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Healthy People Home > Healthy People 2020 > Secretary's Advisory Committee > First Meeting Minutes > Day 1

Healthy People 2020 logo First Meeting: January 31-February 1, 2008

Secretary's Advisory Committee on
National Health Promotion and Disease Prevention Objectives for 2020

U.S. Department of Health and Human Services, Hubert H. Humphrey Building
Room 800, 200 Independence Avenue, S.W., Washington, DC 20201

First Meeting: January 31-February 1, 2008

Day 2: February 1, 2008

Recap of Day #1 and Charge for Day #2
9:00 AM - 9:30 AM

Dr. Fielding commended the Committee on its previous day's discussion encompassing the Healthy People 2020 vision, goals, mission, and framework. He introduced Dr. Everold Hosein, who spoke to the Committee about related international efforts to help the group think about the task before them. Dr. Hosein described his work on the WHO's Integrated Marketing Communication for Behavioral Impact, a strategic communication planning approach to achieving results in health. 

Continued Committee Discussion: Vision, Mission, Overarching Goals, Framework, and Focus Areas
9:30 AM - 12:00 noon


Dr. Fielding explained that some Committee members met informally on the previous evening to draft statement's that reflected the Meeting Day 1 discussion. They created a document, "Draft for Committee Consideration 1-31-08 (see Appendix D)," which served as a starting point for Committee work on Meeting Day 2. Referring to this draft, Dr. Kumanyika introduced the Committee members to preliminary versions of a vision statement. Yesterday's discussion indicated that this statement should be short, inspiring, memorable, enduring, and would not need to be measurable. The previous night, Committee members had drafted two different types of vision statements, shown below.

Preliminary Draft: Vision Statements for Committee Consideration

  • A society in which all people attain maximum years of healthy life.
  • The healthiest people in the healthiest nation.

Dr. Kumanyika explained that in the first statement, the words, "A society in which..." address the issue of social determinants of health. The phrase "all people" touches on the need for equity, and "…maximum years of healthy life" offers continuity with the previous Healthy People 2010 goals. The second statement is short and sweet, but Dr. Kumanyika remarked, "It's interesting how much that one says when you think about it." Dr. Fielding opened the floor for comments.

Committee members preferred the first statement, "A society in which all people attain maximum years of healthy life." They worked collaboratively to edit the phrase. Suggestions included making the phrase more active, addressing behavior, and thinking about "individual versus collective aggregations." One member felt the term healthy should be defined in the glossary as "not just being about the body." The WHO definition of health could be useful for this purpose. For the second statement, "The healthiest people in the healthiest nation," one person asked, "Does it mean something that no verb is associated with that?" but the group felt this issue was not problematic. Some cautioned against relying too heavily on a glossary to convey the statement's intended meaning. The Committee voted unanimously in favor of the vision statement:

Advisory Committee Recommendation #1: Healthy People 2020 Vision Statement

  • A society in which all people live long, healthy lives.


Dr. Kumanyika introduced goal statements that had been prepared the previous evening. In the first goal, the group tried to avoid defining environment narrowly, and included explicit reference to the economic environment. For communication, they sought to address a range of issues from patient-doctor relations to the media. The second goal, "Eliminate preventable disease..." is a rewording of the one proposed by the FIW. The third goal addresses health disparities and specifies that we must improve the health of all populations. The Committee examined each goal and adjusted the phrasing to be acceptable to most members. There was discussion regarding the order of the statements. The Committee agreed that health equity and prevention were seen as being the most important, and a goal should be added to talk about the "life course." The preliminary draft statements are listed below.

Preliminary Draft: Goal Statements for Committee Consideration

  1. Create health-promoting environments: physical, social, cultural, economic, and communications.
  2. Eliminate preventable disease, injury, and disability, and premature death.
  3. Eliminate health disparities while improving the health of all groups.

For the first goal, "Create health promoting environments: physical, social, cultural, economic, and communications," some members feared the public would not understand the broad usage of the word "environment." Access to health was raised as an element of health economics. A member said the group must clarify what is meant by a "communications environment," but discouraged using the word "marketing." Some thought the word "community" might be clearer than environment, but the group discarded this idea. Members explored whether they should be specific about types of environments, (i.e., family, school, or worksite). It was noted that because the concept of environment is too great to focus on specific examples. Dr. Fielding put forth the goal statement: "Create social and physical environments that promote good health for all."

  • The Committee voted in favor of this statement, with one opposed.

