Secretary's Council on Health Promotion and Disease Prevention Objectives for 2010

DR. SONDIK: What I thought I would do is, given that the topic of data has come up so often, I would just highlight the points that have come up. I would like everyone to keep in mind Mike Friedman's framework, which I really think is very useful in thinking about data and thinking about--the framework of questions that we're thinking about, this entire effort. He said, where do these objectives actually come from? Are they a wish list, or is there some strategy for that? My understanding was, actually, that there really is a strategy for developing these objectives, and it's based on those areas or interventions that can have the greatest impact. Those were selected across the Department.

He also asked the question as to whether this is strategic or tactical. He asked, "Is this encyclopedic or focused?" and "What's the criteria for success?" We actually have been using the number of objectives that have been reached as a measure of success and we might want to keep that in mind.

All of this relates to the point that Phil Lee first brought up, which was framework. Coupled with framework, I would add philosophy. I was a little surprised, as I mentioned earlier, by the focus groups, because it seemed to me that part of what seemed to be missing was a philosophy as to how this was to be used. I thought it was actually perfectly clear, in my narrow view, but obviously it isn't. So, I think we need to keep that in mind as we put the overall effort--we put it all together.

Now, an aspect of the framework here is that we're talking about measurable objectives. This effort, I think, is really one of the most important things in the Department. I can't underscore how important I believe this is, because I believe it provides a framework, and has provided a framework, for the Department for prevention activities. I heard more today about how the various components are involved than I've heard before, but I felt that there's even more involvement than we heard today about this.

The thing that makes this so valuable, I believe, is its credibility. Its credibility is built on the fact that it's data-based, or has been, anyway, data-based and science-based. I don't think there's any question on the database, but there may be some issue about the science base when we start talking about targets for the objectives. I know that when we were--and I, personally, was involved in the Cancer Institute and NIH, actually was involved in the objectives. We were always worried about whether the science was there to buttress the interventions, and whether the targets were achievable. The broader we get in the interventions, the farther we start getting from what it is we know about the evaluation of various interventions.

This starts to raise some questions about the targets. But, at the same time, one has to keep in mind what Marty said earlier, that, in fact, local areas may very well take pieces of this and set their own targets. Nothing says that this is inviolate in any way, but still, in the document that was produced, my understanding was that the ground rule was that those targets be achievable in the minds of the scientists who put the document together.

So it's an aspect of data, as to what the baseline is at this point in time and how it is we're going to measure this target in the future, and of course whether or not that target is achievable. That's less data and more philosophy.

An area that's come up several times today, and I'm really, personally, very pleased about it, is, actually, technology. The technology--the point was made earlier that the health care system is going to be changing quite radically, and somehow we have to build that in this, but as far as data goes, I think we have to build into it, as well, that our data collection system is going to be changing very radically. The involvement of the private sector clearly will be changing. What we're going to be getting from local areas is going to be changing, in vital statistics as well as in surveys--the way we get this. I expect that technology is going to help us be much more responsive to what's going on in communities, and communicating this back on a much more frequent basis than we have, in the future, and we might want to plan for that, and that might change the framework a bit.

Now, an area that we did not concentrate on in the year 2000 objectives, but one that I believe we need to concentrate on for the year 2010 is in the local use of this document, this effort, and in particular local data. Since I've been at NCHS, it seems I hear at least once a week that local data is absolutely essential for buy-in. If people are going to take this activity, or any health-related activity, and apply it, they need to understand what's going on in their local community.

We need a strategy, as part of this effort, for developing that information, not necessarily us to develop it, but a strategy to help it be developed, and to help it be used, which raises another issue as well, which is training, and the local infrastructure for collecting and using this information.

Currently, there's relatively little that we support, or that the Federal government, in my knowledge in any case, supports in terms of the local development of data, the training of people to use that data, and apply it. I think it's absolutely crucial to this effort. It may well be that, by a closer involvement with the private sector on a local level, we can bridge this gap, but I think it's quite important.

