1. While this group is in favor of the elimination on health disparities, the concern is whether we are at a point where we are able to set the same targets for special populations as that for the total population?
2. Take the necessary steps to develop strategies that will set comprehensive targets that are effectively communicated to the individual target populations.
3. What will be the level of commitment by the Department on eliminating disparities especially where there are documented health conditions requiring followup and/or treatment, but there is limited or no access to the required health services. In order to eliminate disparities, increased efforts will be required to better understand the needs and the particular types of disparities experienced by these populations which should lead to better coordination of screening, treatment and other health services. It was felt that for the commitment to be strong the process must have:
4. • a more effective data collection system where national surveys have larger sections of subpopulation data
   • a comprehensive data system that provides information on the socioeconomic status of populations and subpopulations and the use of nontraditional indicators of socioeconomic status such as the number people with jobs
   • a more inclusive data system where data from special and subgroup populations are presented with data from a complementary population
5. What will be the criteria used in HP 2010 to assess the health status and/or disparity of subpopulations within the Special Populations focus?
6. Where there are large disparity gaps how will those gaps be bridged and will HP 2010 place special emphasis and move resources towards the larger gaps? It is felt that in situations where the scenario dictates that the smallest groupings could demand more of the resources that are available. The argument for the reallocation would be hard to make (counter intuitive). There needs to be some hard driving, soul-searching discussion around the issue of allocation and reallocation of resources to eliminate disparities.
7. Will the methodologies used be appropriate for the populations that are reported on?

II. HP 2010 Framework

1. One of the first questions asked was, "What type of document will HP 2010 be?" Will it be an educational, policy, budget allocation, or tracking document or a combination. We should be clear on the structure and intended use of this document.
2. So far Healthy People 2010 appears to be disease driven and does not give equal weight to the concept of prevention to address poor health brought on by being of lower economic status, having dangerous life styles and other undesirable behaviors which have dramatic impact on the well-being of individuals especially vulnerable populations. There have been many studies that illustrate that there is a good correlation between poor health and lower socioeconomic status.
3. There appears to be a missing piece to the framework and that is the elimination of social disparities such as illiteracy, poverty, etc. that contribute to health disparities in some special populations.
4. Communities should be a more visible part of the HP 2010 Infrastructure focus area.
5. It was felt that the elimination of disparities should be one of the overriding factors in the fan framework.
6. In the HP process and goals, who will decide who we are (special populations) as it relates to data and the allocation or reallocation of resources?
7. There should be extensive feed back and aggressive marketing of Healthy People and the framework in the community. Since national organizations don’t reach everyone in the community, some thought should be given to the use of other mechanisms to reach the community including the use of community leaders who are on the front lines in these communities, but are not members of National organizations. A wider net should be cast to the "grassroots" community through the use of postings and PSA’s on radio, TV, and in newspapers, ensuring that the messages are culturally and linguistically appropriate and easily accessible to those who do not have computers. Focus group and stakeholder meetings would also be another mechanism to obtain feedback.

III. Framework - Fan

1. One suggestion was that the visual of the framework (fan) should be more circular in structure, more like a wheel. This visual would illustrate more of where people see themselves in the framework. The outside ban of the wheel would list the overarching goal of HP 2010 in the areas of: Social Support, Education, Environment, etc. The spokes of the wheel would be the objectives grouped by: Life Stages, Conditions, Population, Geography, etc. The inner band would show enabling goals. The center core would have "Health for All."
2. Another suggestion for the visual was to keep the HP 2000 concept of the House, because it is easy to understand and recognizable. The top of the house (roof area) would list the HP 2010 goals of 1) eliminate health disparities; 2) eliminate social disparities; 3) Increase years of healthy life; and 4) health for all. The interior of the house would list the HP 2010 priority areas. The foundation would be divided into two levels one atop each other with Data supporting the focus areas and Populations/Community holding up the entire structure.
3. Data and surveillance should be more in the foundation of the graphic. The fan appears to be rigid and suggests a separation of focus areas along the "solid" lines in the graphic representation. It is hard to see the connectedness of the focus areas to each other and to the goals.

IV. Vision Statement

1. Healthy People comes out clear in reference to the goals and objectives; the Healthy Communities are not as clearly reflected in the goals and objectives.

• Objectives should be set to make allowances for changing conditions that could effect outcomes and achievement of goals. There should be (periodic assessment of systems.
• More health objectives should be developed for the Pacific Islander population.
• More health objectives should be developed for Asian subpopulations
• There should be some objectives that measure the impact of social disparities such as employment, educational attainment, income, etc. on health disparities.
• HP should take into consideration international health trends that could have impact of the health status of the American people.
• There should be objectives that are related to life stages, demographics, social environments, etc.
• If objectives are developed by populations and not by categorical topics, communities would be able to see themselves and their health status reflected in HP.
• There should be objective to address the immigrant population, and children’s issues.
• Communities should be asked to tell us what "Health Promotion" is to them in the context of their environments.
• In the aggressive marketing of HP at the community level, we should position ourselves to be asked to come into the community to gather input and learn. Persons working with communities should have correct "Atools" (culturally competent) to gather and translate information and data.
• Many Hispanics prefer to be referred to a "Latino."
• Confidentiality issues need to be addressed.

Participants

Tuei Doong, Facilitator, Office of Minority Health
Theresa Rogers, Recorder, Centers for Disease Control and Prevention
Neal Adams, Public Health Service
David Baker, Office of Disease Prevention and Health Promotion
Peggy Gilliam, Substance Abuse and Mental Health Services Administration
Betty M. Hong, Asian Pacific Islander American Health Forum
Doug Kreider, Hawaii Department of Health
Bonnie Lefkowitz, Health Resources and Services Administration
Lia Margolis, Lia Margolis and Associates
Theda McPheron, West Virginia University
Caroline Quijada, National Coalition of Hispanic Health and Human Services Organizations
Jane Suen, Centers for Disease Control and Prevention
Grace Wang, Seattle-King County Department of Public Health
Pheamo Witcher, Rhode Island Department of Health

Breakout Session List