Another member brought up the tension between aspirational and realistic objectives. He felt there should be a set of rules for deciding how targets will be set. These should address the nature of data used to set realistic targets; when it is appropriate to use aspirational targets; and overall decision criteria for setting targets.

A member asked for clarification of when assessments of progress are completed for each decade of Healthy People. He requested clear guidance to help states answer the question, "If you set targets for a given year, what year do you evaluate progress?" He had heard that the baseline data for the 2000 data was collected in 1987 and that the final evaluation was based on data from the late 1990s. In the past, evaluations were not based on data collected in the final year of the decade; this is an important detail that should be clarified.

He also asked when the baseline data for 2020 be collected. If the objectives are framed as measuring progress from 2010 to 2020, but the data that are collected are really from 2007 to 2017 this should be clearly explained in advance. States will try to replicate Healthy People and match their objectives to it, and most will assume that the 2010 objectives are evaluated with data from 2010. Dr. Fielding agreed that this is an important issue to discuss.

Evidence-based Actions

Dr. Patrick Remington, Committee member, noted that Wisconsin has been compiling a list of over 400 evidence-based programs and policies, which he would be happy to share. This has highlighted the difference between asking the question of, "where we want to be?" versus, "how do we want to get there?" He said the Committee should spend time on the complex issues related to deciding where we want to be in ten years; that process relates to setting targets and tracking data sources. For example, should one look at inputs? Should one measure outputs, processes, and short-, immediate-and long-term outcomes for all of these health problems? Should they each have logic models? That would be a large task. The question of how to get there would add another layer of complexity.

Dr. Kumanyika said that the Committee should create an "upstream to downstream" sense of these issues, perhaps by arraying some of the objectives and targets in the ecological layers of the Committee’s Action Model. This would allow the members to see how the objectives and targets fit together without creating a logic model for every single one of them. She added that interim targets and objectives are important because 10 years is not long enough but it is too long. If the Committee can show actions to be taken in the short-term, as well as issues that are longer-term, it might help to clarify the question of "how we get there."

Another member agreed with the suggestion to apply an ecological model to identify "low-hanging fruit." She expressed that Healthy People 2020 should be relevant, showing how it is tied to the nation’s crises and ongoing issues. She went on to suggest that environmental health and preparedness issues could be featured very prominently as well. The more the Committee can tie into those issues, the better. The goal of "relevance" should be explicit.

VI.  Developing Recommendations for Phase II Efforts

Dr. Fielding asked the Committee what would make Healthy People 2020 a successful effort. They had already agreed that work was needed on target-setting and topic area categories over the short-term, and had already done some work on objective development, although this may need to be refined. The Committee would like to offer recommendations on technical assistance and refine its recommendations regarding the proposed relational database. He asked what three or four deliverables the Committee would like to produce by the end of Phase II, such as technical assistance or interfacing with the evidence-base.

RADM Slade-Sawyer offered to submit in writing the questions that she had posed to the Committee earlier. She added that it would be helpful to get the Committee’s feedback on how to devise a system that is flexible enough to change as priorities and data sources evolve over time. Dr. Fielding said that part of this would have to do with software used, as well as a standardization process.

Objective Development and Selecting Topic Areas

A member asked for clarification of the Committee’s role in setting objectives. Specifically, should there be a Subcommittee on Development? This could be very time-consuming from the Committee’s perspective. As a realistic charge for this group, he did not think it would be viable to have a subcommittee delve deeply into data sources, regression models for projecting into the future. Instead, he noted it would be more appropriate for the Committee to react to work that has already been done by the FIW and ODPHP.

RADM Slade-Sawyer commented that the FIW has already tasked several interagency work groups with looking at the Healthy People 2010 focus areas and objectives. They are reviewing which objectives should be retained, revised, or eliminated as Healthy People 2020 objectives. She said ODPHP would be happy to make the FIW’s work available for review by the Committee. A member asked for an update from the FIW about where they are heading.

Dr. Fielding agreed and felt that the Committee should opine broadly on data issues, requirements, and the degree to which existing data systems will meet the needs for setting targets and tracking progress over time. He felt the Committee should not get involved in methodological concerns. Dr. Fielding said that intermediate targets and data sources are also important. There are multiple questions relating to data, including sources of data, types of data, quality of data, and timeliness of data. He indicated that a very brief set of lessons learned and recommendations in that area should be part of the Committee’s Phase II work.