DEPARTMENT OF HEALTH AND HUMAN SERVICES
Meeting of: Secretary's Council on Health Promotion and Disease Prevention Objectives for
2010
April 23, 1999, Proceedings
The next topic has to do with engaging stakeholders in health through Volume I, and I think, now that we have gone over the focus areas, it is appropriate to bring attention to what remains. There are two additional volumes to the one that contains the focus areas and objectives, and you have them-Volume I, of course, which is engaging stakeholders, and Volume III, which deals with data.
So I am going to ask Mark Smolinski whom you heard from this morning on the framework to describe engaging stakeholders. I do not know if we said it this morning. Mark Smolinski is a Luther Terry Fellow in the Office of Disease Prevention and Health Promotion and, as you can see, is doing a great job.
DR. SMOLINSKI: Well, hopefully this is going to answer some of the questions that came up this morning. One of the concerns that we have had in ODPHP is obviously that, even though we are fully supportive of trying to reduce the number of objectives-I think as Dr. Fox has pointed out, Volume II, which is essentially all of Healthy People, is used more as a reference document by a lot of individuals-what we want to do is, we want to try to get not only those individuals who have always used Healthy People to continue to use it. We would really like to engage new stakeholders that may be intimidated by the large volume and show what Healthy People is all about and how they can use it. How do we get new people aboard in this process?
So we have developed Volume I of Healthy People, which is going to be Engaging Stakeholders in Health. We had a large debate about, you know, who is our target audience. One of the things I wanted to make clear up front is the general public is not the target audience for this volume. We realize that there is a lot to communicate to the general public, but we probably need to do that in another venue. This is really to engage policymakers, decisionmakers, businesses, communities, sort of the entire realm of people that were mentioned in the Leading Health Indicators. Of course, we hope Volume I will be interesting to the general public should they decide to use it, but we really had a clear focus on trying to bring more policy issues into this group.
We also have a commitment to make sure that this volume ends up being no longer than 50 pages. We would really like this volume to be more of a story that people will pick up and read from beginning to end, and we are very strict on trying to stick with that for the communication process to be effective with this volume.
I know you all have a draft that came last week, but I am sure you have not had a chance to go through it. So what I wanted to do was just basically take you through the table of contents and tell you what we are envisioning Volume I will look like. We really do welcome your input on this process. Obviously this is a little behind the rest of the Healthy People process, but now we clearly need to bring it up to speed to go through the clearance process with the rest of the document. So we are going to give you two weeks to really look over the volume that you have with you, and please get comments back to me by May 7.
Again, what we are doing is-some of this information is also in Volume II in much more detail, but we have to realize there are going to be individuals who may pick up Volume I of Healthy People, and that may be all that they read. So we wanted to make sure we covered some basics, such as, you know, what is Healthy People? We present the conceptual framework right up front in the document, and we state the purpose is really to engage stakeholders in health and talk about how we really want to create a multidimensional approach to health in order to achieve our two goals.
So that is all done right at the beginning, and then what we have basically done is used the framework to be the table of contents for Volume I of Healthy People. So the first part is what is our vision of health for the nation, and that is where we present this row here, with a little more information on what we really mean by each of these goals. For instance, we explained that eliminating health disparities is not only racial and ethnic disparities; it is income, education, rural and frontier health. We have the whole gamut of responses from the public comment period that we have incorporated into that. So that is basically what takes you through the first section.
The second section is really "How healthy are we?" That is where we will present the major causes of morbidity and mortality within this country, and we are going to try to do this as graphically and pictorially as possible so when you pick up the book it is very interesting to look through. I know that what you have is a lot of text, but it is also only 27 pages, and we are pretty much hoping that that may be the extent of most of the text. The rest we will fill in with graphs and figures, because we would really like it to be very visually appealing to look through this book. Again, in the "How healthy are we?", we will cover what we measure in healthy people, the life expectancy, the quality of life, and then the major burden of illness factors.
Then what influences or determine our health is basically going through the main components of the blue box. This is where we are not really sure if the Leading Health Indicators, if they all end up being determinants of health-we may build some of the discussion on the actual facts and figures within that area, or we will present some of the key other behaviors and so forth within that text.
But really the focus is the last section, and that is about what can be done to improve the nation's health over the next decade. That is where we talk about the entire multidimensional influence, because people will have read through the first part. They will understand the model, what we are trying to get through. We have decided that the Leading Health Indicators are going to be the objectives that will be in Volume I, because we want Volume I to be widely distributed to everyone. Even though we will explain the breadth and depth of Volume II of Healthy People within Volume I, we want to make sure that everybody knows the leading health indicators, and that they will be a large focus of the data that goes into what can be done to improve health over the next decade.
The last component that we are trying to build into there-and you have a few examples in your draft-is, we really wanted to point out categorically how Healthy People can be used, and then to represent that with real examples of, you know, names and organizations that people will recognize when they look through that and try to get a real mixture of school health, workplace health, Federal, local, State governments, so people can look at-wow, Healthy People can be used for this reason, and here are people who have done it. Really give more of a concrete approach to the uses of Healthy People, and in that we will include the encouragement for companion documents and some of the processes that are already under way and some examples of other things that can be done.
So, again, this is in the infancy stage. We have hopefully put enough together for you to read through and get a clear vision of what we think this document should look like. But we really welcome your input on things we may have overlooked or things you think would be much more important to get out there in this document. Again, the bottom line is we want it to be brief; we want people to read it from cover to cover. We want it to tell a story, and hopefully it will encourage them to pick up volume II and really get involved in the Healthy People process.
