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.
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
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
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