| The Assistant Secretary for Health and Surgeon General
chaired the third and final review of progress in achieving Healthy People 2000 objectives
for Clinical Preventive Services, designated as priority area No. 21. The review was
organized by the co-lead agencies for the priority area, the Health Resources and Services
Administration, the Agency for Healthcare Research and Quality (AHRQ), and the Centers for
Disease Control and Prevention. The presentations and discussion addressed three
themes—1) setting priorities for delivery and coverage, 2) improving measurement and
quality, and 3) interventions to encourage increased coverage and utilization. Through
broadcast facilities of the National Institutes of Health, participants were linked with
viewers at remote sites. This was the first Healthy People review to offer eligible
viewers continuing education credits (CME’s, CNE’s and CEU’s). During the
overview and data review, attention was focused on the following objectives: 21.2 Childhood Immunization.
Rates of immunization of children aged 19-35 months have increased for all
recommended series. Antigen-specific rates for diphtheria/typhoid/pertussis (DTP), polio,
measles/mumps/rubella (MMR), and Haemophilus influenza B all exceed the target of 90
percent. However, the rates for hepatitis B and 4DTP/3Polio/1MMR are short of the 90
percent target.
Immunization in Older People.
The proportion of the population aged 65 and over who had received an influenza
vaccination during the preceding 12 months increased from 42 percent in 1991 to 58 percent
in 1995. The target is 60 percent. In 1997, all but 6 states and the District of Columbia
had met or exceeded that target. For pneumococcal vaccinations, the target is for 60
percent of people aged 65 and over to have been vaccinated during their lifetime. No state
has met this target. In 1995, the national rate was 34 percent.
Cholesterol Screening.
The proportion of the total adult population who had their cholesterol level checked in
the preceding 2 years increased from 50 percent in 1991 to 54 percent in 1993. For
selected population groups, the increases from 1991 to 1993 were: for Whites, from 51
percent to 55 percent; for Blacks, from 47 percent to 56 percent; for American Indians/
Alaska Natives, from 38 percent to 50 percent. The rate for Asian/Pacific Islander
Americans was 44 percent in 1993. The target is 70 percent for all groups.
Pap Testing. The target
set for Pap tests within the preceding 3 years is 85 percent of all adult women. In 1994,
77 percent of the total adult female population had received Pap tests, and the
proportions of selected populations tested were: females aged 65 and over, 57 percent;
Blacks, 84 percent; American Indians/Alaska Natives, 73 percent; Asian and Pacific
Islanders, 66 percent. When Pap screening is considered by state, a majority of the states
have achieved the 85 percent target.
Breast Cancer Screening.
Between 1992 and 1994, the rates at which females aged 50 and over received breast exams
along with mammograms within the preceding 2 years increased as follows: for the total
population, from 51 percent to 56 percent; for females aged 65 and older, from 43 percent
to 49 percent; for low-income females, from 30 percent to 38 percent. There is little
difference in screening rates by race and ethnicity, but marked differences between women
grouped by income and education levels. In 1994, only women with incomes greater than
$50,000 per year or with at least 13 years of education had, as a group, achieved the
target of 60 percent.
Check-ups. The
proportion of adults aged 18-64 who obtained a routine medical check-up within the
preceding 3 years increased from 74 percent in 1991 to 81 percent in 1995. Those aged 65
and over who had a check-up in the preceding year increased from 67 percent in 1991 to 74
percent in 1995. The target is 91 percent for all. Between 1991 and 1994, there was no
change in the proportion of adults (56 percent) who were asked at least one screening
question (e.g., about diet, physical activity, or tobacco use) during a routine check-up.
The target is 80 percent.
21.3 The proportion of the total
adult population who had a regular source of primary care increased from 80 percent in
1991 to 85 percent in 1995. For selected population groups, the change between 1991 and
1995 was positive, but still short of the target of 95 percent.
21.4 In 1996 the proportion of
people under 65 years of age without health care coverage (age-adjusted) was 16.1 percent
for the total population, 31.6 percent for all Hispanics, 36.7 percent for Mexican
Americans, 14.4 percent for Puerto Ricans, 17.6 percent for Cubans, and 19 percent for
Blacks. In terms of income level across ethnic groups, 33 percent of the lowest income
group lacks health care coverage, compared to only 8 percent of those with the highest
income. The target is to reduce the proportion who lack coverage to percent.
21.8 Between academic years
1990-91 and 1995-96, the proportion of all degrees in the health professions and allied
and associated health professions awarded to members of under-represented racial and
ethnic minority groups changed as follows: for Blacks, the proportion increased from 5.7
percent to 6.6 percent (target, 8.0 percent); for Hispanics, it decreased from 4.3 percent
to 3.8 percent (target, 6.4 percent); for American Indians/Alaska Natives, it increased
from 0.4 percent to 0.5 percent (target, 0.6 percent).
21.8a Between 1991-92 and
1995-96, the proportions of under-represented minorities enrolled in schools of nursing
increased as follows: Blacks, from 9.1 percent to 9.4 percent (target, 10.0 percent);
Hispanics, from 3.1 percent to 3.5 percent (target, 4.0 percent); Asians and Pacific
Islanders, from 2.9 percent to 4.0 percent (target, 5.0 percent). The proportion of
American Indians/Alaska Natives enrolled was the same (0.7 percent) in both academic years
(target, 1 percent).
HIGHLIGHTS
- Eighty-two percent of employer-sponsored insurance plans now
include childhood immunizations and 90 percent include Pap smears and mammograms. However,
coverage for some effective services, such as smoking-cessation counseling, is much less
prevalent.
- The Health Plan Employer Data and Information Set (HEDIS)
reports on the delivery of clinical preventive services provided by Health Maintenance
Organizations (HMOs). Varicella immunization for adolescents, flu shots for older adults,
comprehensive diabetes care, and smoking cessation advice were added to HEDIS in the past
3 years.
- Increased utilization of electronic birth certificates has
enhanced outreach
- programs to teach new mothers the value of periodic
check-ups for their infants.
- The recent downturn in the number and fiscal health of
non-profit hospitals has impacted disproportionately on the uninsured, for many of whom
such hospitals have been the chief source of primary, preventive and emergency care.
- General Motors Corporation’s LifeSteps program covers
704,000 employee households, including retirees and dependents, and focuses on enhancing
knowledge about health and awareness of individual risk factors. All enrollees over age 19
are offered an annual Health Risk Appraisal (over 360,000 have been processed) and have
24-hour access to a registered nurse by telephone and, as of last year, to a LifeSteps
electronic Web site.
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