Healthy People 2000 Consortium Meeting November 7, 1997

Summary of Breakout Group Discussion Concerning Priority Area 8: Educational and Community-Based Programs

I. Structure

A. Goal to eliminate health disparities: The group supports the establishment of a common target for all populations even though it does create problems.

• How do you come up with a common target on a health issue (e.g., TB) when one group may have 4 or 5 times the rate of the general population?
• We do not want to wash out the importance of the differences between populations; need specific information on populations to best focus programs.
• One goal may confuse the process since you would agree on an overall goal then, when designing programs, we would need to go to data on different groups to focus the program for the specific populations with greater needs.
• One national number is difficult to set when communities vary, so set a national goal but encourage communities to set their own goals based on community data.
• We need a national objective; different levels might cause us not to work as hard.
• If we change to one national goal, the one number might have a numbing effect; we might sweep problems under the rug; do specific populations want their own targets/goals to be part of the melting pot?
• We should have the same goal, but as we report on it, we need to address disparities.
• If we do not concentrate on disparities, resources will not go to reducing disparities.

B. Addressing special populations

• We need to recognize disparities and allocate resources accordingly.
• Data on specific populations are needed to be able to address problems appropriately.
• A master plan should be included for outcomes of improved health care for all people.
• Addressing special populations makes sense, but we need to incorporate special populations completely in the process and in developing effective programs.
• It is unclear in the framework how special populations will be handled; they should not be separate but integrated into all focus areas.
• The school-age group needs to be kept because the group is developmentally different and has specific needs.
• There should be consideration of additional special populations, for example, sexual orientations, recent immigrants, family structures (families that are not intact), and the homeless.
• Special populations should not be separate but under each focus areas.
• There should be a clear focus and messages throughout the document that emphasize the importance of addressing disparities.

C. The FAN and the framework

• The boxes are a visual problem. Things need to be more connected and interrelated.
• A focus on infrastructure and systems is needed; the Infrastructure focus area is a good one.
• If we keep the fan, stop the lines down between focus areas when they come to the gray area (the enabling goals); then place the enabling goals randomly in the gray area to show they are interrelated.
• Change "strengthen community prevention" to "strengthen health promoting communities" to make it more proactive and more community owned.
• Eliminating disparities should be part of the vision: "Healthy People in Healthy Communities Without Disparities."
• "Community" should be added to the whole structure; it is at the community level that all sectors need to come together to determine priorities and improve health.
• The visual should be a circle with NO boxes, no lines to box things in. A circle will emphasize connectedness more so than the fan.
• The foundation of fan should address poverty and lack of access.
• At the foundation of the fan should be a "healthy community."
• Overarching goals such as "increasing years of healthy life" are good.
• Enabling goals should focus on measuring healthy communities.
• A category for "healthy environment and social support" should be included (environments conducive of healthy choices; different from the "green" meaning for environment).
• Community action should be strengthened as a component of healthy communities.
• There should be more research in the behavioral sciences (not just medical research).
• If you keep the fan, be accurate. When the colors of the fan come together at the bottom, they should make the color brown.
• Instead of distinct colors that emphasize separateness, shading or patterns could be used in the fan.
• The fan, as is, does not show up well as a black and white copy.
• The framework needs to strengthen the "role of communities" and the concept of "healthy years." It needs to put more emphasis on "health" and less on "medical care."
• The document needs to be structured so people can search on key words. This will help communities and groups to pull out information that will be helpful to them.

