Healthy People Consortium Meeting November 7, 1997

Summary of Breakout Group Discussion Concerning Priority Area 7: Violent and Abusive Behaviors

The facilitator encouraged everyone to submit comments to the Healthy People web site and stated that the purpose of the session was to obtain comments on the proposed structure and to make recommendations for deletions, modifications, and additions to Healthy People objectives. The facilitator also pointed out that the decision had been made not to have duplicate objectives between focus areas. The group agreed that this was a good decision.

I. Discussion of Special Populations

The facilitator raised the issue regarding special populations, specifically, that the proposal to change the second Healthy People 2010 goal "Reduce Health Disparities" to "Eliminate Health Disparities" in an effort to strengthen the overall process. Views of the group regarding the pros and cons of having special focus areas (priority areas) on these special populations-race/ethnicity, age, gender, low-income, and people with disabilities were as follows:

Questions

• Special mention of the baseline helps to draw attention to where we should focus our attention. While this is good for the Nation, the average is not totally representative. How do we recognize incremental progress?
• Are people lost who think they are okay as compared to the target?
• Is it possible to report for every demographic sub-group? The labeling "subgroup" is an issue in and of itself. These are simply population groups who suffer disproportionately.
• What about age group breakouts? How do you decide what to report (i.e., youth/adolescents has many different age breakouts)? There needs to be consistency.
• The difference needs to be visible and clear without sub-objectives. How can you format to meet population goals?

Comments

• The larger issue is how we set targets.
• Issues regarding the language/wording (minority) needs to be addressed.
• There are no direct resource allocations for closing/eliminating disparities.
• We need to think about which States have capacity to track special populations.
• Eliminate the word special from "special populations."

II. Discussion of Healthy People Structure

The workgroup reviewed the proposed Healthy People 2010 structure (the fan). The views of the group were as follows:

Questions

• What does protect health mean?

Comments

• The issue of coping with death was not included.
• What is NOT a special population? Recommendation was made to substitute another term such as "demographic subgroups."
• Substitute the term "emergency medical services" for emergency medicine.
• There needs to be a sequential flow. The fan poses a natural eye pattern problem. Suggestion for revision is to reverse the text to include the vision first, health for all, enabling goals and then the focus areas.
• Cute concept, but confusing. It will not make sense to the general public.
• It is not a good 10-sec sound-byte to sell the message.
• Our issues (violent and abusive behavior) are crosscutting, but it is not clearly communicated that all the enabling goals play a part in achieving objectives within the focus area. This can be reasonably assumed by a public health professional, but the general public won't "get it."
• What about using quality of life with an objective of increasing years of healthy life.
• The term increase years of healthy life excludes persons with disabilities. The real issue is quality of life. Change term to "Increase quality of life."

III. Discussion of Healthy People 2010 Objectives

In beginning the discussion of objectives for 2010, the facilitator informed the group that there will be two types of objectives in Healthy People 2010--measurable and developmental objectives. Measurable objectives will have baseline measures. Developmental objectives do not currently have a data source but are considered important enough to have one developed. They will be included in Healthy People 2010 to generate data collection. If they do not have one data point by 2004, in time for the Midcourse Review, they will be dropped. With this in mind, the workgroup made the following recommendations for 2010 objectives:

