The overall reporting statement was "less is more, and here is how we could get there":
Remove the services and protection objectives from measured objectives and use them as strategies that States and localities could measure, if they chose.
Prioritize the worst diseases by a priority setting model using disease burden, feasibility and cost of intervention as factors.
Organize priority areas by life stages or by actual causes of death or behavioral risk factors.
Report a few objectives in a USA Today report card format to inform the public.
Reword overarching goals.
Highlight special population targets for the purposes of advocacy.
Make the document more salable.
Create different versions of the document for different audiences to shape opinions and create demand.
Everyone thought the document should be shorter, simpler, and more focused. One comment on the other side was, "this may not be the best, but if it aint broke, don't fix it too much. The names are bad... I mean 'health promotion' that sounds... overblown or something. Lets call it something nice, up to date, media-like." His suggestion was to make minor changes in wording.
Remove service and protection objectives
There was general agreement about removing these objectives except as strategies. "They'd be objectives, but they don't have to be tracked." "They could just be recommended strategies." "They could be tracked, if you want to track them... the States can use them, but we don't need to set up a national data test."
One man brought up another way to organize the Healthy People objectives, "Another thing we could recommend along the same lines is to be sure that the health problem has matching risk factors and the health problem has matching strategies. There are some strategies in the book now with no health problem."
The number of priority areas suggested ranged form 12 to 15, however one man said "just because we say we have twelve instead of twenty-two, the same amount of material is going to be in there."
"I would prioritize diseases off the top ten or top twenty."
"I'd rather do it backwards and prioritize the risk factors." "You don't even have to put the diseases under each factor. You could have a separate chapter just talking about all the connections. One suggestion was to use a mathematical priority-setting model including as factors the amount of disability, the intervenability, and the cost of intervention. One person commented "The number one priority is probably going to be along the lines of the leading cause of death."
Most of the group were in favor of organizing by life stages: "People can quickly relate to it." and, "You’d get better coordination and integration that way - you can force collaboration." There was also the opinion that the public could grasp it better.
Opposing comments were, "It would be hard to report that way. Too many different players would have to be involved," and, "You'd have to add an overall because too many objectives would be for every single life stage-- we would be duplicating objectives." Another person said, "Certain things start early, for instance, a child who is five years old and who is overfed will be a fat adult and you can't wait until they're 45 and say 'Now get yourself healthy'."
Organize by actual causes of death or risks --(McGinnis and Foege article)
Many were in favor of this organization. One person said, "a lot of people criticize Healthy People 2000 because it's a menu approach... and it's really not a blueprint for the health of a nation. Something like the actual causes of death is more important." "What really causes death? alcohol, injuries, violence... if you really want to say how you're going to improve the health of the nation..." Another said, "Instead of talking about the leading causes of death, we should be talking about behavioral risk factors."
It was also suggested that a chapter would be needed that covers public health functions--"So we hold the public health community to a standard of excellence."
One contrasting opinion was, "We can't just focus on causes of death... you've got a large population that's growing older-- it's just as important to focus on disabilities."
One man thought the program would be more acceptable politically if it did not include a goal to improve disparities. One man apologized for seeming misanthropic, but said " if you have 'reduced health disparities' as one of your overarching goals, as they found when they tried to put in a national health insurance scheme, and as they found out when they tried to cover prescription drugs for older people, the guys who are currently on top don't relate to that. They say, why should I be interested in reducing health disparities? It's going to come out of my pocket and its not going to help me. It's a great goal but... experience has been that in the last few years in the context of health insurance or getting employers to foot bills, it's been hard to sell." Another added, "I think you should get rid of the term disparities. And you simply call it 'special population targets' or 'progress in special problem areas' or whatever."
There were protests from others: "I'd hate to see that go away as a goal, it has to be there." and "I think that really is a core function of public health is to look after populations that are under served, that are not performing as well as the other part of the population."
One suggestion was to extract all of the special target goals and put them into a separate chapter. In answer to that suggestion, another woman said "It's like putting it all over here and don't deal with it... Its good to have them in the area."
Another said, "I don't want to see it too fragmented... I would see to it that the special challenges that lie within some of these priority areas should be highlighted. Almost as an advocacy piece. It gets back to how do we want to use this? And in what ways do we want to make it more visible and more a household word to the American public? ...and for those who can do something about it in their communities. Also keep in mind that by 2010 the special populations will be much larger in proportion to the total population".
Give the document more public appeal
"Think about how a new document could really communicate these issues to not only the American lay public, but professionals out there who don't have the slightest idea." "You might want to go back to what we talked about this morning...what this document is to achieve... then you might want to think about what it is that you can market. That's a very different strategy than what we need to do with public health service agencies... or what needs to be done at the local level in public health service. I'm talking about describing the objectives in a way that they could be marketed.... if you want to sell these things to employers and HMOs and people who are sort of economically driven and who read the USA Today and listen to CBS news, you gotta describe it in ways that are going to get into the USA Today. I feel like we don't want to sell Healthy People 2000, we want to sell healthy behaviors...so we can sell these concepts to a managed care plan, saying hey, we have this program that will help your employees eat healthier. ...and by the way, you may be interested to know that there's a national health goal to do that and here's what it is. The interest in Healthy People 2000 will be for the same reason companies now spend more money advertising prescription drugs to the public than they spend advertising to doctors. These guys are interested in what their customers want."
Create Different Versions of the Document for Different Audiences
There was a discussion about the AIDS Clinical Practice Guidelines. "They have one for primary care physicians, one for specialists, and a consumer guide. They're all the same message put out in different ways... I think a similar thing could happen with Healthy People 2000, where you could have a consumer guide." Several others joined in to add to this idea. They suggested working with communications people and including some of the numerical data, as well using graphics as in the USA Today, because individuals like to know how they measure up. One man made the point that we are trying to create a public demand to the health care provider. "We've had that on oral health with the dental sealant, that it's the public that's created the demand."
What's
New Fact
Sheet 1998 Public
Comment Related Activities
1997 Public Comment Secretary's Council Consortium
Healthy People 2000 Contact the Staff
2010 Development
2010 Home