II. Objectives for Focus Areas

A. General recommendations

• We need to assure access to quality health care; objectives should address quality.
• Protective factors and not just risk factors could be included (e.g., each child having a significant adult; things that support family structure).
• Targets could be set at different levels — the individual, family, and community levels.
• A broader definition of health, which includes economics, etc., should be used; the document should include objectives that address more than public health issues.
• Mental health issues are important to address.
• We should address alternative therapies, cultural competency, the training of healthy professionals and the training of people to be good consumers of health services.
• Emerging infectious diseases are important and need to be addressed under focus areas #12 (Infectious diseases) and #18 (Infrastructure).
• Objectives should relate to identifying adequate funding and resources to address priorities.
• The objectives should support the shift of funds from technology and medical care to prevention.
• More priorities mean more mandates and fewer resources to go to any one priority. We need more resources.
• More attention should be paid to education and economic status.
• The objectives should emphasize the use of resources early in the prevention process (e.g., if a child does not start to smoke there will be an impact on heart disease, cancer, and many other problems). Behaviors are interrelated and should often be addressed together.
• The document should clearly state that we must finance prevention; it could establish policy that ties funding to health promotion.
• Action should be taken to increase awareness of Objective for the Year 2010 among all sectors; get communities involved.
• One focus area should be to decrease poverty.
• There could be a distinction between outcome and process objectives by making the outcome objectives the same and specialize the process objectives to meet needs of specific populations.
• The objectives should address the root causes (e.g., poverty and access to care); resources and infrastructure need to address the root causes.
• Better community-level information needs to be available for program planning.
• Prevention begins in culture; issues need to be addressed in culturally appropriate ways.
• Actions should be taken to ensure that these objectives are Objectives for the NATION and not public health; we need to work more with the business sector and with faith and other groups.
• Efforts need to be undertaken to improve the science base and determine what works to improve health.
• There should be more process objectives.
• There could be "advocacy" objectives that would not be as measurable.
• We need to develop more of the science base for educational objectives.
• The present structure supports categorical issues; we need to emphasize collaborative efforts.
• Community-based programs should include collaborative objectives and the use of psychosocial services and other things broader than health/medical services.
• The present Objective 8.11 on cultural competencies should be part of the basic way we do business; it should be integrated into the philosophy of the entire document.
• The mainstream and culturally diverse populations need to be addressed so everyone is included.
• The disabled could be addressed by expanding objective related to "healthy life."
• The focus group looking at Public Health Infrastructure should look into increasing data collection; better use should be made of existing data such as data schools routinely collect and report to their districts or State departments of education and data collected by managed care organizations.
• More emphasis should be placed on quality of life indicators.
• The ease of measurement should not drive public health priorities; rather the priorities of public health should drive the development of good data systems.
• Sentinel goals should address educational achievements (e.g., graduation rates) and income levels.
• We need to develop data collection tools and increase the capacity of local health departments to collect and collate data. Funding and regulatory agencies need to coordinate data needs so communities have less paperwork and more uniform reporting. All health departments need good computer resources.
• The agenda should go beyond outcomes; performance measures are a way to address process (e.g., % of kids to receive EPSDT screening). We need to include systems objectives and program outcomes. National data need to be readily available.
• Other agencies should be included more in the process (e.g., HUD, National Service Corps, Department of Education, Department of Agriculture).

B. Specific Objectives To Be Dropped or Added

• School health objectives should emphasize comprehensive school health.
• Add an objective similar to "enhancing the number of health professionals primarily responsible for population-based planning and programming." ("Health educator" is now a job category as defined by the Department of Labor.)
• Add an objective to increase the number of Hispanics and other minorities in training for public health.

Participants

Brick Lancaster, Facilitator, Centers for Disease Control and Prevention
Nancy B. Watkins, Recorder, Centers for Disease Control and Prevention
Mary Bobbitt-Cooke, North Carolina Department of Health and Human Services
Janis Borton, Colorado Department of Public Health
Kim Callahan, Chandler Chicco Agency, New York
Nadine Cid, Aspira Association, Inc.
Rickey C. Dennis, University of South Carolina
Naomi Ervin, Binghamton University
Beverly Flynn, Indiana University School of Nursing
Frances T. Gibson, Health Resources and Services Administration
Kristen Gloege, Minnesota Department of Health
Anne Helmke, National Wellness Institute
Amy Holmes-Chavez, Centers for Disease Control and Prevention
Don Hyman, Bayer Pharmaceutical
Lauren Leifer, COMPDISK
Bill Livingood, Society of Public Health Education
G. Bernett Marion Sr., New York Department of Health
Delores J. Moon, Black Nurses Association of Indianapolis, Inc.
Linda Redman, Virginia Department of Health
Sarena D. Seifer, University of Washington
Katim S. Touray, Madison, Wisconsin
Aubin Tyler, Arizona Department of Health Services
Scott Whoolery, Louisiana Office of Public Health
Susan F. Wooley, American School Health Association


Breakout Session List