Agenda Item: Closing Comments

MS. MAIESE: We always try to be audacious in ODPHP in trying to summarize an eight-hour meeting in four minutes or less. It is an awesome task, but let me try. First of all, we began this morning, thanks to Drs. Satcher, Simpson and Hamburg, with a discussion of the challenge at hand on eliminating health disparities. We reaffirmed that that is, in fact, a goal worthy of pursuing for Health People 2010. One target for all objectives is what we should be striving for.

However, there was no consensus, it seems to me, on the target-setting methodology. There seemed to be the most support for a methodology that looked at achieving the rate of the best group in the population. As Dr. Wasserman has said -- and I will certainly turn to our statistical advisors in the National Center for Health Statistics -- look at other ways that we could advise our lead agencies and work groups to make sure that our target-setting methodology is statistically sound, one that works for our colleagues around the world, as well as at state and local levels.

I think we did come to a conclusion that the reporting template for all people objectives should be the OMB standards for race and ethnicity. In the event that data systems allow us to go beyond that minimum standard, we should certainly achieve those data divisions that are important to bring attention to disparities. As Jeanette Takamura brought to our attention, the age breakouts are particularly important as we focus on the aging of our society. Certainly, as Dr. Brandt really laid on the table, if you are born in Oklahoma as an American Indian, let's hope you die as an American Indian. So, we need to work with states and localities to use that standard with us as a national government.

I think the other theme that emerged was making connections, as Christina Markides just pointed out, the global connection. We have colleagues, as you can see from the participants list, from Egypt here, through a USAID-sponsored project. There is a WHO fellow from the Philippines as well, and our colleagues from the Pan American Health Organization.

We also talked today -- and Claire brought up global connections with infectious diseases, Dr. Satcher with tobacco, drugs, food safety, and environmental health.

So, we all really need to take these sets of objectives and make sure that we have done the international and global connections that are important to make.

Certainly, Bob Knouss challenged us this morning to see whether achieving these objectives would, in fact, enable us to achieve the goals. We need to evaluate this framework in that iterative process as well.

There was certainly a lot of discussion this morning and this afternoon about making connections between chapters -- on substance abuse and injury, the integration of primary care and preventive care strategies across chapters, perhaps into access and quality health services. Dr. Richmond certainly challenged us this morning to make the connections in human services, and with the Department of Education and, as Dr. Wasserman just did, between labor and commerce and others. So, we continue to need to strive to make those connections across agencies of the Federal Government and then to translate that to state and local levels.

Certainly, in addressing the importance of public health infrastructure, we need to be mindful of the importance of data and surveillance systems in this framework and make sure that they have the prominence in those objectives that we give them in all of our discussions. To that end, let me pass out the drawing that Dr. Richmond made, talking about a framework that enables us to bring integration to this. Just what you need, is one more piece of paper. It really is a lovely integration with Healthy People in the center with promoting healthy behaviors, healthy communities, and preventing and reducing diseases at the borders. I would leave that as a thought of how we should integrate our chapters and go forward this fall in publishing these objectives for public comment.

We continue to be mindful of making the linkages as the Secretary pointed out, to make sure that we can communicate Healthy People 2010 in all of its complexity, but in a powerful and forceful manner, with simple messages not only to American school children, but to all of the people in this country.

Fourth, I think we have as OPDIVs the task of going back to refine these objectives, to make sure they are focused on people, not programs. This morning, I think there were several themes of counting the percentage of people who are trained in public health, the percentage of people who receive work site health promotion. We need to be mindful that our title is Healthy People and our focus should be healthy people.

I think Dr. Friedman talked about the need to refine the drug safety objectives. There were discussions this afternoon about looking at hospital care, care in jails, and making sure that we have a complete set of objectives.

Of course, we will be going through OPDIV clearance this summer in order to meet a publication schedule of having these objectives out for public comment this fall. We will be looking forward to your sign-off and clearance and working through the remaining issues this long, hot summer.

It seems to me that we need to begin and continue to look at how we make Healthy People a communication device, not only through the Internet, but through other means, and continue to determine the best way to reach all the American people with our message of health improvement.

I know I probably haven't touched base on all of the many topics we have covered today, but let me thank you. You have inspired us, and we need to continue to pursue an audacious agenda for the year 2010.

DR. SATCHER: Thank you very much. Does anyone want to take issue with that summary?

DR. DUVAL: No, I am not about to take issue. My compliments to Debbie for summarizing it as well as she did, as rapidly as she did. It is a great skill. I envy those persons who are able to do that.

David, before we break up, I would like to say both -- personally, I don't want to speak for anybody else

-- but I certainly am one who is very complimented to have been asked to sit in on this exercise and listen to all that has gone on. I certainly feel enormously laudatory and complimentary to those persons who have put hours and hours and hours of effort into producing the product that you brought today.

I would have to believe that most people in this room would simply say -- or some variant of what I am about to say -- that if you really want a healthy population by 2010, you would immunize 90 percent of the children and you would eliminate obesity and physical inactivity and substance abuse and violence, and we have got it made. On the other hand, you can't do that. That isn't possible.

I would repeat once again, to make those people who are doing this effort feel that their effort is worthwhile, you are basically -- by having an extraordinary profusion of objectives across the board, rather than just a few that might be achievable -- you are basically changing the culture of the American public. That makes this entire exercise worthwhile. I hope everybody that spends hours and hours at home and at night and so forth redefining this, digging up data to support this, that and the other position, that their contribution is a contribution to changing American culture. Thank you.

DR. SATCHER: Thank you very much for that perspective. It is very helpful.

DR. WINDOM: I would like to ditto Dr. DuVal's eloquent presentation without repeating it.

Secondly, there are three groups that I would like to see -- as we go forward between now and 2000 to get these objectives out on the board -- be present at our next meetings. One of them is the AMA and another is NMA. Every day in this country there are over five million people who have contact with a physician, every day. These doctors need to be completely aware of what we are talking about. The third group is the AAMC, the medical colleges, because every day 60,000 medical students are in contact with the issues of delivery of health care, education.

Those are the people who are going to be on the front lines and who are going to help change this culture by delivering the messages that we are here trying to develop.

Therefore, I would like to see that we develop them. David, under your direction and invitation, I am sure they would respond.

DR. SATCHER: I appreciate that. That is a very good suggestion.

DR. SONDIK: I was just going to throw one word into Debbie's summary, which is data. I think it is going to be a continuing challenge, and particularly in the area of the disparity goal.

DR. SATCHER: Okay, let's see if we can meet that challenge. Thank you, all of you. You have been great.

[Whereupon, at 4:35 p.m., the meeting was adjourned.]

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