A member commented that this would require formative research and
usability testing with these user groups. That could occur in two stages:
first, research could be undertaken to understand users' informational
needs and habits and the things that would influence their use of Healthy
People 2020. And second, web-usability studies could explore the
human-computer interface aspect of it.
Dr. Fielding asked the Committee whether there was agreement that
Healthy People 2020 should enable user groups to define how this database
can be accessed (e.g., by risk factors, by life stages, etc.), rather than
making an a priori decision about focus areas. Committee members voted to
approve this approach to organizing the Healthy People 2020 objectives (12
votes in favor, 1 absent).
Advisory Committee Recommendation #4: Approach to Organizing
- The relational database should enable user groups to define how they
will access and organize the objectives. Thus, a priori focus
groups need not be defined.
RADM Royall offered to explain how the FIW is approaching this issue.
She indicated that the FIW is in agreement with the Committee on including
a health determinants approach in Healthy People 2020. As a practical
matter, the FIW has suggested mobilizing the current Healthy People state
coordinators around the current 2010 focus areas, with a focus toward
developing the 2020 objectives. Those topics would not necessarily be the
focus areas for 2020, and groups are likely to form around new topic areas
as discussions progress. Since technology enables the creation of a
searchable database, objectives can be reconfigured to represent a more
cross-cutting approach after they have been developed. Federal teams
responsible for coordinating Healthy People can also be rearranged at a
later point in time.
Dr. Fielding asked Committee members for their thoughts on the FIW's
approach of starting the work to develop objectives in workgroups
organized around the original twenty-eight focus areas of Healthy People
2010. He noted that the Committee did not want to impede the FIW's
progress in any way. Yet based on their last vote, he also said the
Committee did not necessarily want to bless the previously existing 28
categories as being the "right way" to organize Healthy People 2020. The
objectives can be organized in other ways.
One member cautioned that other issues have emerged in the decade since
these focus areas were developed (e.g., such as socio-economic
determinants and early developmental milestones) that are not covered by
an existing Healthy People 2010 focus area. Such topics may be overlooked
in this early period of the FIW's work. The Advisory Committee may want to
help bring some of these issues forward to ensure they receive appropriate
attention. RADM Royall agreed with this point, adding that preparedness
and health information technology have also emerged as important issues
since the drafting of Healthy People 2010.
Dr. Kumanyika brought up the fact that, as the Healthy People
initiative has evolved over the decades, the term "priority areas" was
used in early decades, and then later it became "focus areas." She
expressed concern about the differences between these two terms, and the
fact that they leave different impressions. She felt it is important to
clarify that "focus areas" offer a way to group objectives, but they are
not priorities. A Committee member said that vote #4 should be clarified
to indicate that the approach was to organize objectives into focus areas,
rather than priority areas. Dr. Fielding clarified that vote #4 was simply
about ensuring that the database enables user groups to easily search for
areas of their concern.
Dr. Fielding said the committee supported the FIW's decision to move
forward with the existing 28 focus areas without necessarily agreeing that
these should be the primary areas of emphasis or the focus. A member added
that the group should go further and state explicitly that the term should
be "focus areas," not "priority areas." Dr. Fielding stated that, for
Healthy People 2020, the group hasn't suggested that focus areas will
really be a component—apart from user-defined focus areas. Another member
commented that the issue is not that the Committee members don't have an
opinion about focus areas; it's that they're not ready to address this
issue yet. This is simply the best way for the FIW to start their work.
RADM Royall thanked the Committee for their feedback.
Dr. Kumanyika expressed concern that if the FIW does too much work
using an approach that lacks any particular conceptual organization, the
results will be inconsistent across focus groups. She asked whether it
would be possible for the FIW to try to arrange the objectives using some
of the concepts in the Healthy People 2020 model (i.e., determinants,
pathways, outcomes). She asked whether there was a guiding principle that
would help the focus areas to fit with the model once the work is done.
RADM Royall explained that ODPHP has already done that. They have assigned
interns within the office to go through all of the Healthy People 2010
objectives and put them into cross-cutting categories. Dr. Fielding noted
that this work will be useful to the Committee, as it will highlight areas
where there is a great deal of emphasis, and other areas where attention
RADM Royall indicated that ODPHP's work is almost ready to share.
VII. Preparing Final Report of the Committee to the
Dr. Fielding said that NORC would draft sections of the final report
for each of the subcommittees for September, working with the Committee
members for review and editing. Writing teams can parallel the
subcommittees, but they can involve more people if necessary. He
emphasized that the real issue is integration, at this point—not having
separate subcommittee reports. At this point, the voting will not be on
subcommittee products, but on the final report itself. The subcommittee
reports will be excellent background material for those who want to delve
deeper into particular issues. The subcommittee reports will be useful
background for preparing report sections.