The second goal, "Eliminate preventable disease, injury, and disability, and premature death," highlights the importance of prevention. One member said this should be phrased positively, and suggested changing, "Eliminate preventable" to "promote healthy." Another member suggested that the word "lifestyles" could address health behavior. Others were concerned this could be viewed as implying that health is within the control of the individual. It was recommended that this statement put emphasis on prevention. Dr. Fielding called for a vote on the goal statement, "Eliminate preventable disease, injury, disability and premature death."

  • The Committee voted in favor, with one abstention, and none opposed.

The third goal, "Eliminate health disparities while improving the health of all groups," addresses the importance of health disparities. One member felt that the word "create" is more empowering than eliminate, but it was decided that it is more important to be clear than to express this idea in a positive light. The Committee agreed that "achieving health equity is just one of several ways to eliminate health disparities." Dr. Fielding called for a vote on the goal statement, "Achieve health equity, eliminate disparities, and improve the health of all groups."

  • The Committee voted unanimously in favor.

As they discussed the goals, the Committee realized none of them addressed healthy behaviors or healthy development over the life course. They agreed it was important to cover families, family life, and child development, and to mention health behavior while avoiding use of the word "lifestyle," given that "lifestyle" is open to misinterpretation. Dr. Fielding called for a vote on the goal statement, "Promote healthy development and healthy behaviors across every stage of life."

  • The Committee members voted in favor, with one abstention.

Advisory Committee Recommendation #2: Healthy People 2020 Goals

  1. Achieve health equity, eliminate disparities and improve health of all groups.
  2. Eliminate preventable disease, disability, injury and premature death.
  3. Create social and physical environments that promote good health for all.
  4. Promote healthy development and healthy behaviors across every stage of life.

The Committee then took a 10 minute recess.

Mission Statement

Dr. King presented the preliminary draft mission statement that had been prepared the previous evening. The group began with the FIW's draft mission statement and decided to break up the revised version into bulleted sentences to facilitate wordsmithing and to ensure sure it captured all relevant points. The group's initial draft is shown below.

Preliminary Draft: Mission Statement Elements for Committee Consideration

  • Increase recognition of the underlying determinants of health and disease.
  • Identify highest value opportunities to improve health through use of best knowledge.
  • Provide a framework for selecting and implementing strategies and tactics.
  • Provide a framework for assessing progress to guide further improvement.
  • Incorporate new science and technology to strengthen policy and program effectiveness and efficiency.

Committee members discussed the function of the mission statement, and whether it should refer to the framework, objectives, or overall categories to be addressed by the initiative. Should it talk about the work that the Healthy People initiative has done, or what it will do in the future? They agreed that the mission statement should motivate action and provide a framework for planning, but at the same time, the statement is meant to be the mission for the entire Healthy People enterprise, not a set of instructions for what the user is supposed to do.

The members felt it was important strive for simplicity and that key elements of the mission statement should highlight the concepts of understanding, action, results, and new knowledge. Under these rubrics, Committee members discussed key concepts that should be conveyed in the mission statement and revised phrasing of each component accordingly. The salient points in their discussion are summarized below.

"Preamble" for Users
The Committee felt there should be some articulation of who the document is for, without being overly specific about intended audiences. A preamble was drafted to clarify the initiative's purpose and intended audiences:

Healthy People 2020 will be useful to anyone interested in improving health. Users will include members of the general public, health professionals, and civic leaders. Healthy People 2020 will also be used by private and public health agencies, educational institutions, and other community organizations. Healthy People 2020 is an essential tool to any individual or agency striving to improve the health of individual, communities, and our nation.

Due to time limitations, no formal vote was taken on the preamble. Suggested edits were: adding researchers, or all categories in the Institute of Medicine's definition of the "public health community" (e.g., academics, communities, employers, governmental public health, and the healthcare system).

Mission Element #1: Understanding
The concept of health determinants inspired much discussion. Some members wished to avoid the "jargonesque" aspect of the word "determinants;" others felt it would be worthwhile to educate the primary audience about this term. One member felt that this element should comprise the entire mission statement. Dr. Fielding called for a vote on the statement, "Increase public awareness and understanding of the underlying causes of health, disease and disability."

  • The Committee voted unanimously in favor.

Mission Element #2: Results
Committee members discussed the value of Healthy People for improving results. It was suggested that the concepts of data, measurement, evaluation, assessment, and progress might be nested under "results." It was agreed that the word "priorities" was important for inclusion as Healthy People is a guide to objectives, strategies and tactics. Dr. Fielding called for a vote on the statement, "Improve results by providing priorities, measurable goals and objectives, and guidance on effective strategies and tactics."

  • The Committee voted in favor, with one abstention.

