 |
 |
|
 |
||
Print 
Download Reader 
|
|
|
|
||
Print Download Reader
OFFICE OF PUBLIC HEALTH AND SCIENCEFY 2003 PERFORMANCE PLANThe Office of Public Health and Science (OPHS) provides leadership to the Nation on public health and science issues that are important to the American people. OPHS policy, program and operational components make it unique among the Staff Divisions in the Department of Health and Human Services (HHS). OPHS is led by the Assistant Secretary for Health (ASH), a key leadership position in HHS whose chief interests are promoting, protecting, and improving the Nation's health. The ASH provides senior professional leadership on population-based public health and clinical preventive services, directs thirteen program offices housing a variety of essential public health activities, provides senior professional leadership across HHS on White House and special Secretarial initiatives involving public health and science, and guides and provides technical assistance to the ten Regional Health Administrators. OPHS consists of the Immediate Office of the ASH, the Office of the Surgeon General (OSG), the Office of HIV/AIDS Policy (OHAP), the Office of Population Affairs (OPA), the Office of Disease Prevention and Health Promotion (ODPHP), the President's Council on Physical Fitness and Sports (PCPFS), the Office of Minority Health (OMH), the Office on Women's Health (OWH), the Office of Emergency Preparedness (OEP), the Office for Human Research Protections (OHRP), the Office of Global Health Affairs (OGHA), the Office of Research Integrity (ORI), the Office of Military Liaison and Veterans Affairs (OMLVA), and the National Vaccine Program Office (NVPO). These offices are actively engaged in a broad array of activities that support and facilitate the work of many of the Department's Operating Divisions. OPHS Theme/Priorities OPHS has developed a theme, priorities, enabling objectives, and common strategies based upon the 5-year HHS Strategic Plan, ASH priorities, and special annual initiatives. The theme of OPHS is Healthy People in Healthy Communities through Public Health and Science. By applying sound science to public health policies and programs, and by educating people and communities about prevention, health, and the health care system, OPHS will stimulate research, policies, and interventions that will improve the Nation's health. OPHS will focus its efforts on three health priorities: 1. Move toward establishing a balanced community health system a. Assure every child the opportunity for a healthy start in life; b. Promote healthy lifestyles and behaviors; c. Enhance mental health for all; and d. Strengthen the health sciences research enterprise. 2. Maintain a global approach to public health a. Increase awareness of and attention to global health concerns and their effects on the domestic issues; and b. Ensure a safe food and blood supply and prepare for and respond to terrorism threats. 3. Eliminate racial/ethnic disparities in health OPHS will achieve success with these three priorities by employing the following cross-cutting strategies: Strengthen the science base for decision-making by fostering research integrity, protection of human research participants, demonstration projects, and evaluations; Improve the policies, programs and practices required to achieve priority objectives;
OPHS values collaboration and works in partnership with other HHS components, as well as a variety of other Federal agencies (including the Departments of Education, Justice, Labor, Agriculture, Defense, State, Transportation, Commerce, Energy, Housing and Urban Development, and Veterans Affairs; the Environmental Protection Agency; the Federal Emergency Management Agency; and the US Consumer Product Safety Commission), tribal, State and local governments, health departments and agencies, the academic community, health providers, national professional associations, tribal, national and international health-related organizations, community-based organizations, minority community-based organizations, faith-based institutions, the media, advocacy groups, the business community, foundations, the public, Congress, and others. Through its program offices, OPHS has established close ties with stakeholders who are critical to addressing significant public health and science issues in the Nation and around the world. OPHS Role and Contributions OPHS' essential role in achieving each priority is to provide leadership, assess national health trends and problems, stimulate serious debate, engender creative ideas, and give critical visibility to health problems, needs, and solutions. Investments in programs and activities that are effective pay off heavily in the improved health and productivity of the American people and our global partners. The results - better health for individuals and longer life spans - are highly valued by the public. Of the strategies utilized by HHS and OPHS, most include a combination of research, prevention, public health programs, public education services, and regulation. OPHS contributes by: Building a Stronger Science Base
Influencing and Improving National Policy
Promoting Effective Partnership Activities
Engaging in Strategic Communication
External Factors OPHS is committed to assuring sustained progress and improved health outcomes within each priority through coordinated public and private efforts. The effectiveness of OPHS's activities are essential to the achievement of this ambitious goal, but its programs and activities alone cannot assure success. The problems underlying OPHS's priorities are complex and reach beyond the control and responsibility of any one arena or effort. Achievement is dependent on various health programs and providers, all levels of government, and the efforts of the private sector as well as individual contributions. While external factors beyond the control of OPHS may affect outcomes (including factors such as legislative and court decisions; education and social services; availability of resources; and shifts in the economy and demographics), OPHS's essential role in achieving each priority is to provide leadership, assess national health trends and problems, stimulate serious debate, engender creative ideas, and give critical visibility to health problems, needs, and solutions. OPHS continues to strive to better measure and communicate the ways in which its contributions improve the health of the US population. Where data for FY 2001 reporting is unavailable, we have indicated estimated dates for receipt of final data where possible. In assessing achievement of goals, it is appropriate to note that OPHS activities are but some of the many public and private contributions necessary to achieving the goals and priorities set out in this plan. Target Setting, Data Sources and Validation for Performance Measurement Most performance measures in this plan were selected from among the nationally-recognized health objectives of Healthy People- the state-of-the-art for consensus on population-based health status outcomes. Healthy People objectives contain decade-long targets. OPHS based its performance measures for FYs 1999 and 2000 on objectives from Healthy People 2000 (launched in 1990 with health targets for the year 2000), and performance measures for FY 2001, 2002, and 2003 on Healthy People 2010 (final edition released November 2000 with health targets for the year 2010). The targets for the 317 objectives in Healthy People 2000 were challenging. Although 60�percent of the objectives were either met or are moving in the right direction, there are areas where progress is not so clear. For the purposes of this performance report, OPHS has selected targets consistent with Healthy People 2010, the nation's health agenda for the first decade of the twenty-first century. It contains two goals, 467 objectives, and 28 focus areas. Each year, the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention publishes the most recent data on progress towards the Healthy People targets. The data produced by NCHS are compiled from State and local public agencies, Federal surveys and other data sources. The data are used for a wide variety of purposes by Federal, State and local officials; researchers; legislators; the media; the public; and others. The validity of these data has been subjected to internal and external scrutiny.(1) [Note: Healthy People 2010 was released in January 2000 as a conference edition. New data were added and the final edition was released in November 2000. Baselines drawn from Healthy People 2010 were updated to be consistent with the updated document, as appropriate.] OPHS proposes to use the most recently published NCHS data as its primary source for performance measurement whenever possible. For performance measures that are not included in Healthy People, and therefore not monitored by NCHS, other data sources have been identified. OPHS's use of NCHS data provides many benefits. For example, the data have been subjected to intense review and are regarded as the "gold-standard" for health information. Without NCHS data, OPHS could not include health outcomes - of the utmost importance to Congress and the American public - as performance measures. In addition, OPHS will not need to invest significant resources in the development of monitoring systems for its performance measures. These factors are consistent with Congress's intent for GPRA. One problematic aspect of relying on NCHS data is that there will be a lag in reporting on the performance measures. For the measures based on mortality or death rates, the lag time will be 1 to 2 years; for measures based on behaviors and morbidity, the lag time is likely to be 2 to 3 years. On balance, OPHS considers the strengths of the data to outweigh the weaknesses. For those performance measures based on Healthy People 2010 objectives, whenever more recent and more complete baseline or actual performance data are available from the Data 2010 database (http://wonder.cdc.gov/data2010/obj.htm), such data are now used in the performance plan and report. If more recent and more complete baseline or actual performance data are not available from Data 2010, then data are obtained from the specific data source for the objective in question (e.g., National Vital Statistics System, HIV/AIDS Surveillance System). Measuring OPHS Progress The three priorities of OPHS are presented in the following sections. Each section presents a list of OPHS offices that contribute to goal achievement, a brief description of significant OPHS contributions and context for performance, a performance summary of past fiscal year activities, a listing of performance measures with baselines and targets for performance and the latest actual performance data available, and links of OPHS measures with the HHS strategic plan. OPHS PRIORITY 1: MOVE TOWARD ESTABLISHING A BALANCED COMMUNITY HEALTH SYSTEM This balanced community health system must include health promotion, disease prevention, early diagnosis, and universal access to quality care. It must be grounded at the community level, calling on the serious involvement of civic and other local groups, community schools, and faith-based organizations to work in concert with the health system both public and private. And, finally, it must be supported by a strong and balanced research agenda. 