DR. SATCHER: Okay, thanks very much, Mark.
I would like to open the floor for discussion of this Volume I. Again, the goal here is to open new doors to Healthy People and encourage stakeholders to become more involved. That is the goal.
Comments, questions?
MS. MOORE: Is this on the Web, on your Web page for comment?
DR. SMOLINSKI: No, this was not out for public comment.
DR. RICHMOND: Just kind of a minor question, but it may not be. I guess I am curious about the term stakeholders and how you define stakeholders. I guess to some extent, going about in professional circles, I find that we use this jargon so commonly and often it's so ill-defined that I guess I just have a question as to whether that is the message or not.
DR. SMOLINSKI: No, again, we welcome comments like that. If you think there is a better term that would explain it-we would like to try to avoid jargon if that is truly what it is and try to use terminology that would hopefully get more people interested in Healthy People.
DR. SATCHER: Well, define it. How are you using it?
DR. SMOLINSKI: Well, basically in "stakeholders" we were using-that is sort of the term that has been used through Healthy People since I have been here in ODPHP, just sort of the categories of parties that were interested in getting involved-business, academics, private corporations-
DR. SATCHER: And we are always looking for new stakeholders.
DR. SMOLINSKI: It is basically another term for partners.
DR. RICHMOND: I do not want to overdwell on it, but to me it had a certain kind of proprietary connotation. Each group and so on has a stake.
DR. SATCHER: Well, obviously we are talking about new partnerships and could use that.
DR. SMOLINSKI: Maybe engaging partners in health would be a better term.
MS. MARKEIDES: I am Cristina Markides from PAHO. I have a few comments. One is, of course, I was a little bit surprised to see that Health for All sort of fell-I do not know if it fell through the cracks, but it was not obvious to me in the new framework that was put out for discussion. Although Healthy People in Healthy Communities is the national vision, perhaps Health for All is the global vision to which the United States is committed as a partner, as a nation, in this world that is more and more globalized.
The other one is, I also wondered perhaps where we could include-if it isn't the social aspects or social factors-the psychological and the spiritual dimension that is very important, and it is essential many times if we are talking about a multidimensional perspective.
The other one-continuing a little bit to look at the global issue-and you talked about this at the beginning when I was lucky enough and had this wonderful learning experience to spend 2 years at ODPHP. Perhaps a mention on how global issues in terms of trade, in terms of work, in many other aspects, have some influence on the health of Americans. The same way that the IOM published a few years ago this book on America's Vital Interest in Global Health, I think there is also an interest in looking at what happens outside and what happens here and, by the same token, how other nation's policies are also influencing or could influence the health of Americans in such a way.
Thank you.
DR. SMOLINSKI: Just to address a couple of those-we hopefully are building some of the spiritual and cultural issues into the social environment. I think the term that we have in the draft there is basically your social networks. We tried to communicate that that involves your churches and cultural beliefs and so forth. Again, we have a lot of text and so forth that still needs to be developed. That is more of an expanded outline that you have a version of.
The global health issues-again, obviously they are very important. What we came down to was, you know, how are we going to approach this to still make this a very concise document, and what kind of justice can we do to entering the global environment within this book and not go beyond our 50 pages? But certainly we really have not dealt with it at all in the draft, and if it is felt that, you know, we need to make the effort and make sure that that is covered, then I think that that is a great suggestion, and we can certainly do that.
MS. SPAIN: Wanting to keep the document concise and yet giving people access to models, et cetera, and having that evolve throughout the decade-perhaps we ought to consider each of the leads and co-leads having a section on their Web sites or home pages in which there are additional models that we could continue to add. Because you will not be able to put it in here, nor will they be done by the time you print.
DR. SATCHER: I just want to make another comment about the global issues, and I really appreciate your making that comment, because there are two ways of looking at it. My way of looking at it is that every one of these issues is a global issue, and if we do not reflect that awareness of the continuity between what we are doing here and our global neighbors, then I think we do need to go back and figure out a way to make that point. I do not know whether it is by connecting it to Health for All or talking about the global implications of a lot of these areas, but our approach to public health now is a global approach. We can no longer separate it from the global picture.
So it is just a matter of how we make that clear in this document. So I appreciate your bringing it up. I mean, obviously what we are dealing with now with tobacco is an example of how the trade issue-but also pharmaceuticals, food safety, emerging infections.
DR. FOX: David, this is kind of a peripheral issue and a little bit out in left field, but I will bring it up now. I would assume that Volume I, as well as Volume II as well as Volume III, we plan to update when we do the midyear update in 2005. This document-I think this is an excellent document to have, and I just think we need to make sure that when we do the midyear review, the mid-decade review for 2010, that we also ought to update-I would assume we are going to try to update all three volumes, not just Volume II. I just wanted to go on the record as saying we ought to put that on the agenda now and just plan on doing that.
DR. SATCHER: All right. Thank you very much, Mark. I think I am going to move us along.
The last major topic is addressing data issues through Volume III. The third volume focuses on data. In Healthy People 2000 we had an objective to share information so comparable statistics could be calculated by national, State, community agencies, or other partners interested in comparing their groups with the nation as a whole, and as you heard, that is very important.
Volume III is our attempt in this decade-indeed, this millennium-to meet that intent at the outset and not wait until we are partway through the decade. So Dr. Edward Sondik, the Director of the National Center for Health Statistics of the Centers for Disease Control and Prevention, is going to lead us in a discussion of this volume and some crosscutting data issues for Healthy People 2010.
Ed?