Dr. Fielding felt these changes would be consistent with the information in
the main body of the report. He asked the Committee members to review the
recommendations, and to email their comments to NORC staff. He and Dr. Kumanyika
would make a final decision on the wording of the mission statement, based on
the members’ final comments. A Committee member did not entirely agree with the
proposed changes. He offered his understanding of the intent of the suggestions,
as well as some alternate phrasing (see Table 1, below). Dr. Kumanyika suggested
the phrase "best available knowledge" be used instead of "best available
evidence" or "best available information." This would be a point to consider
during later word-smithing. Dr. Fielding asked Dr. Patrick Remington to
e-mail suggestions for mission statement revisions to the entire Advisory
Table 1. External Reviewers’ Suggestions for the Mission Statement,
and Committee Reactions
|External Reviewer Suggestions
"Increasing public understanding of the underlying determinants of
health, disease, and disability—and the opportunities for
improvement." (Michael McGinnis)
|The focus on increasing public awareness should be captured
in the third bullet, not the first.
||Dr. Remington will email suggested revisions to the Advisory
"Catalyzing action directed by the evidence and engaging
multiple sectors." (Michael McGinnis)
"Catalyzing action using the best available evidence and
information." (Lawrence Green)
|Use "Best available knowledge," not "best
||To be determined during future word-smithing.
External Reviewers’ Suggested Revisions to the Body of the Report
Dr. Fielding said Dr. McGinnis had offered corrections to some of
the historical background information about Healthy People that had been
provided in the report. For example, Dr. McGinnis emphasized the important
role of states and localities in Healthy People and said this had not been
adequately addressed. Dr. Fielding felt it would be appropriate to make
this and other corrections.
Dr. Georges Benjamin, another external reviewer, had submitted comments
suggesting that the report did not address in a concentrated way the
issues of public health infrastructure or ensuring a trained public health
workforce. In his written suggestions to the Committee, he suggested the
report should discuss these issues; information and communication systems
to collect and disseminate accurate data; the role of public health
organizations at the state and local levels; and the need for
multi-disciplinary, intersectoral partnerships. These suggestions had been
incorporated into page 26 of the revised draft report. Dr. Fielding asked
if the Committee members had any concerns about this change.
A Committee member suggested the Committee craft a paragraph to define
what is meant by a multi-sectoral approach, offering specific examples.
Dr. Fielding said that many specific examples are already included in the
report, but he urged this member to review the relevant section and see
whether any additions are needed. Dr. Manderscheid agreed to review
pages 26 and 27 of the draft report and submit any suggested revisions or
Revised Audience Matrix
Dr. Kumanyika explained that revisions had been made to the
audience matrix (page 38 of the final draft). It had originally classified
audiences into "information seekers" and audiences that "need awareness
raised." In the updated version, the audiences were classified as "primary" and
"secondary," rather than active and passive. The secondary
audiences are "targets for information about Healthy People," and the
primary audiences are "seekers of information." Dr. Kumanyika asked Dr.
Douglas Evans, Chair of the Subcommittee on User Questions and Needs, if
the changes were acceptable. Dr. Evans said that he had not had a chance
to discuss the changes with members of the Subcommittee, but he felt they
were useful. Other members agreed that the changes were an improvement.
Additional Changes to the Report
Dr. Fielding briefly reviewed additional substantive changes that
had been made to the report. For example, the language in the section
describing the importance of prevention was reworked emphasize balance
between over-selling the monetary savings of prevention versus
under-selling the importance of prevention. The current version of the
report mentions that not all prevention activities save healthcare
dollars, but some prevention activities remain valuable because they
improve the health and well-being of individuals.
Other changes included adding more emphasis of the importance of meeting
the needs of diverse audiences (e.g., in terms of race, ethnicity,
language, background); clarifying what is meant by "upstream;" and noting
the need for measuring actual interventions (e.g. policies, programs,
etc.)—not just measures of outcomes.
Dr. Fielding asked the Committee members if they had found any other
changes in the report to be problematic. The members did not raise any
issues. Dr. Fielding stated that the only remaining revisions to be made
were minor adjustments to the mission statement, and an additional
paragraph from Dr. Manderschied to clarify the meaning of "multi-sectoral
partnerships." He also noted that Dr. Vincent Felitti (Committee member)
had submitted comments on the report earlier that day and that his remarks
would be reviewed. Dr. Fielding asked whether members wanted to wordsmith
the mission statement by full Committee, or if they would delegate that
task to the Chair and Vice-Chair. (Dr. Remington had offered to provide
preliminary revisions). The Committee members agreed to entrust Dr.
Fielding and Dr. Kumanyika with making final changes to the mission
statement, with Dr. Remington’s help.
A Committee member asked whether it would be possible to invite other
individuals with relevant experience or insight to review the report and
offer comments at this stage. Dr. Fielding responded that individuals have
been able to comment on the ongoing work of the Advisory Committee through
the Healthy People web site, regional meetings and public comment at the
June 2008 meeting of the Advisory committee, and while there was no doubt
that they could obtain other comments, it was necessary to finalize the
report and move forward. This would not preclude others from making their
own comments, continuing to submit comments through the Healthy People web
site, or blogging, or providing feedback in other ways. However, Dr.
Fielding said that on balance the report was strong, and that it was time
to finalize it.