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Dr. Fielding suggested that the Committee issue a document highlighting the role of Healthy People 2020 in the economic recovery and the key actions by HHS that would improve the nation’s economy and facilitate achievement of the Healthy People 2020 objectives. Dr. Fielding added that it may be useful to consider issue papers regarding health and the economy that have been issued recently by organizations, including Trust for America’s Health, and Partnership for Prevention. A recent forum was held on the issue of health reform called, "Rhetoric to Reality." Dr. Fielding asked NORC to use these resources to prepare bullets for the Committee to use in preparing recommendations.

Overview of Processes for Phase II

Dr. Fielding brought up the fact that, for Phase I of its activities, the Committee issued a single document. He asked whether the Committee should take the same approach for Phase II, or if they should issue a set of shorter documents on specific subject areas. He felt the latter approach might be helpful to a broader audience and would not require waiting to put recommendations on paper. RADM Slade-Sawyer agreed that a series of shorter documents with the Committee’s recommendations would be more useful for HHS for Phase II of the Healthy People 2020 process. This would allow HHS to take the Committee’s advice into consideration in a timely manner. Dr. Fielding solicited the Committee members to see whether any members preferred to issue a longer report at the end of Phase II, but none preferred this option.

V.  Guidance for the Objective Development Process

Target-Setting Methodologies

Dr. Shiriki Kumanyika, Committee Vice-Chair, said NORC’s draft report had not made clear why certain objectives had not met their targets in the past. RADM Slade-Sawyer responded that this is a complex issue that would require research to answer completely. The target setting method for Healthy People 2010 was "better than the best" (i.e., targets for all groups were set to exceed the level of the racial/ethnic population with the best status.)

RADM Slade-Sawyer commented that she views the targets as being "aspirational," for the reason that one would want every population in America to exceed the best population group within a decade. However, she noted that it is not a practical method of target-setting. This is part of the explanation for why so few of the objectives met their targets. Additionally, multiple factors influence whether many of the objectives are achieved; for example, one factor influencing target achievement is people’s behavior. As Healthy People looks upstream towards issues that are not health-related (e.g., social determinants and disparities), the problems are harder to fix. Ms. Blakey added that for some cases, such as the obesity epidemic, we face an overwhelming increase in disease incidence that may take more than a decade to fix.

Dr. Fielding said it is nearly impossible to separate targets from objectives. Specific targets are very different, depending on the quality of the data and the extent to which there are known evidence-based interventions, and whether those interventions will have impact over the short or long term. The effect sizes of those interventions and the secular trends add to the difficulty of setting comparable targets. However, he felt it would be helpful to suggest approaches for how different groups should go about setting targets, so that there is not one target that is aspirational and another that uses the best data and is realistic. Dr. Fielding suggested that the Committee opine on approaches that lie between the range of the aspirational and the practical, data-driven efforts, where target-setting can be accomplished.

Another member asked whether there were exemplars from Healthy People 2010 of objectives that moved in the right direction. There is a wealth of information from past efforts that would help to understand how and why objectives did or did not move towards their targets. She asked if there were advances with which ODPHP has been particularly pleased. RADM Slade-Sawyer answered that objectives related to smoking have made good progress. Yet even this issue is fraught with challenges. Many streams of combined effort are required for an objective to achieve its target. Major policy decisions, or budget decisions at all levels, can affect the degree to which progress is made. Achievement of the objectives is multi-factorial.

RADM Slade-Sawyer offered to have ODPHP staff review the Healthy People 2010 Midcourse Review and determine whether identity is possible to identify factors that affected progress. Dr. Kumanyika requested analysis of two or three exemplars—one where the targets was reached, one where the target was not relevant or where results were mixed, and one where the target was not reached. Dr. Fielding said the Committee should make a recommendation that there be some a finer-grain analysis of which targets have been met and which have not to identify lessons learned that can be included in technical assistance materials for implementers.