1(a) Assure every child the opportunity for a healthy start in life The type of start a child experiences plays a major part in determining that child's future. A healthy start involves several things - the health of the parents and whether they are experiencing a planned pregnancy, and whether either or both of them are teenagers. It relates to the health of the mother, including whether she has access to quality prenatal care. And it involves the health concerns of the baby in utero, ranging from reducing the risk of having HIV transferred from mother to child to avoiding exposure to tobacco, alcohol, and crack cocaine in utero. We also must focus on issues affecting the newborn, including breast feeding and nutritional habits and the sleeping position the parents select for the baby. A healthy start also means looking at a child's environment and making sure that it is safe and nurturing, offers protection from infectious disease through access to immunizations, and is free from toxins, violence and abuse, as well as unintentional injury. We know that children develop best in supportive environments where there are loving, caring adults who will take the time to read to them and stimulate their senses. OPHS Contributing Offices The Office of Population Affairs, Office of Disease Prevention and Health Promotion, Office of HIV/AIDS Policy, Office of the Surgeon General, Office of Minority Health, Office on Women's Health, National Vaccine Program Office, and Office of Research Integrity. OPHS Role and Contributions OPHS's essential role in achieving each priority is to provide leadership, assess national health trends and problems, stimulate serious debate, engender creative ideas, and give critical visibility to health problems, needs, and solutions. OPHS - together with HHS agencies and other partners - invests in programs and activities that are effective in providing a healthy start for children. Some examples of the direct contributions of OPHS include: Building a Stronger Science Base
Influencing and Improving National Policy
Engaging in Strategic Communication
Promoting Effective Partnership Activities
� FY 2001 Performance Summary OPHS is committed to assuring sustained progress and improved health outcomes within each priority through coordinated public and private efforts. The effectiveness of OPHS's activities are essential to the achievement of this ambitious goal, but the problems underlying OPHS's priorities are complex and reach beyond the control and responsibility of any one arena or effort. Achievement is dependent on various health programs and providers, all levels of government, and the efforts of the private sector as well as individual contributions. In FY 2001, OPHS continued to move toward assuring every child the opportunity for a healthy start in life, through building a stronger science base, influencing national policy, promoting effective partnerships, and engaging in strategic communications. The birth rate for teenagers continued its steady decline since the early 1990s - between 1991 and 2000 (the latest year for which data are available) there was a 29 percent drop in the birth rate for teenagers 15-17. The percent of women who began prenatal care in the first trimester of pregnancy was 83.2 percent for 2000, the same as the level reported for 1999. The proportion of women with timely prenatal care had improved steadily between 1989 and 1999, rising from 75.5�percent. This measure has shown steady progress during the 1990s, with the most notable increase being among black and Hispanic women, with an increase of approximately 25 percent over the last decade. Among the factors accounting for the overall falling birth rate among teenagers are decreased sexual activity, increases in condom use, and the adoption of injectable and implant contraceptives. Within the larger public health framework, OPHS's Office of Population Affairs and the programs it administers (the AFL program and the Family Planning Program) play a central role in assuring a healthy start for every child by preventing unintended and adolescent pregnancies, providing abstinence education for adolescents, and providing related preventive health care and counseling. In an effort to promote effective partnerships to reduce adolescent pregnancy, the AFL prevention projects continue to focus on abstinence as the most effective method of preventing adolescent pregnancy and sexually transmitted infections. In 2001, the program supported 73 prevention projects focusing on encouraging adolescents to remain abstinent and served an estimated 91,000 adolescents. The program also supports care projects which work with pregnant and parenting adolescents to assure healthy outcomes for themselves and their children. In 2001, the program funded 37 care projects providing almost 22,000 pregnant and parenting adolescents, their families and infants with access to health (including prenatal care) and social services. In 2001, the family planning program, the primary provider of subsidized family planning services for low-income individuals, provided funding for service delivery grants to 91 public and private organizations supporting a nationwide network of more than 4,500 family planning clinics. Title X provide reproductive health services to approximately 4.4 million persons each year, enabling women to avoid unintended pregnancies. Pregnancy testing is a common and frequent reason for women coming to visit a clinic, and family planning is often an access point for women entering early prenatal care. The program also plays an important role in adolescent pregnancy prevention. Approximately 30 percent of those receiving services are under 20 years of age. In addition to clinical services, outreach and education (including counseling to encourage continued postponement of sexual activity for adolescent clients who are not yet sexually active) are important components of family planning services for adolescents. The reduction of new perinatally acquired HIV infections has also been a high priority for the Department since the definition of effective treatment options that reduce the risk of transmission from mother to child. OPHS has coordinated a Department-wide effort across the research, prevention and treatment arenas to maximize opportunities to reduce the incidence of new perinatal HIV infections. HRSA, CDC and SAMHSA all have extensive program efforts in place to reach and offer pregnant women with HIV infection effective treatment for their own illness and to reduce the risk of perinatal transmission. The U.S. has seen dramatic reductions in perinatal HIV transmission rates in the past decade; these initiatives have been successful in dropping the number of new perinatal AIDS cases diagnosed each year, with 102 cases diagnosed in FY 2000 compared to a target level of 203 cases, well exceeding the target set. Surveillance data reported through December 2000 show sharply declining trends in perinatal AIDS cases, showing a reduction of 69 cases from the FY 1999 level of 171 cases (to 102 cases in FY 2000), or a 40 percent reduction; this decline was strongly associated with increasing zidovudine (ZDV) use in pregnant women who were aware of their HIV status, at delivery, and in treatment of the infant after birth. More recently, improved treatment also likely delayed onset of AIDS for HIV-infected children. These declines also reflect the success of widespread implementation of PHS recommendations for routine counseling and voluntary HIV testing of pregnant women. With efforts to maximally reduce perinatal HIV transmission and increase treatment of those infected, declines are likely to continue but may be affected by treatment failures and missed opportunities to prevent transmission. In 2001, the Adolescent Family Life program took several steps to promote effective partnerships between the grantee, their staff and the clients they serve. The program initiated a training program for its prevention grantees and the front-line staff who work with adolescents. The training focused on providing front-line staff members with an opportunity to improve their skills in communicating and working with youth. In 2002, the program will continue to conduct another series of training workshops for staff in prevention and care projects. The OPHS Office of Population Affairs also contributes to building a stronger science base through funding support for national surveys such as the National Survey of Family Growth, a periodic survey of a national sample of women 15-44 years of age which collects data on factors affecting pregnancy and women's health in the United States. The survey collects data on a wide range of topics including: pregnancy and birth, marriage, divorce, cohabitation, sexual intercourse, contraception, infertility, use of family planning and other medical services, health conditions and behavior. OPA is providing an estimated $4 million over the period FY 1998 - 2002 to support the development, testing and implementation of the next survey cycle, which will include a sample of men for the first time. In 2001, the OPA worked with the National Center for Health Statistics and other funding partners to ensure that there will be reliable national data focusing on marriage and cohabitation, sexual behavior and reproductive health, including risks related to the transmission of HIV or STDs. Finally, in the area of influencing national policy, OPHS's Office on Women's Health led the development and publication of the HHS Blueprint for Action on Breastfeeding released by the Surgeon General. The Blueprint establishes a comprehensive policy for the nation to improve children's health by promoting the benefits of breastfeeding through the family and community, workplaces, and the healthcare system. Over 70,000 copies of the Blueprint have been distributed. In addition, collaborations have been formed with the American Association of Health Plans, American College of Obstetricians and Gynecologists, and the African American Breastfeeding Association. A National Breastfeeding Media Campaign and community outreach will be launched in FY 2002. In addition, Surgeon General reports released in 2001 addressed the health needs of children and adolescents, including the Report of the Surgeon General's Conference on Children's Mental Health: A National Action Plan, Youth Violence: A Report of the Surgeon General, and The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. Performance Measures
Related HHS Strategic Goals
