Agenda Item: Goals of the Meeting

DR. SATCHER: Thank you very much. Let me welcome you to this meeting of the Secretary's Council on Health Promotion and Disease Prevention Objectives for 2010. My name is David Satcher. I am Assistant Secretary for Health and the Surgeon General. I am delighted to be able to serve as Vice Chair of this very important Council.

I think most of you know we have a very busy steering committee within the Department working on 2010 objectives for Healthy People. We have this very important Council reviewing the work of the steering committee and input that the steering committee is getting from people outside.

Then we have a Consortium which actually consists of about 350 groups around the country that will certainly come together in November before we finalize objectives. So, there are three levels of this work.

I think this Council is certainly key for many reasons. One of them, of course, is because it has such distinguished representatives. I speak specifically about the former Assistant Secretaries for Health who serve on it and who help us to consider the issues involved. We are very pleased to have them with us today.

I think what I want to do is go around the room and have us introduce ourselves, starting with the former Assistant Secretaries, including the one who came by my house the other day to see how things were, Bob Windom.

(Introductions made around room.)

DR. SATCHER: Okay, thank you very much. Even though we are not taking the time now to introduce all the people who are gathered here, we do plan to have a period in the afternoon when we call for public comment. I take that very seriously. So, we are going to do our best to reserve time for that this afternoon. Let me just take a few minutes to discuss the agenda.

The Secretary is going to be joining us, hopefully in a few minutes, to make some comments and to spend some time with us this morning. So, we are looking forward to that. In the process, she will swear in Dr. Ed Brandt as a member of this Council. Dr. Brandt was not here the last time we met, so the Secretary will swear him in.

We have three goals for this meeting. One is to recommend a framework for Healthy People 2010. That is very important because I think one of the most important things we have to do is communicate the objectives for Healthy People 2010. I think that having the right framework will help us to more clearly, if you will, communicate 2010 than we have in the past.

We ought to be getting better at this. We have people around the table who have been involved in this for many years, some of them since the beginning. So, I think we are getting better at this, and we ought to be getting better at communicating to the broader public the objectives for 2010. So, we are looking for the framework that will allow us to do that.

The second goal of the meeting is to review and discuss draft objectives for 2010 and, finally, to spend some time doing something that I don't think we have done before, and that is to examine the various scenarios for the future, what-if kinds of things and how those various scenarios could, in fact, impact on the Healthy People 2010 objectives.

Those are the three goals of the meeting, to recommend the framework for 2010, to review the draft objectives, and to examine the scenarios.

Let me say that we have just been joined by another former Assistant Secretary for Health and Surgeon General, and that is Dr. Julius Richmond. A Surgeon General's report in 1979 initiated the whole concept of Healthy People, and we are very grateful to him. Julie, welcome.

The second item on the agenda will be to discuss the whole concept of eliminating health disparities. I really think the Secretary, by making a very courageous decision to adopt as this Department's contribution to the race initiative the whole idea of eliminating disparities in health among racial and ethnic groups in six very important areas -- I think that in itself really challenges us as we look at 2010 objectives.

We are going to have a pretty incisive discussion of what that means and what some of the pros and cons are of considering setting as our goal eliminating health disparities; what are the issues; what are the challenges. Peggy Hamburg and Clay Simpson will lead the discussion of eliminating health disparities.

Then we will have a report on the public comments on the proposed 2010 framework, options for publication in the fall of 1998. Dr. Earl Fox will lead that discussion.

Let me just say here, I will have to leave somewhere around that time to go over to the Hill to testify before the Women's Congressional Caucus. They said, if anybody would understand that, it would be your former Assistant Secretaries for Health. So, I will have to leave, I guess around 9:30, and Earl will take over the chair of the meeting.

The next agenda item will be the development of objectives for 2010, and we are going to hear from each of the agencies that is involved in that, and have time for discussion of those objectives for 2010.

By that time, I think we will be ready for lunch, if this goes according to plan, and come back after lunch and discuss setting the context for 2010 objectives, and also have Mike McGinnis lead us in a discussion from the National Academy of Sciences on leading health indicators for the future.

Lauren Leifer is with us to lead us in a discussion of the business community's perspective on Healthy People 2010. So, we are looking forward to that. The Partnership for Prevention has this Business Advisory Council. Lauren chairs that Council and will be discussing that with us later on. I think that is a tremendous addition to these deliberations. Then we will wrap up today by reviewing the recommendations and next steps.

Any questions, comments about the agenda? Any concerns? Is everybody comfortable with that agenda? There are going to be some changes, I know, because primarily people like Michael Friedman, John Eisenberg and I will have to be out more than we had planned because of things happening over on the Hill. Michael, I believe, will be making the FDA report after lunch -- right? John Eisenberg also will be making his report after lunch.