7.1	Reduce Homicide to no more than x per 100,000 people. Recommendation: Keep objective. Consider including legal interventions.
7.2	Reduce suicides to no more than x per 100,000 people. Recommendation: Keep objective.
7.3	Reduce firearm-related deaths to no more than x per 100,000 people from major causes. Recommendation: Keep with the following modification: Reduce firearm-related deaths from "major causes" to no more than x per 100,000. If the phrase "major causes" has no significance, then eliminate phrase or define phrase.
7.4	Reduce to less than x per 1,000 children the incidence of maltreatment of children younger than age 18. Recommendation: Keep with the following modification: "Reduce to less than x per 1,000 children the incidence of maltreatment of children younger than age 18." (1). Maltreatment is not abuse, it is a catch term. (2). Why not say "0-17" instead of younger than age 18. (3). Who is doing the maltreatment (Needs clarification: is it the parents or the caregivers)?
7.5	Reduce physical abuse directed at women by male partners to no more than 27 per 1,000 couples. Recommendation: Keep with the following modification: "Reduce physical abuse of women by their intimate partner to no more than x per 1,000 women." (1). Terminology indicates male to female relationships and we miss a lot of data from gay/lesbian relationships. (2). Does this include mental and emotional abuse?
7.6	Reduce assault injuries among people aged 12 and older to more than x per 1,000 people. Recommendation: Keep.
7.7	Reduce rape and attempted rape of women aged 12 and older to no more than x per 100,000 women. Recommendation: Keep. (1). Concerns with gender specific focus, what about men? (2). How are we defining sexual abuse and rape? (3). If we add a special population target, make it men. (4). Clarify that this objective is not duplicative of 7.4. (5). Consider re-wording the objective using sexual assault instead of rape or attempted rape.
7.8	Reduce by x percent the incidence of injurious suicide attempts among adolescents aged 14 through 17. Recommendation: Keep. (1). Do we need the word "injurious"? (2). There are gender issues to consider regarding injurious attempts.
7.9	Reduce to x per 100 the incidence of physical fighting among adolescents aged 14 through 17. Recommendation: Keep.
7.10	Reduce to x per 100 the incidence of weapon carrying by adolescents aged 14 through 17. Recommendation: Keep. The types of weapons needs to be written into the objective similarly to the maltreatment objective (7.4)
7.11	Reduce by 20 percent the proportion of people who possess weapons that are inappropriately stored and therefore dangerously available. Recommendation: Keep with the following modification: "Reduce to x percent the proportion of people living in homes with a firearm that is both loaded and unlocked."
7.12	Extend protocols for routinely identifying, treating, and properly referring suicide attempters, victims of sexual assault, and victims of spouse, elder, and child abuse to at least 90 percent of hospital emergency departments. Recommendation: Maybe use the child death review systems in another way as an awareness issue. No concrete decision on whether to keep with modifications or to delete.
7.13	Extend to at least 45 States implementation of unexplained child death review systems. Recommendation: Delete.
7.14	Increase to at least 30 the number of States in which at least 50 percent of children identified as neglected or physically or sexually abused receive physical and mental evaluation with appropriate follow-up as a means of breaking the intergenerational cycle of abuse. Recommendation: Delete.
7.15	Reduce to less than 10 percent the proportion of battered women and their children turned away from emergency housing due to lack of space. Recommendation: This objective could possibly be reworded and introduced as a developmental objective.
7.16	Increase to at least x percent the proportion of elementary and secondary schools that teach nonviolent conflict resolution skills, preferably as a part of quality school health education. Recommendation: Keep with modification. (1) May offer rewording based on portions of the violence against women funding, which is mandated to be spent on education. (2). To add objective regarding children and "gun safety awareness."
7.17	Extend coordinated, comprehensive violence prevention programs to at least 80 percent of local jurisdictions with populations over 100,000. Recommendation: Delete
7.18	Increase to 50 the number of States with officially established protocols that engage mental health, alcohol and drug, and public health authorities with corrections authorities to facilitate identification and appropriate intervention to prevent suicide by jail inmates. Recommendation: Delete, although this is a duplicate objective of the mental health focus area we will consult with this group for their recommendation.
7.19	Enact in 50 States and the District of Columbia laws requiring that firearms be properly stored to minimize access and the likelihood of discharge by minors. Recommendation: Keep.

IV. Recommendations for New Objectives

The workgroup was asked to offer their recommendations for new objectives, which are listed as follows:

1. Objectives for occupational health
2. Objectives for homicides in the workplace
3. Violent injuries in the workplace
4. Increase # of victims who receive forensic diagnosis by trained professionals.
5. Reduce lethality of assaults.
6. Improving e-code reporting in some measures.

Participants

Laura Martin, Facilitator, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
Dia Taylor, Recorder, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
Martha Highsmith, Facilitator, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
Becca Knox, Center to Prevent Hand Gun Violence
Cecilia McKenzie, Office of the Attorney General, State of Texas
Fred Seitz, National Center for Health Statistics, Centers for Disease Control and Prevention
Renee Semonin-Holleran, Emergency Nurses Association
Jennie Tasheff, Kansas Department of Health