1(b) Promote healthy lifestyles and behaviors Promoting healthy lifestyles means paying greater attention to physical activity. We have found that if we can get people who are sedentary up and moving for 30 minutes a day five days a week, we could greatly enhance the health of the nation. It also means allotting greater attention to nutrition by encouraging people to follow the Dietary Guidelines for Americans, including eating at least five servings of fruits and vegetables each day. It means encouraging people to avoid toxins, like tobacco, excessive alcohol and illicit substances. And it means educating people so that they commit to responsible sexual behavior. By reducing tobacco use, we will improve health outcomes in the areas of cancer, cardiovascular disease, lung disease, and low birth weight and other problems of infancy. Diet and activity behaviors are associated with chronic health problems such as heart disease, hypertension, diabetes, osteoporosis, obesity, and certain types of cancers. Abuse of alcohol and illicit drugs results in motor vehicle fatalities, violence, and other deleterious health, social and economic consequences. Unsafe sexual practices are associated with sexually transmitted diseases, including HIV/AIDS, and hepatitis, as well as unintended pregnancies. Oral health is also an important component of healthy lifestyles. OPHS Contributing Offices Office of the Surgeon General, Office of Disease Prevention and Health Promotion, President's Council on Physical Fitness and Sports, Office of HIV/AIDS Policy, Office of Minority Health, Office on Women's Health, Office of Population Affairs, Office of Global Health Affairs, and Office of Research Integrity. OPHS Role and Contributions OPHS's essential role in achieving each priority is to provide leadership, assess national health trends and problems, stimulate serious debate, engender creative ideas, and give critical visibility to health problems, needs, and solutions. To reduce the number of premature deaths, OPHS - together with HHS agencies and other partners - invests in programs and activities that are effective in reducing or eliminating behavioral threats, resulting in improved health and productivity of the American people. Some examples of the direct contributions of the Office of Public Health and Science include: Building a Stronger Science Base
Influencing and Improving National Policy
Engaging in Strategic Communication
Promoting Effective Partnership Activities
FY 2001 Performance Summary OPHS is committed to assuring sustained progress and improved health outcomes within each priority through coordinated public and private efforts. The effectiveness of OPHS's activities are essential to the achievement of this ambitious goal, but the problems underlying OPHS's priorities are complex and reach beyond the control and responsibility of any one arena or effort. Achievement is dependent on various health programs and providers, all levels of government, and the efforts of the private sector as well as individual contributions. In FY 2001, OPHS continued to promote healthy lifestyles and behaviors through building a stronger science base, influencing national policy, promoting effective partnerships, and engaging in strategic communications. Through the Office of Population Affairs, OPHS contributes to departmental efforts to reduce the incidence of sexually transmitted diseases, specifically those addressed in measures 1.10, 1.11 and 1.12. Related to performance measure 1.10, in 2000 (the latest year for which data is available), the median chlamydia test positivity among 15-24 year old women who were screened during visits to selected family planning clinics in all states and the outlying areas was 5.9�percent. After adjusting trends in chlamydia positivity to account for changes in laboratory test methods and associated increases in test sensitivity, chlamydia test positivity decreased in four of ten PHS regions from 1999 to 2000 and increased in six regions. Although chlamydia positivity had declined in the past year in some regions, most likely due to the effectiveness of screening and treating women, continued expansion of screening programs to populations with higher disease prevalence may have contributed to the increases in positivity seen in other regions. With regard to the incidence of gonorrhea (performance measure 1.11), following a 72�percent decline in the reported rate of gonorrhea from 1975 to 1997, in 2000 the gonorrhea rate remained fairly steady as compared to the 1999 rate, which had reflected an increase for the second year in a row. Although increased screening (usually associated with simultaneous testing for chlamydia infection), use of more sensitive diagnostic tests, and improved reporting may account for a portion of the recent increase, true increases in disease in some populations and geographic areas also appear to have occurred. Finally, in reference to performance measure 1.12, between 1999 and 2000, the national rate of congenital syphilis decreased by 7.6 percent from 14.5 to 13.4 cases per 100,000 live births. The continuing reduction in congenital syphilis rates, evident since the early 1990s, reflects the substantial reduction in the rate of primary and secondary syphilis among women over the same period. One example of OPHS's use of partnerships to promote healthy lifestyles and behaviors is the Title X Family Planning program's continued collaboration with the CDC to implement effective prevention strategies designed to reduce the prevalence of chlamydia and its debilitating complications. The effectiveness of large-scale screening programs in reducing chlamydia prevalence has been well documented in areas where this intervention has been in place for several years. CDC estimates that every dollar spent on early detection can save an estimated $12 in complications-associated costs. The chlamydia prevention partnership, begun in 1987 as a demonstration project in PHS Region X, has now been expanded to all ten PHS regions. The success of this approach had been demonstrated by the fact that the chlamydia prevalence rate decreased by as much as 69 percent in Region X, where the program has been in place for more than ten years. Family planning clinics provide a broad spectrum of preventive health services in an effort to promote healthy lifestyles and behaviors. Title X clinics provide services to a population that matches the demographics of the population of women most at risk for sexually transmitted diseases (STDs) and HIV infection - primarily young (60 percent under the age of 25), low-income (65 percent under 100 percent of the federal poverty level), and minority (40 percent). Most clients are sexually active and in conjunction with contraceptive services, Title X-supported clinics have helped numerous women detect and obtain early treatment for a range of medical conditions, including sexually transmitted infections and HIV, as well as breast and cervical cancer. In 2000 (the latest year for which data are available), Title X clinics provided 2.9 million pap tests and 2.8 million breast examinations to family planning clients - seven pap tests and over six breast exams for every ten female family planning users. The program also provided almost 366,000 HIV tests to clients - about one HIV test for every twelve users. OPHS's President's Council on Physical Fitness and Sports (PCPFS) is involved in activities directly related to achieving performance measure 1.8, which addresses increasing physical activity among adults aged 18-74. In conjunction with the Healthy People 2010 objectives, PCPFS continues to work with schools and outside organizational components to promote regular physical activities/fitness and non-competitive sports as positive, healthy behavioral patterns. To improve health behaviors related to physical activity and fitness, PCPFS coordinates activities through its long-standing signature programs, the President's Challenge Physical Activity and Fitness Awards Program (for school and community-based achievement) and the Presidential Sports Award (for ages six to adult). During FY 2001, materials were distributed to more than 190,000 schools and organizations; more than five million young people participated in the President's Challenge in FY 2000. Following the recommendations of a President's Challenge special workgroup, comprised of PCPFS members, fitness professionals (representing such groups as the American Alliance for Health, Physical Education, Recreation, and Dance and the American College of Sports Medicine), the American Academy of Pediatrics, and individuals from academia noted for their expertise in exercise science and kinesiology, the PCPFS launched in the fall of 2001 the Presidential Active Lifestyles Awards Program to further enhance the adoption and maintenance of regular physical activity. This workgroup was instrumental in initiating an enhanced physical activity component which will empower and engage individuals to change behavior as well as address societal goals and objectives outlined in Healthy People 2010. This concept will be expanded to all adults in the Fall of 2002. During FY�2001, more than 400,000 brochures regarding the Presidential Sports Award program were mailed to the general public and sports organizations and groups. In response to goals established by the HHS Initiative to Eliminate Racial and Ethnic Disparities in Health, PCPFS translated materials on these two programs into Spanish and collaborated with the OMH clearinghouse for appropriate dissemination to Hispanic leaders, schools, and others. Efforts to build and strengthen coalitions and partnerships with minority organizations to enhance outreach to minority communities and youth will be addressed with the incoming administration's Council members. PCPFS promotes physical activity/fitness and sports through numerous partnerships and collaborative projects with Federal agencies and offices, as well as non-Federal organizations. PCPFS publishes a quarterly periodical, the PCPFS Research Digest, a synthesis of the latest scientific information presented in lay format, which is intended for use primarily by fitness, physical education, and allied health professionals. Otherwise, the PCPFS web site and publications are designed primarily for use by the general public. Using these two modes of communication, PCPFS received more than 50,000 inquiries during FY 2001 and also responded to a high volume of requests received by telephone and mail. The PCPFS staff functions in an advisory capacity to provide technical advice and assistance to individuals seeking funding, referrals to appropriate organizations, and other resource material about physical activity/fitness and sports. PCPFS has a well-deserved national reputation as a credible voice calling for increased physical activity/fitness and sports by Americans of all ages and is in a unique position to address cross-cutting issues, policies, and programs at Federal, state, and local levels. Also, the fifth edition of the Dietary Guidelines for Americans issued in May 2000 greatly expanded emphasis on the vital importance of physical activity to health. The guidelines advise adults to accumulate at least 30 minutes of moderate physical activity each day and recommend 60 minutes for children. These guidelines are promoted by all Federal nutrition education activities and are coordinated with HHS by the Office of Disease Prevention