Since the Secretary is not here, let me then make some comments about this whole concept of eliminating disparities as a lead-in to Peggy's and Clay's presentation. As most of you know, Peggy Hamburg and I are co-chairing a departmental steering committee on eliminating disparities in racial and ethnic groups. We have selected six areas -- infant mortality, immunization, HIV/AIDS, cardiovascular diseases, diabetes and cancer.

Peggy is going to talk about that a little bit, and then Clay is going to lead us in a more extensive discussion of what the implications are, as we look to 2010, for approaching the objectives from the standpoint of eliminating disparities, as opposed to reducing disparities.

There are some very important pros and cons that we need to be aware of, because we need to know what we are doing.

We have had a lot of discussion with outside groups. There is overwhelming support for the idea of having an approach of eliminating disparities, as opposed to reducing disparities. I think you can understand that. Let me just give an example. If you take infant mortality, we say that today the infant mortality rate for African Americans is 14 per thousand, and for a white baby the risk of dying in the first year is six per thousand.

Sort of logically, as you look over the next 10 years, you would say, well, if we are going to make progress and even if we are going to make equal progress, we would expect the rate for white infants to go from six to, let's say, four, and maybe for an African American infant it would go from 14 to 10 or to 8. That is the way we have approached it, and there is a logic about that; there is no question about that.

There is another kind of logic, however, that relates to adopting a concept of eliminating disparities. It requires, I think, a different kind of commitment than we have made in the past in terms of really focusing. For example, the Surgeon General's report released this week on smoking among racial and ethnic minority groups was an attempt to focus on those four groups in a way that we haven't before. I think most people would agree that we learn something by focusing that we didn't know before. We learned something about American Indians and Native Alaskans and smoking patterns. We learned something about smoking patterns in African Americans, especially the recent change for African American youth.

So, there are advantages for adopting the goal of eliminating disparities in terms of the nature of the programs and the nature of the way you focus. Of course, there are some very important disadvantages there, too, the risk of failure being one of them, and what it means if you fail. How do people in the public respond when you set objectives and then you fall far short of them? I think what we are trying to do is balance the pros and cons of setting the goal of eliminating disparities, and that is what the discussion is going to be about with Clay, in terms of experiences we have had, and discussing this perspective with various groups.

Let me just say a little bit about the Secretary's commitment to eliminating disparities in those six areas, because I think we face similar kinds of concerns in those six areas. Obviously, six areas are more manageable than the number of objectives that we are going to be talking about, but I think we were trying to send some messages in doing that.

Number one, we were trying to say that we value equity and we value equality in health. Therefore, our contribution to the discussion of race in this country would be to eliminate disparities, and to go all out to do that, knowing that we were really going to have to pull out a lot of stops in order to achieve those goals.

The other thing that I think is very important that we have been trying to communicate is that it is not a zero-sum game. We don't believe that we have to take anything away from one group in order to bring another group up.

I would like to refer to our experience with the immunization program over the past five years. In 1990, we decided to set some national goals and we set the same goals for every group. We wanted 90 percent of children by the age of two to have reached all the major vaccines. We reached the national goal. In order to do that, we had to make much more progress with African Americans and Hispanics than we did with white children, because we had further to go. The bottom line is that we improved the infrastructure for immunizations in this country, especially the community infrastructure. In getting to 90 percent, we improved immunizations for everybody. The only way we could do that, we had to make a lot of progress for some groups, maybe less progress for others, but we raised it for everybody because we had to develop an enhanced system of public health relative to immunizations.

So, it is not a zero-sum game. If you are going to focus on those who are at the bottom, if you will, you are going to have to change the way you do business. If you do that, everybody is going to benefit. That is the thinking; that is the logic; and that is how we are pursuing the six areas for eliminating disparities relative to race and ethnicity.

Any comments on that before I call on Clay? So, I have given half of it already, at least? Yes, Bob.

MR. WINDOM: Certainly we want to eliminate them. The question is, in a decade can we do it? And is it better to maybe set some achievable goal to show some realistic gain, than to say all the way and not get all the way?

DR. SATCHER: I think that is the question. There are pros and cons. Clay is going to comment on that. Any other comments?

Okay, Clay, why don't we go to you. You understand that, when the Secretary comes, we will interrupt, because we need to take advantage of her time in being here. Wherever we are at that time, we will stop so that the Secretary will be able to make her comments. For those who don't know, Dr. Clay Simpson is Deputy Assistant Secretary for Minority Health. He runs the Office of Minority Health.

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