dr. Fielding thought another option could be to ask NACCHO or ASTHO to identify content that their members would find to be helpful for Healthy People 2020. Dr. Evans pointed out that those organizations are represented on the User Question and Needs subcommittee.

Dr. Manderscheid added that preparedness and health technology are issues that need to be discussed and potentially incorporated, or considered as separate focus pieces. Dr. Fielding agreed that these should be put on the agenda, and that particularly preparedness is an issue of importance. Dr. Remington further added that from a systems approach, Health IT addresses the issue of enhancing public health system infrastructure.

Dr. Fielding added that if anyone would like to suggest additional agenda topics, they should contact him or Dr. Kumanyika.

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