and Health Promotion (ODPHP), in collaboration with USDA. In addition, to alert the American public to the critical nature of the epidemic of overweight and obesity, one of the ten Leading Health Indicators of Healthy People 2010, and to mobilize national collaborative efforts to address it, The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity was released on December 13, 2001 in Washington, D.C. Further, OPHS (ODPHP) led the creation of the Leading Health Indicators (LHIs) which contribute to meeting performance measures 1.7, 1.8, and 1.9, relating to tobacco use, physical activity, and drug/alcohol abuse, respectively. These LHIs are a special subset of measures based on objectives in Healthy People 2010. Promotion of the LHIs indirectly contributes to meeting these performance measures by promoting awareness and driving action nationally about ways we can improve and assess the nation's health. ODPHP is currently preparing the first annual report on the status of the Leading Health Indicators, expected for release in 2002. The report will provide the latest data used to monitor the LHIs on a national and state level. During FY 2001, ODPHP complete development of a communications plan for the LHIs. A contract to begin implementation of the plan will be awarded in February 2002. Through ODPHP, OPHS is also engaged in overarching efforts that more generally promote the health of the nation. Two of these efforts are Healthy People 2010 and healthfinder®. Healthy People 2010 is a compilation of the Nation's health objectives for the first decade of the 21st century. Released by the Department on January 25, 2000, it reflects the thinking of a broad cross-section of the nation's public health scientists and planners. Central to Healthy People 2010 are its two overarching goals: (1) increase quality and years of healthy life, and (2) eliminate health disparities. To monitor the Nation's progress in attaining these goals, Healthy People 2010 identifies 467 specific objectives covering a comprehensive array of health issues. Each objective has a target for specific improvements to be achieved by 2010. The objectives are organized into 28 focus areas and were developed by work groups of experts with broad public input. To stimulate local, community-level activity that supports the national health goals of Healthy People 2010, ODPHP launched the Healthy People 2010 Community Implementation Program in FY 2001. ODPHP developed a Request for Proposals (RFP) for the new pilot program and issued it in July 2001; over 85 applications were received for two cooperative agreements. FY 2001 awards totaling $1.1 million were made to two intermediary organizations to conduct pilot projects to study the efficacy of microfinance to support Healthy People 2010 implementation activities by community-based organizations. The intermediaries will administer microgrants (of up to $2010 each) to local community-based organizations in their areas to focus on health promotion and disease prevention activities that link to Healthy People 2010 objectives and/or Leading Health Indicators. healthfinder® is the first Federal health information portal to provide easy public access to resources from Federal, State, and local agencies, voluntary and professional organizations and other reliable non-commercial sources. healthfinder® was the first to organize content by topics and audiences rather than by agencies or organizations. healthfinder® now links to over 4,500 carefully reviewed resources from almost 1,900 selected organizations. Its easy-to-use searches direct users efficiently to specific resources across the country. Statistical measures of increased access confirm the site's success: the number of visits to the site has increased from 1.6 million in its first full year of operation (April 1997-March 1998) to 3.8 million in 2001, or a 138 percent increase. healthfinder.gov has increased the total number of resources and organizations reviewed and linked from 1,600 to 6,400, or a 300 percent increase. In addition, more citizens are accessing a wider range of quality information every month. In 2001, healthfinder® was redesigned and a new Spanish-language version of the site was released, along with one especially for children 8 to 12. In 2002, new sections targeting additional under-served populations are planned. As for its goal of improving access to Federal health information specifically, healthfinder.gov now directs users to other Federal health web sites an average of 200,000 times each month. In addition to healthfinder®, many other OPHS activities target strategic communications to highlight the importance of health lifestyles and behaviors. For example, OWH has launched "Pick Your Path To Health," a community-based health education campaign targeting women of color. More than 100,000 booklets containing action tips were distributed nationwide through over 20 local and national conferences, regional offices, the National Centers of Excellence, community groups, media outlets, and national partners in the communities. Partnerships have been developed with more than fifty private sector groups that actively promote the campaign, its themes and weekly action steps to a healthier lifestyle. Weekly news articles on how to improve healthy lifestyles are placed with a news syndicate reaching more than 200 community papers, including 26 news articles reaching African American community newspapers and two news articles in Spanish-language newspapers reaching Latinas. In September 2001, OPHS initiated a new partnership with the ABC Radio Networks and ABC Radio's Urban Advantage Network to inform minority communities on ways to achieve better health and close the health gaps between them and the rest of the U.S. population. This partnership aims to inform and educate African Americans about the health gap and empower individuals to adopt healthier lifestyles through a health information and education campaign entitled "Closing the Health Gap: Reducing Health Disparities Affecting African Americans." In FY 2002, in collaboration with OASPA, this new partnership is being expanded and strengthened. In December 2001, OWH released the second "report card" on women's health, Making the Grade on Women's Health, which included a special chapter on women and cardiovascular health. The "report card" is designed to provide policy makers, heath care planners and providers, educators, researchers, advocates and the public with a comprehensive assessment of women's health and to establish a framework to measure progress. Also, the HHS GirlPower! Campaign targeted at 9-14 year-old girls and the adults who care about them creates PSAs, programs, and activities to assist girls in realizing their full potential. A GirlPower! Community Education Kit has been designed to help those who work with girls to create programs with messages that girls have the right to be the best that they can be - confident, fulfilled, and true to themselves. GirlPower! uses interactive educational materials to help girls develop the skills they need to resist unhealthy influences and to make positive decisions in their lives. Topics covered include eating disorders, illicit drug and tobacco use, chronic illness and disability, and science careers. In FY 2000, there were 60 National Endorsers and 9,000 local programs using Girl Power! materials, and approximately 2 million hits per month on the web site. Finally, the BodyWise evaluation was conducted in FY 2001 to assess whether school nurses report a shift in school practices and exhibit changes in behaviors, attitudes, and knowledge after exposure to BodyWise, an OWH program to increase awareness and knowledge of eating disorders. Not only did results indicate positive trends in each of theses areas, nurses also exhibited increased awareness about how eating disorders and related issues are handled in their schools. Performance Measures
Related HHS Strategic Goals
� 1(c) Enhance mental health for all OPHS will work to enhance mental health and mental illness services for all Americans. OPHS efforts will be focused on reducing the stigma of mental illness, finding effective mental health promotion and mental illness prevention strategies, detecting mental health problems early and assuring that mental health/mental illness services are utilized for cure and care. Mental health problems often relate to other serious health problems, including substance abuse, suicide and violence. The first ever Surgeon General's Report on Mental Health has brought the latest science on mental health/mental illness into the domain of all Americans. OPHS must follow that release with outreach, education, and collaboration with mental health advocates to move mental health squarely into the mainstream of health care for all. OPHS Contributing Offices Immediate Office of the ASH, Office of Disease Prevention and Health Promotion, Office of Emergency Preparedness, Office of Minority Health, Office of the Surgeon General, Office on Women's Health, President's Council on Physical Fitness and Sports, Office for Human Research Protections and Office of Military Liaison and Veterans Affairs. OPHS Role and Contributions OPHS's essential role in achieving each priority is to provide leadership, assess national health trends and problems, stimulate serious debate, engender creative ideas, and give critical visibility to health problems, needs, and solutions. OPHS - together with HHS agencies and other partners - invests in programs to improve the mental health of Americans. Some of the direct contributions of OPHS include: Building a Stronger Science Base
Committee (NHRPAC), is addressing the need to assure that individuals who are decisionally-impaired due to mental illness and who participate as human research subjects are adequately and appropriately protected Influencing and Improving National Policy
Promoting Effective Partnership Activities
�
Engaging in Strategic Communication