Mission Element #3: Action
Committee members felt a key mission of Healthy People is motivating people to act is and that people can be catalyzed to act through health policy, programs, and other actions, both public and private. The point was made that policies and programs should be evidence based. Dr. Fielding called for a vote on the statement, "Catalyze action through the use of best available evidence, practice, and policy." This was later modified to, "Catalyze action using best available evidence to improve policy and practice."

  • The Committee voted in favor, with one abstention.

Mission Element #4: New Knowledge
The Committee discussed issues of new knowledge, science, new evidence, data, and trends. The Committee also considered the need to identify gaps in knowledge in order to stimulate new research, new science, and the development of new evidence. The gaps could be in measurement, programs, or the knowledge of what works, in general. Dr. Fielding put forth the statement, "Identify research and measurement priorities for improving the evidence base for effective action and evaluation."

  • Due to time limitations, no formal vote was taken on this element of the mission statement.

The Committee then adjourned for lunch.

Advisory Committee Recommendation #3: Healthy People 2020 Mission

  • Increase public awareness and understanding of the underlying causes of health, disease and disability.
  • Improve results by providing priorities, measurable goals and objectives, and guidance on effective strategies and tactics.
  • Catalyze action using best available evidence to improve policy and practice.
  • Identify research and measurement priorities for improving the evidence base for effective action and evaluation. (Not approved by formal vote of the Committee due to time limitations)

Dr. Fielding explained that he and Dr. Kumanyika had decided to depart from the agenda, as it was important to address the framework. He noted that a draft of the Committee's discussion and consensus of the mission, vision, and goals had been distributed to the Committee members. The group then turned to the framework.

1:00 PM - 2:30 PM

Dr. Remington explained that several Committee members met the previous evening to consider the FIW's draft organizational chart and add the concepts discussed by the Committee. He described a chart that the group had produced which included a sector and ecologic approach with elements ranging from individuals and families to systems (including, but not limited to, public health and health care), the idea of preparedness, health IT, and the social and physical environment, built on a base of measurement of health outcomes. (A draft of the diagram can be found in Appendix E.)

Dr. Remington also shared examples of frameworks that are being considered in Wisconsin, including a logic model and a Venn diagram. The Committee's discussion of the framework highlighted individuals, systems, and environments; these categories are being used by the National Committee on Vital and Health Statistics to organize the statistical system and the IT system for the 21st century.

The Committee agreed that it was premature to finalize the look of the framework, but agreed that these are the organizing principles the Committee would like to use. The Committee generally agreed that, for now, a Venn diagram would be an appropriate choice for the organizing framework. A formal vote was not made on the framework.

Advisory Committee Pro Tem Decision: Graphic Depiction of Framework

  • The Committee informally agreed to use a Venn diagram showing the three circles of individuals, systems, and environments (social and physical), to organize their thinking about the framework.

The Committee explored the issues of how topics should be configured, what level of aggregation is needed, what topics should be used, and whether determinants or risk factors should be the organizing principles. Committee members did not reach any conclusions. They sought to examine the best ways to think about the totality of health improvement, including setting priorities, organizing objectives, and catalyzing action. To provide some structure for this exchange, Dr. Fielding pointed out that this component of the Healthy People 2020 model involves a couple of different issues. The first deals with how one identifies and set priorities. The second deals with how the objectives should be organized. Because it is difficult to address both issues at the same time, Dr. Fielding suggested the Committee consider how to organize the framework in a parsimonious way, given the challenge that is presented when categories overlap.

It was noted that the group should consider whether they were outlining a model that would make sense to other people when they communicate about it. The Committee's discussion moved across a variety of topics. Members' comments are summarized below under the headers of priorities/ organizational structure, risk factors/ determinants, targets/ outcomes, and user groups/ communication.

Priorities/ Organizational Structure

Dr. Fielding noted that it's hard to separate the issue of priorities from that of organizational structure. Indeed, many Committee members referred to these two issues interchangeably, or linked them together. There were other areas of overlap, including health issues and focus areas that fall within both determinants and outcomes.

The Committee considered the priority and focus areas from Healthy People 2000 and Healthy People 2010, mapping the objectives onto a framework, and a modeling approach to developing the priorities and focus areas.

In thinking about what should be included in Healthy People 2020, the Committee addressed the need to continue the measurement work of Healthy People 2010 and determine what interventions are efficacious and efficient.

Risk Factors/ Determinants

It was noted that one state's model was built entirely on health determinants, but that it is important to also address outcomes: morbidity, mortality, quality of life and that organizing objectives by disease-specific categories (e.g., cancer, heart disease, and oral health) drives a set of objectives that may overlap.