Also, in addition to the local use of the data-- that's sort of point number one. Point number two is the point that was raised about how this effort intersects with the other Department efforts that relate to a framework for prevention. By this, I mean performance measurement, and I mean GPRA. The point has been made. I don't have any specific answers to that, other than, clearly, we need to coordinate this. I think this is going to be a significant challenge for us in the future.

I mentioned the private sector. I think this is very important in terms of the development of a collection of data and supplying of data to us to be used in this effort. We have not built on this in the past at all, and I think it's critical that we do it in the future. As I mentioned, this clearly relates to information about the local area.

I think the most difficult area to deal with with respect to data has to do with the specific populations, which has been raised by several of us here. I think we've got a problem here on several levels. First of all, we have a practical problem in terms of getting data on these populations. We, speaking of NCHS, met with Craig Vanderwagen a couple of weeks ago and discussed how it is that we develop data that is of sufficient detail to be useful to the Indian Health Service and the tribes. We simply don't have enough resources in NCHS to be able to do this. We need to be able to develop a strategy for gathering this information, clearly, over time.

In order for us to deal adequately with the problems as far as Healthy People goes, with the problems of American Indians, of any of the specific subpopulations that we might identify, we need an enormous amount of information that, at this point, we really have very little of. It's, I think, an important issue as to how we're going to develop that information. We need a strategy for doing this over this period of time, over this decade. I hope that that strategy--in fact I think it's absolutely critical--that that strategy be coupled with what it is we're doing in development of the 2010 document, of the 2010 objectives.

We have a philosophical issue related to data on specific populations. Craig actually said it, I thought, very well earlier. Again, it was repeated when Earl was discussing the framework for Healthy People 2010. That is, where do we set--it's quite clear that we need a baseline that's credible, that represents where these populations are today. But, then, where do we set the target? Do we set the target so that we, as it says on goal six, "eliminate health disparities," so that the target is the same for all populations, or do we set the target at a level that reflects the progress that one believes one can make over the period 2000 to 2010?

It's a data issue in that it tells us something about the precision of the information we're going to need, how frequently we're going to need that information, and reflects I think enormously on the entire credibility of the effort.

The point was raised earlier that perhaps we need different types of objectives. Perhaps we need an objective that says, this is where we ought to be with respect to rapes, and another objective that says this is how far we believe we can go during this decade. I think a lot of thought has to go into this, as to how these different--having multiple objectives is going to be viewed by the community.

Now, the area that I think is perhaps most difficult, and the one that I've implicitly mentioned, is in finding the resources to get the information that we're going to need in order to develop the credible database for 2010. There's a list of the various data sources in here under the data issues chapter. If one looks at this, you can see that a variety of different types of surveys from across the Department--actually this doesn't seem to spell T U R F. In fact, it seems to spell rather a community effort here on the part of the Department to develop this information.

Resources that need to go into this are really quite large, and we recently found an issue in finding the resources, or have an issue in finding the resources to do the latest supplement to the Health Interview Survey that will give us a very large number of endpoints for this decade. Again, what I think we need is a strategy that integrates this effort across the Department, and consider the responsibility of the individual agencies. Consider what amounts to cross agency responsibility, some activities that are the responsibility of the Department, and the strategy by which we're going to work with State and local sources for this information. I think it's important that we, to the extent possible, lay out these resources ahead of time and have a fairly good handle on when we're going to be collecting what information.

One of the great potentials here, given Kennedy-Kassebaum and the standardization of information, and the interest in BRFS, in fact, I think Healthy People has really been--that's the Behavioral Risk Factor Study that CDC runs across the country--I think Healthy People has really been one of the major influences in the success of BRFS. Collecting this information at the local level, and considering the possibility of being able to aggregate this and use this at the national level raises the question of maintaining the privacy and the confidentiality of this information, which is a challenge and one that I know the Kennedy-Kassebaum implementation effort on the part of the National Committee on Vital and Health Statistics is addressing, but clearly more needs to be done with respect to that.

I guess those are the major issues that I see with respect to data. It's critical again that we not lose the credibility of this activity. Again, it's based on--it's a very, very strong database, objectively collected and has targets that are achievable as identified by the science.

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