� FY 2001 Performance Summary OPHS is committed to assuring sustained progress and improved health outcomes within each priority through coordinated public and private efforts. The effectiveness of OPHS's activities are essential to the achievement of this ambitious goal, but the problems underlying OPHS's priorities are complex and reach beyond the control and responsibility of any one arena or effort. Achievement is dependent on various health programs and providers, all levels of government, and the efforts of the private sector as well as individual contributions. In FY 2001, OPHS continued to move toward enhancing mental health for all, through building a stronger science base, influencing national policy, promoting effective partnerships, and engaging in strategic communications. As science is progressing in discovery of the causes of mental illness and its effective treatment, OPHS works to get out a message of hope by working collaboratively to shape a scientifically sound and effective national campaign to destigmatize mental illness. In 1999, 2000 and 2001, a series of OPHS-led events including the White House Conference on Mental Health and the Surgeon General's Workshop on Underage Drinking, and reports, such as Mental Health: A Report of the Surgeon General, the Surgeon General's Call to Action to Prevent Suicide, and the Surgeon General's Report on Youth Violence, focused national attention on enhancing mental health for all Americans. In 2001, the Office of the Surgeon General coordinated the development and release of two additional, comprehensive reports, Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda and Mental Health: Culture, Race, and Ethnicity - A Supplement to Mental Health: A Report of the Surgeon General. These mental health reports include cutting edge information about the status of mental health and mental illness and new science and research on etiology, treatment and services within the United States. As mental health and mental illness become more mainstream and less stigmatized, health insurance coverage is likely to become more universally available with less restrictive benefits. The reports serve as a basis for shaping future mental health policy and program initiatives for State and Federal governments, as well as providing the public with valuable information about mental health issues impacting the Nation. Several strategies highlighted in the January 2001 report Youth Violence: A Report of the Surgeon General were promoted through a series of community listening sessions held in November and December 2001. The purpose of these sessions was to obtain the direct input and recommendations of organizations, communities, and individuals addressing the problem of youth violence throughout the country, including those with differing viewpoints. In addition, the sessions increased awareness of the models documented in the Report that have been shown to be effective in reducing youth violence. A summary of the input received from these sessions, which were held in Philadelphia, Atlanta, Chicago and Denver, is currently being prepared and is expected to be released in 2002. Additionally, the Secretary's Steering Committee for the National Suicide Prevention Strategy, led by the Surgeon General, released a comprehensive strategy document in May 2001. The document, entitled Goals and Objectives for Action, contains eleven broad goals with approximately 70 measurable objectives. The product of broad public-private collaboration, these goals and objectives will seek to involve public and private stakeholders within the healthcare, public health, education, justice, faith-based, business, labor, and social service sectors, among others. OPHS is monitoring the implementation of the recommendations of these Surgeon General's reports across the Department through the activity of the HHS Mental Health Coordinating Committee. In November 2001, OPHS convened a groundbreaking meeting of diverse participants to begin to develop core principles and a direction for a national action strategy for the integration of mental health services and primary health care. Highlights of the meeting and recommendations of the participants were published in December 2001 in the Report of a Surgeon General's Working Meeting on the Integration of Mental Health Services and Primary Health Care. Additionally, OWH partnered with the American Psychological Association to convene a Summit on Women and Depression in October 2000 - another example of OPHS partnership activity. This summit confirmed that translating the research into practice, community interventions, and policy continues to be difficult. It serves as a prelude to the upcoming meeting "Psychosocial and Behavioral Factors in Women's Health: Enhancing Outcomes in Women's Health" in February 2002. As many as 1,000 participants are expected at this interdisciplinary conference. Finally, OEP developed a model metropolitan mental health response plan for inclusion in local disaster preparedness systems through an FY 2000 agreement with the Uniformed Services University of the Health Sciences (USUHS)/Department of Defense (DoD). The goal of the agreement was to develop educational materials for public officials on the behavioral and mental health issues most relevant to preparing for and responding to terrorist acts using WMD. Performance Measures
� Related HHS Strategic Goals
1(d) Strengthen the health sciences research enterprise A strong health sciences research enterprise is required because it expands the knowledge base that underlies clinical treatments, public health policy and further research. OPHS contributes to the strengthening of the health sciences research enterprise by promoting the responsible conduct of research, the effective handling of scientific misconduct, and the expansion of the knowledge base related to the responsible conduct of research and research misconduct, all while protecting research subjects. In making and publicizing 125 findings of scientific misconduct since its establishment in 1992, the Office of Research Integrity (ORI) actions serve as a deterrent to misconduct and educate the scientific community regarding the importance of research integrity. In initiating 725 investigations since 1990, the Office for Human Research Protections (OHRP) actions serve to provide oversight against non-compliance with research subject protections and educate the scientific community regarding the importance of protecting research subjects. OPHS Contributing Offices Office of Research Integrity and Office for Human Research Protections. OPHS Role and Contributions OPHS's essential role in achieving each priority is to provide leadership, assess national health trends and problems, stimulate serious debate, engender creative ideas, and give critical visibility to health problems, needs, and solutions, and, as necessary and appropriate, take essential regulatory actions. To strengthen the health sciences research enterprise, OPHS makes direct contributions that include: Building a Stronger Science Base OPHS is building a stronger science base by ensuring that all applicant and awardee institutions have an administrative process available for handling allegations of scientific misconduct in PHS supported research and are taking steps to promote a research environment that emphasizes integrity. ORI has requested institutional policies for responding to scientific misconduct allegations from 1,720 institutions for review to date and supports studies that address problems inherent in responding to such allegations. In addition, the ORI Research Grant Program on Research Integrity awarded seven grants in collaboration with the National Institute for Neurological Disorders and Stroke and the National Institute of Nursing Research to expand the knowledge base related to research integrity, the responsible conduct of research, and research misconduct. ORI is also developing an education program to promote the responsible conduct of research by all persons supported by PHS research or research training funds. Influencing and Improving National Policy OPHS is contributing to the development of an effective national policy on scientific misconduct and research integrity. ORI organized a workshop on implementing the Federal Policy on Research Misconduct that was attended by representatives of 27 Federal agencies. ORI has funded studies of whistleblowers, respondents, guidelines adopted by medical schools for the conduct of research, research integrity measures utilized in biomedical research laboratories, and the incidence of research misconduct in biomedical research. In addition, ORI is supporting the development of a report by the Institute of Medicine on assessing integrity in research environments. OPHS is also contributing to the development of an effective national policy on research subjects protections. OPHS has established a National Human Research Protection Advisory Committee (NHRPAC) which provides guidance on conducting responsible research while protecting research subjects. OHRP also provides a leadership role for all agencies signed up to implement the Common Rule. Promoting Effective Partnership Activities OPHS is promoting effective partnership activities with funding agencies throughout the government, scientific societies, institutional associations, research institutions, and foreign governments. ORI has organized a Federal Research Misconduct Officials Network that includes representatives from 27 agencies. In addition, all five conferences or workshops held in FY�2001 were in collaboration with research institutions, scientific societies, or professional organizations. ORI also helped to organize an international conference on conflict of interest in clinical and basic research that will be held in Poland in April 2002 that includes representatives from the World Medical Association, the Council of Europe, the European Forum for Good Clinical Practice, the European Science Foundation and 19 countries. In addition, ORI is planning a conference on international collaboration in health research involving human participants in the Americas in Puerto Rico in February 2003. Finally, ORI is developing a liaison with about 25 scientific societies and institutional associations. OHRP leads the Human Subjects Research Subcommittee of the Committee on Science of the National Science and Technology Council, in promoting effective inter-agency partnerships. Engaging in Strategic Communication OPHS engages in strategic communication with about 4,100 institutions that apply for or receive funding from the Public Health Service to develop effective administrative processes for responding to allegations of scientific misconduct and protecting research subjects and to promote a research environment that encourages the responsible conduct of research. ORI publishes a highly regarded quarterly newsletter and specialized publications, frequently holds conferences and workshops, maintains an informative website, meets with misconduct officials in other agencies, and promotes interaction with scientific societies and institutional associations. OHRP conducts regular educational workshops and interactive town-hall meetings in collaboration with research institutions, scientific societies, or professional organizations, and individual technical support on-site visits across the country and the world, to provide guidance and education in the ethics of and requirements for protecting research subjects. OHRP maintains an informative website, meets with officials in other agencies, and promotes interaction with scientific societies and institutional associations. FY 2001 Performance Summary OPHS is committed to assuring sustained progress and improved health outcomes within each priority through coordinated public and private efforts. The effectiveness of OPHS's activities are essential to the achievement of this ambitious goal, but the problems underlying OPHS's priorities are complex and reach beyond the control and responsibility of any one arena or effort. Achievement is dependent on various health programs and providers, all levels of government, and the efforts of the private sector as well as individual contributions. In FY 2001, OPHS continued