The Committee addressed a concern about focusing on risk factors, noting the importance of taking an approach that considers broad environmental factors as risk factors given that “risk factors” or “determinants” are not mutually exclusive. The Committee also considered organizing the objectives by four overarching principles, given that this approach would reflect the topics that had been outlined in the Venn diagram (Environment, systems, individual/ families) but looked at them in another way.

Targets/ Outcomes

The Committee highlighted the need to: build on the targets and work done in Healthy People 2010; recognize that while many objectives in Healthy People are moving in the right direction, others are not; acknowledge that an objective should not necessarily be a priority because it is moving in the wrong direction (i.e., away from its target); create accountability; and consider the value of data reporting for policy development and tracking progress.

User Groups/ Communication about Healthy People

The Committee considered whether the objectives should be organized by problem, stakeholder user groups, audience, or population (i.e., in terms of the groups that take action). For example, what can the health care system do? What can the public health system do? From a functional perspective, this approach might be more helpful for the target audience, but it would be a significant departure from what's been done in the past.

The Committee discussed the need to provide Healthy People users (e.g., community groups) with tools or guidance for achieving the objectives. In the past, Healthy People has given users a wealth of data, including baselines and targets, but it hasn't provided clear guidance on what to do under various circumstances. The advent of the internet could allow for the creation of an interactive database that would generate community-specific implementation plans based on demographic information entered by users, such as local health departments. ODPHP is working on such an interactive web-based tool. Dr. Fielding asked the Committee to think of questions that the users of Healthy People are seeking to answer when they consult this resource:

  • Are we on track? If it works, why? And if it doesn't, why not?
  • Can I continue to work with this level of disability or problem?
  • Does this support the things I'm already doing? Does this threaten my job?
  • How are these adverse conditions reflected in the health data?) How can I achieve the target?
  • How can we address this health problem both in the clinic and in the community? (Thinking upstream.)
  • How do the health data reflect the situation in my community? (e.g., Housing issues, loss of jobs.
  • How is my community the same or different from the norm?
  • Should we use HHS data to help us try to figure out the framework?
  • We're considering intervention X for population Y. Does it work?
  • What are the best interventions to reduce burden based on existing evidence?
  • What are the greatest causes of preventable disease, injury and disability in my area?
  • What is the health profile of smaller populations within my community?
  • What is the relationship between individual behaviors and the larger structure?
  • What key health behaviors should I be focusing on?
  • Who else in my state, region, or locale cares about the problem I care about? Who can I collaborate with for programming?

Discussion of Subcommittees to the Secretary's Advisory Committee

The Committee discussed the need to establish subcommittees to advance the Committee's work before its next meeting, and agreed to create a subcommittee for each of the four draft goals proposed by the Committee.

Dr. Fielding stated that the subcommittees would be charged with providing directional advice and recommendations to the Committee for consideration. Prior to the next in-person meeting, subcommittees will be asked to provide Committee members with short, written reports. They will also orally present their recommendations. Dr. Fielding noted that the reports will help to inform the next meeting and help to set the next meeting's agenda. The Subcommittees will work via conference calls and the extranet. Once specific subcommittees were named, a sign-up sheet was circulated so that members could indicate their interest. The titles of the subcommittees are listed below; the subcommittees' charges and interested members are shown in Appendix F.

  • Subcommittee on User questions and Needs
  • Subcommittee on Developmental Stages, Life Stages, and Health Outcomes
  • Subcommittee on Environment/ Determinants
  • Subcommittee on Health Equity and Disparities
  • Subcommittee on Priorities

Topics for Future Meetings

The Committee identified the following agenda items for the next meeting:

  • Issues related to target-setting, (e.g., evidence, context, aspirational vs., realistic targets;
  • Focus areas for objectives;
  • Subcommittee reports;
  • Debriefing from feedback for regional meetings;
  • Opportunity for public comment.

Unfinished business and Action Items

Dr. Fielding noted that the subcommittees will be able to communicate via conference calls. He and Dr. Kumanyika will select chairs for the subcommittees. The group discussed the possibility of holding a public webinar before the next in-person meeting. Committee members mentioned several issues that they may wish to consider in greater depth at later meetings, or at subcommittee meetings. There is also the possibility that they could invite experts to speak to them about these issues. These topics included:

  • Health Information Technology
  • Preparedness
  • Preventive services/ health systems
  • The public health system
  • The media

Dr. Fielding thanked the Committee. He said that this is a wonderful group, and that they will be able to make a difference. He complimented the Committee members for their productivity, compatibility, and for sharing their complementary perspectives.

Meeting Adjourned
3:00 PM

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