First Meeting: January 31-February 1, 2008

Appendix B

Jonathan E. Fielding
Introductory Comments on 2020 Health Objective to the Nation
January 31, 2008

1. What can we learn from past objectives?
   1. What can we learn from how those objectives were developed?
      1. What conceptual frameworks were utilized?
      2. What process was employed?
   2. Who has used them?
      1. Federal government
      2. State government
      3. Local government
      4. Voluntary organizations
      5. Business
      6. Educational institutions
      7. Community groups
      8. Other
   3. How have they been used by each of these groups, and to what extent?
   4. Why have we gotten closer to some objectives than others?
      1. More realistic objectives?
      2. Better use of evidence based strategies?
      3. Other factors e.g. HEDIS, pay for performance, etc.
   5. What cross cutting lessons can be learned?
   6. What can we learn from other nations that have developed health objectives?
2. Who should be the primary and secondary target audiences for the 2020 objectives?
   1. How do we decide?
   2. How do we get the best input?
   3. How do we efficiently reach those groups?
3. Who are the principal stakeholders for the 2020 Objectives?
   1. How can their differing perspectives be understood and, to the degree possible, reconciled?
4. Overall goals and objectives
   1. Increase healthy years of life
   2. Reduce disparities
   3. Modify a and/or b
   4. Add or subtract
5. How can we best conceptualize the opportunities to maximize health improvement?
   1. In the overall population
   2. In reducing subgroup disparities by:
      1. Race Ethnicity
      2. Gender
      3. Age
      4. Place
   3. How do we prioritize those opportunities?
      1. Burden
      2. Reducible burden
      3. Financial considerations
         1. Costs
         2. Costs vs. savings
         3. Cost effectiveness/ health effectiveness
      4. Ease of implementation
      5. Other criteria
6. What alternative approaches can be used to organize objectives?
   1. Diseases/ injuries
   2. Risk factors
   3. Life stages
   4. Underlying determinants
   5. Combinations of a-d
   6. Implications of choices for likelihood of disparity reductions
7. What is the role of evidence?
   1. In development of quantifiable objectives
   2. In making assumptions about potential health improvement
      1. Population effects
      2. Distribution of benefits/ harms
   3. Criteria for identifying evidence of effectiveness
      1. Systematic reviews
         1. As part of broad effort (e.g. Community Preventive Services Task Force, Cochrane Collaboration, etc.)
         2. Individual reviews
         3. U.S. versus international
      2. Other types of evidence
8. What is the appropriate degree of emphasis on policy change (public and private)?
   1. Role in Health Objectives 2020
   2. Evidence based
   3. The challenge of conflicting perspectives on role of government
9. Ability to track progress
   1. Are there reliable/ valid measures for each Objective?
   2. Are baseline measures available, at what level of aggregation?
   3. Are there standardized data collection systems for tracking interim changes?
   4. Is there a coordinated data collection, analysis and dissemination plan?
       
10. Pathways and roles
    1. Roadmaps for progress towards objectives
    2. Roles of different entities
    3. Emphasis on collaborative efforts
    4. U.S. alone versus collaborations among nations

The hardest questions:

• How would our expectations of health in 2020 change if there were no 2020 Objectives for the Nation?
• How can our advice add the most health to the base case for 2020?

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Last revised: July 9, 2008