to strengthen the health sciences research enterprise, through building a stronger science base, influencing national policy, promoting effective partnerships, and engaging in strategic communications. ORI took several steps in FY 2001 to build a stronger science base by (1) awarding seven research grants to conduct studies related to research integrity, the responsible conduct of research or research misconduct; (2) initiating an educational program in the responsible conduct of research (RCR) for all individuals supported by PHS research or research training funds; (3) closing 18 misconduct cases; (4) approving 102 institutional research misconduct policies, (5) holding five conferences/workshops and (6) concluding a study of research guidelines adopted by U.S. medical schools and a needs assessment for the ORI educational program. The research on research integrity awards were made to universities, hospitals, and a research foundation. Grant applications received in the second round increased 25 percent to 30. The RCR educational program is seeking to provide basic instruction in subjects that appear to generate misconduct allegations, conflict, and interpersonal problems in research organizations. Continuing support was given to The Online Resource for Instruction in the Responsible Conduct of Research. This site provides individuals and institutions with the tools and resources to refine existing programs or develop new programs to foster the responsible conduct of research. The website is located at [http://rcr.ucsd.edu]. ORI also expanded the RCR Education section on its website. A draft of the RCR self-instruction booklet was received from the contractor. In FY 2001, ORI exceeded the target rate set for completing ORI oversight of scientific misconduct cases within eight months of receiving final decision from institution, which was 70�percent. Of 18 cases closed by ORI during FY 2001, 78 percent were closed within eight months of receiving the institutional documentation and final decision. The average ORI processing time for the 18 cases was seven months. Nine of the 18 closed cases resulted in misconduct findings and the imposition of administrative actions. In addition, ORI has now reviewed the policy of 41.6 percent of the institutions that have an assurance on file, which slightly exceeds the FY 2001 goal of 40 percent. OHRP program activity also contributes to strengthening the health sciences research enterprise. In FY�2001 OHRP's Division of Compliance Oversight (DCO) conducted four (4) compliance oversight site visits (St. Jude Children's Research Hospital, Johns Hopkins University School of Medicine, the Johns Hopkins Bayview Medical Center and Suburban Hospital in Maryland). Additionally, DCO opened 37 new compliance oversight cases and closed 96 cases in FY�2001. The number of open cases has been reduced from its peak of 182 in July 2000 to 108 as of December 31, 2001. Approximately 60 additional cases have undergone extensive evaluation and are approaching closure. A new program of not-for-cause compliance oversight surveillance evaluations is a highlight of efforts to increase accountability of the human subjects protection system, working in concert with education, support and quality improvement efforts. Additionally, OHRP has developed a simplified Institutional Assurance system in conjunction with the IRB Registration System. This system will greatly reduce the administrative burden on the individual institutions and OHRP, resulting in faster assurance approvals, and enable the institutions to focus more attention on quality improvement. Both ORI and OHRP are also taking action to influence and improve national policy. ORI contracted with the Institute of Medicine (IOM) in September 2000 to prepare a report on assessing integrity in research environments. The PHS regulation (42 C.F.R. Part 50, Subpart A) states that "institutions shall foster a research environment that discourages misconduct in all research and that deals forthrightly with possible misconduct associated with research for which PHS funds have been provided or requested." The IOM report, which will be published in September 2002, addresses the conceptual issues related to the development of a longitudinal database that could track institutional efforts to foster integrity in research environments. A conference will be held in October 2002 to present the report to the research community. An analysis of research guidelines adopted by U.S. medical schools was completed; a resource document on developing effective research guidelines is being developed and a conference on research guidelines will be held in September 2002 in Philadelphia. In addition, ORI contracted for a study of integrity measures utilized in biomedical research laboratories. On February 1, 2001, about 80 representatives from 27 agencies attended the workshop on the Federal Research Misconduct Policy, developed by the Office of Science and Technology Policy; the policy was published in the Federal Register on December 6, 2000. ORI also developed and maintains the Federal Research Misconduct Officials Network to generate discussion and cooperation among Federal agencies concerned with research misconduct and the responsible conduct of research. Under the leadership of OHRP, efforts will continue in the Department to initiate a process to develop standards for IRB Accreditation. The Institute of Medicine produced a report in April 2001 outlining standards for Institutional Review Boards to achieve accreditation. During FY�2001, OHRP developed a unified IRB Registration System. The new system, initiated at the beginning of December 2001, provides for the voluntary registration of IRBs. This system can be utilized by OHRP, FDA, and other Federal Departments and Agencies to facilitate communications with these IRBs. OHRP also developed a simplified Assurance system for institutions conducting federally supported or conducted human subject research. The new Assurance, called a Federalwide Assurance, can significantly reduce the administrative burden on individual institutions, OHRP, as well as other Federal Departments and Agencies. Reduction in burden is gained by: 1) the increased simplicity of the form and process, 2) increased approval period of the Assurance for most institutions (from a project by project approval to an approval period of three years), and 3) acceptance of an OHRP approved Federalwide assurance by other Federal Departments and Agencies of the Common Rule, thus removing the need for duplicate effort on behalf of other Departments and Agencies. If an IRB will be the designated IRB of record for a given institution's Federal wide Assurance, then it will register through its Assurance, in OHRP's IRB Registration System, providing much of the same information it had to under other Assurance mechanisms. This required step actually decreases the burden for IRBs as they will have to provide much less interaction with OHRP, whenever the IRB will commit to review human subject research for an institution under a new Assurance. OHRP has developed a Quality Improvement (QI) Program for institution's human subjects protection programs and for independent IRBs. The QI Program will include quality assurance, quality improvement, and continuous quality improvement processes. The primary objective of the QI Program is to increase the performance, quality, and efficiency of an institution's or independent IRB's human subjects protection program. Secondarily, the QI Program will help an institution or independent IRB ensure that its human subjects protection program is in compliance with the federal regulations for the protection of human subjects in research. To facilitate the QI Program, OHRP has developed a Self-Assessment Tool for institutions and independent IRBs. Pilot testing of the QI Program began in August 2001. OHRP launched the QI Program in the Winter of 2001. Once pilot testing of the Self-Assessment Tool is completed, OHRP will submit the tool to OMB for review and approval. After OMB approval of the Self-Assessment Tool is obtained, the tool will be included as an instrument to enhance the quality assurance/quality improvement process. Additionally, the National Human Research Protections Advisory Committee held its first meeting in December 2000. This newly established committee, coordinated by OHRP, will provide expert advice and recommendations to senior departmental officials on a broad range of issues and topics pertaining to or associated with the protection of human research subjects. ORI and OHRP are also working with partners to improve communications aimed at strengthening the health sciences research enterprise. In FY 2001, ORI held five conferences/ workshops on research integrity and research misconduct, in collaboration with professional associations, scientific societies, and Federal research agencies. OHRP is enhancing its education efforts in order to ensure that investigators and IRB members are well informed about the regulatory requirements. As part of this effort, OHRP has increased the number of workshops, town meetings, and presentations conducted by the staff of the Education Division. In FY 2001, OHRP conducted over 90 presentations (ten of which were international), five National Workshops, and three Town Meetings. One of the Town Meetings conducted in FY2001 was a video conference. OHRP plans to expand its use of information technology to conduct video conferences to reach a wider audience in FY2002. In FY 2001, OHRP spearheaded an interagency effort to prepare a Federal-wide IRB Guidebook. This project is expected to be completed by the end of FY 2002. In FY 2002, OHRP will also be developing an interactive guidance resource/repository to provide easier access to OHRP guidance. Finally, OHRP is also planning a public education campaign to better inform lay persons about the research process, informed consent, IRBs and the like. This will ultimately strengthen the consent process and afford greater recognition of OHRP's public service role and the importance of the private accreditation process. Internationally, OHRP activities in FY 2002 will be influenced by the recommendations in the recent Inspector General report on "The Globalization of Clinical Trials - A Growing Challenge in Protecting Human Subjects." Areas of emphasis, already initiated in FY 2001, will be capacity building, harmonization, partnership building, and policy analysis, all based on a strong foundation of strategic communications, training and education. ORI took steps to facilitate communication with institutional officials, journal editors, and researchers during FY 2001. ORI received the final report on "ORI Education Program: A Needs Assessment," which provides information on what institutional officials would like ORI to include in its education program aimed at the responsible conduct of research and the handling of research misconduct allegations. ORI also held exhibits or poster sessions at seven meetings of scientific societies and professional associations in FY 2001 to increase contact and generate a dialogue with members of the research and academic communities. In addition, ORI began planning a workshop for journal editors in collaboration with the Council of Science Editors. Performance Measures
Related HHS Strategic Goals
OPHS PRIORITY 2: MAINTAIN A GLOBAL APPROACH TO PUBLIC HEALTH Realities in today's world call for a global approach to public health and innovative global partnerships. Countries around the world share many of the same public health problems that we face in the United States, including HIV/AIDS, tobacco use, diseases of aging populations, injuries, and problems of mental health, to name just a few. We must translate recognition of our shared problems into action for shared solutions. Our world is interconnected; we must work with partner institutions and nations to improve world health overall. Because of astonishing advances in technology, transportation, international trade, and the passing of two million people crossing international borders each day, Americans can no longer think that we are isolated and protected from health problems around the world. The health of America is now global. Two areas of global health concern for OPHS action are: to increase awareness of and attention to global health concerns and their effects on the domestic issues, and to ensure a safe food and blood supply and monitor threats of terrorism. 2(a) Increase awareness of and attention to global health concerns and their effects on the domestic issues OPHS Contributing Offices Office of Global Health Affairs, Immediate Office of the Assistant Secretary of Health, Office of the Surgeon General, Office of Disease Prevention and Health Promotion, Office of Minority Health, Office of HIV/AIDS Policy, Office on Women's Health, Office of Research Integrity, Office of Emergency Preparedness, National Vaccine Program Office, and the Office for Human Research Protections OPHS Contributions Taking a global approach to health requires both strategic leadership and many governmental and non-governmental partners in the United States and throughout the world working together. OPHS provides critical leadership and, as appropriate, serves as the focal point for coordination of efforts by HHS agencies, other federal agencies, and other partners to optimize efficiency and effectiveness in improving health globally. OPHS has taken the lead in developing a Departmental Global Health website, globalhealth.gov, based on the tenets of "maintaining a global approach to public health," "a healthy world and a healthy America" and "increasing awareness of and attention to global health concerns and their effects on domestic issues." Complementary to fulfilling the primary domestic mandate of HHS, it is clear that HHS's globally-oriented work has positive impact in different types of ways: directly on the health of populations in other countries; through leveraging of technical expertise in the programming and funding of partner agencies; through training and capacity building; through guidelines and public health approaches that can be adapted or adopted by other countries; and directly on health and health programming in the United States by virtue of recognizing and applying information or experiences from other countries to address similar issues in this country. Furthermore, the Institute of Medicine has noted that "The direct interests of the United States are best served when America acts decisively to promote health around the world" (America's Vital Interest in Global Health, 1997). OPHS plays a leadership role in articulating the importance of a global approach to health in the United States and both a leadership and coordination role in contributions to U.S. Government positions and delegations to official international fora. Some examples of OPHS contributions in strategic areas of global concern include: Building a Stronger Science Base OPHS coordinates HHS policy on selected international research to improve the science base. For example, current activities in Russia involve mental health research, as part of the US-Russia Joint Commission on Economic and Technological Cooperation (U.S.-Russia Health Committee) and the Biotechnology Engagement Program that supports collaboration between US and Russian scientists in infectious disease-related research. The Environmental Health Policy Committee, a senior-level committee providing departmental leadership and coordination to resolve science-based policy questions about environmental and occupational health, helps to coordinate the national response to environmental threats. The International Environmental Health Working Group is a group of specialists focusing on global environmental health and relating back to the parent Policy Committee. Influencing and Improving National Policy Through the Secretary of HHS, the Assistant Secretary for Health, and the Surgeon General, HHS and OPHS promote achievement of US global health policy goals through membership and active partnership with multilateral organizations, most notably the World Health Organization, the Pan American Health Organization, and UNICEF. Recently, OPHS has become more actively involved with other groups developing new health agendas, such as the Organization for Economic Cooperation and Development (OECD), the Group of 8 (G8), the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Asia Pacific Economic Cooperation (APEC) and others. OPHS coordinates input from HHS and other agencies in the development of US Government policy statements for these multilateral fora. OPHS also provides and facilitates technical cooperation between HHS and these agencies, as well as the World Bank and other agencies of the United Nations system. Within the US Government system, OPHS helps coordinate HHS technical assistance to the efforts of the US Agency for International Development (USAID), the Department of State and others. Examples include assignment of HHS personnel to USAID to help address national policy related to HIV/AIDS, malaria, reproductive health, and other health priorities in developing countries and the active technical involvement of OPHS and other HHS staff in specific initiatives led by the State Department. In addition, the NVPO is responsible for coordinating the development of the United States Action Plan for Laboratory Containment of Wild Polioviruses, a component of the WHO Global Action Plan - critical to ensuring that, after polio eradication is achieved, chance reintroduction of poliovirus into the community will be minimized. One of the most important areas in which OPHS has influenced national policies is through assisting other countries in developing concrete, measurable, science-based national health objectives, modeled after the US Healthy People 2010 process. Healthy Gente, reflecting US and Mexican health objectives, is one of the innovative ways of influencing border health priorities through policy and collaborative implementation. Additionally, in September 2000, Healthy Egyptians was launched by the Egyptian Ministry of Health in collaboration with OPHS'ss ASH, ODPHP, and OGHA. OPHS also coordinates the HHS blood safety program, with the ASH as the Blood Safety Director. This involves policy formation around donor issues and coordination to avert product shortages with domestic and international partners. Promoting Effective Partnership Activities OPHS works with global health stakeholders in the US Government and throughout the world. OPHS is the US Government member of the WHO Executive Board and leads the US health interests within UNICEF Executive Board. OPHS coordinates the participation of the US Delegation to the annual World Health Assembly, including staffing the HHS Secretary. OPHS coordinates all US Government agreements with WHO and the assignment of US Government personnel to WHO and other United Nations agencies (e.g., UNICEF, World Bank) to address a wide range of issues. OPHS also collaborates on technical and health policy issues with UNAIDS and UNHCR. Additionally, OPHS has placed technical specialists with US embassies/missions in Geneva, India, Vietnam, and (soon) South Africa as resident health attachés. Finally, OPHS coordinates several US bilateral projects with other governments (for example, Russia, Mexico, South Africa). Global women's issues are addressed through various bi-national working groups and representation at international meetings, for example the Working Group on Women's Health of the US-Mexico Binational Commission. An example of international collaboration on women's health issues is the activity of the National Centers of Excellence in Women's Health, sponsored by the Office on Women's Health, which has been fostering new women's healthcare models in the former Soviet Union since 1992. This has resulted in the establishment of a network of pioneering women's wellness centers in the Ukraine, Belarus and Uzbekistan in partnership with the American International Health Alliance (AIHA), based in Washington, D.C., and funded by the US Agency for International Development. OPHS has been designated the lead of the US delegation to the WHO-sponsored negotiations on the Framework Convention on Tobacco Control (FCTC). As such, OPHS coordinates with representatives from the Departments of State, Treasury, Agriculture, Justice, and Commerce, with input from the US Trade Representative, the Environmental Protection Agency, and the Federal Trade Commission. The Healthy People 2010 tobacco goals help shape the US positions for the FCTC negotiations. OPHS has played a critical lead role in preparations for two United Nations General Assembly Special Sessions, one for HIV/AIDS in June 2001 and the other on Children, originally scheduled for September 2001 but postponed until May 2002. OPHS led and largely wrote the U.S. Government's ten-year progress report since the 1990 World Summit for Children, entitled America's Children: Our Challenge, Our Future. OPHS has also participated actively in the official preparatory committee meetings leading up to the 2002 UN Special Session. The Surgeon General holds a preeminent position of leadership with respect to global health policies insofar as he is charged with providing leadership to the health of the American people. Therefore, he is able to expand and make more effective partnerships across all the stakeholders concerned with health within the US and abroad. Engaging in Strategic Communication OPHS is the HHS coordinating office for creating and disseminating information about the vital importance of US involvement in the many areas of global health. The new HHS website, globalhealth.gov, is a global health portal launched during FY 2001 that provides information on international activities of OPHS and agencies HHS-wide; reports and publications; speeches and presentations; calendar of international health events; "hot topics"; information on countries and international travel; world health statistics; and more. The website has been favorably reviewed in formal and informal communications in the United States and abroad. FY 2001 Performance Summary OPHS is committed to assuring sustained progress and improved health outcomes within each priority through coordinated public and private efforts. The effectiveness of OPHS's activities are essential to the achievement of this ambitious goal, but the problems underlying OPHS's priorities are complex and reach beyond the control and responsibility of any one arena or effort. Achievement is dependent on various health programs and providers, all levels of government, and the efforts of the private sector as well as individual contributions. In FY 2001, OPHS continued to increase awareness of and attention to global health concerns, through building a stronger science base, influencing national policy, promoting effective partnerships, and engaging in strategic communications. As described in further detail above, in FY 2001 OPHS launched the Department's new global health website, globalhealth.gov, to provide useful and timely information to a wide range of audiences both inside and beyond the United States. The US-Mexico Border Health Commission (USMBHC) was established in July 2000 through a Memorandum of Agreement between the Department of Health and Human Services and the Mexican Ministry of Health. OPHS coordinates the HHS side of the collaboration. The establishment of the Commission was directed under Public Law 103-400 which authorized the President to enter into negotiations with Mexico to establish the US-Mexico Border Health Commission. The primary goals of the Commission are to 1) institutionalize a domestic focus on border health which can transcend political changes and, 2) create an effective venue for binational discussions to address public health issues and problems which affect the US-Mexico border populations. To address priority health issues in a joint, binational effort, the USMBHC has established the Healthy Border 2010 Program, an agenda of goals and objectives that are mutually accepted by the federal governments of the US and Mexico, and by the four US border states and the six Mexican border states. This program addresses more than 12 focus areas, with more than 20 measurable health objectives for health improvement. The USMBHC works to provide the tools and venues for collaboration between public health professionals along and across the border, both via internet-based communication, and via significant working meetings to address priority issues such as tuberculosis and other health issues. Another example of global collaboration is the work OGHA is conducting with Egypt to improve health. For more than three decades, HHS and the Egyptian Ministry of Health and Population (MOHP) have worked together - including ten years of collaboration with the US Agency for International Development (USAID) - to improve the health of the Egyptian people. The purpose of this current collaboration between HHS and MOHP is to develop a national health agenda, focusing on disease prevention and health promotion priorities and achievement of measurable targets. The Healthy Egyptian 2010 initiative is adapted from the US experience with Healthy People 2000. Healthy Egyptians 2010 is focused on four public health areas: Maternal and Child Health; Injury Control; Environmental Health and Tobacco Control. Healthy Egyptians 2010 was officially launched in September 2000 in Cairo. OGHA has placed a DHHS resident advisor with MOHP to further the development of Healthy Egyptians 2010. The HE 2010 Collaboration will continue for an additional 2-5 years under USAID support. The next phase of the collaboration will focus on expanding the Ministry of Health and Population's capability in delivering HE 2010 messages at the Governorate and District levels. In addition, a DHHS Resident Advisor will continue to work with the Ministry of Health, USAID, Embassy and U.S. Community to support the overall U.S. Health efforts in Egypt. A mid-term review of HE2010 targets will be done in FY 2004-05. The Secretary of HHS leads the US delegations to the World Health Assemblies, the annual WHO gathering of health ministers, and through this leadership role, the Department has worked hard to be viewed by WHO and countries alike as a fellow "Member State" rather than as a "donor country." Preparation for the WHA is a dynamic process that includes close coordination with HHS, DOS, and USAID experts and other stakeholders throughout the year in the development of US policy positions and programmatic strategies. For the 54th World Health Assembly in May 2001, agenda items included infant and child nutrition, health systems performance assessment, nursing and midwifery, polio eradication/vaccine development and a new global mental health initiative. Another example of global partnership includes the HHS Biotechnology Engagement Program (BTEP), which began in 1999 as a result of requests by the Secretaries of State and Defense for HHS to "engage" former Soviet bioweapon scientists in cooperative research. HHS agreed, providing that component agencies (CDC, FDA, and NIH) were compensated for their participation as collaborating scientists, hosts, and technical advisors. Because of the national security importance attached to this non-proliferation activity, OGHA has been provided with a funding stream that runs some $25 million over three years. The vast majority of this funding (70 percent) is intended for Russian and NIS scientists and former weapons institutions. New research projects were submitted, reviewed, approved and initiated during FY 2001. Many OPHS offices are involved in efforts to increase attention to global health concerns. The Office on Women's Health disseminated the technical manual Caring for Women with Circumcision to all medical, osteopathic, nursing, and public health schools in the US. Additionally, this manual was distributed to interested international organizations, as well as State, territorial, and regional women's health coordinators. In FY 2001, over 1000 copies of the manual were distributed. OWH also, in collaboration with the HHS Working Group on Female Genital Cutting, continues its efforts to educate and inform health professionals and the public about female genital cutting(FGC). In FY 2001, OWH provided FGC resources through the National Women's Health Information Center. OWH is also working on the expansion of the Women's Health Workgroup of the US-Mexico Binational Commission to include issues relative to the full range of a woman's life, of which the reproductive phase is a cycle. This expansion is essential in accomplishing the task of providing more than minimum health care for women in the U.S. and Mexico and the states that border both countries. In addition, in 2001 the OWH selected the Mariposa Health Care Clinic in Nogales, Arizona as a Women's Health Community Center of Excellence. In addition, OHAP also plays a critical role in translating research findings and developments into public health practice because of its expertise in clinical and public health issues. OHAP serves on the Panel on Clinical Practices for the Treatment of HIV Infection, led by NIH and comprised of expert clinicians and clinical researchers in HIV both within government and those active in public/private provider settings. The Panel regularly updates sets of treatment guidelines, which provide up to date information for providers and consumers, and are widely accepted as standards of care by providers and payors alike. Colleagues within international health organizations and health ministries have also consulted with OHAP around HIV care and treatment issues on a regular basis. Discussion of Performance Measures There are at least three areas where OPHS, through coordination with other agencies, departments, and governments, has an impact on global health and its relevance to Americans: polio eradication, tuberculosis, and tobacco use. Polio eradication: The ASH has consistently advocated with the WHO Director-General to maintain polio eradication as a WHO priority; with other donor countries (e.g. France, Germany) to mobilize additional resources to complete the global eradication campaign; and with affected countries to encourage their continued efforts toward eradication. In addition, OPHS has coordinated input from different US departments and HHS agencies toward a united voice for global polio eradication. Tuberculosis: The reemergence of TB in the United States is related to both the increase of immigrants and travelers to and from areas of high infection and to the slow disintegration of an established tracking and treatment system throughout the country. In close collaboration with CDC and in regular consultation with the Immigration and Naturalization Service (INS), the US Department of State, and several international agencies, OPHS is working toward closer tracking of TB cases in the United States and improved systems of detection and treatment for all those infected here. Tobacco Use: While tobacco use among some sectors of the US population is decreasing, it is increasing in others, such as among youths and Hispanics. Women now account for 39 percent of all smoking-related deaths each year in the United States, a proportion that has more than doubled since 1965, according to Women and Smoking: A Report of the Surgeon General released March 2001. Similarly, tobacco use is rising rapidly in many developing countries. OPHS serves a coordinating role in HHS international efforts to reduce the sale, promotion, and use of tobacco around the world through active participation in FCTC process. Performance Measures
� Related HHS Strategic Goals
2(b) Ensure a safe food and blood supply, and prepare for and respond to terrorism threats OPHS Contributing Offices Office of Emergency Preparedness, Office of HIV/AIDS Policy, Office of the Surgeon General, Office of Military Liaison and Veterans Affairs, Office for Human Research Protections and National Vaccine Program Office. OPHS Role and Contributions � One of OPHS's primary missions is to help lead the medical response and recovery efforts to the health effects of any disaster, be it a natural occurrence or an act of terrorism. The health effects of biological terrorism are especially problematic, since we may not know where or when the assault took place, and may only see its effects over time. The national response to bioterrorism is led by the ASH, through surveillance activities of FDA, CDC, ATSDR and State and local health agencies, with the assistance of all the HHS agencies. In addition, the ASH is on the front line of response through the National Disaster Medical System, the preparedness of our special response teams, and through our work with local jurisdictions and their medical response systems. OPHS also plays a role in preparing for potential threats of terrorism through national planning efforts. OPHS provides critical leadership around policy and activities to ensure a safe and adequate blood supply. The Secretary placed responsibility for the HHS blood safety program within OPHS, with the ASH serving as the Blood Safety Director. OPHS serves as a focal point for coordinating the surveillance, research and regulatory activities of the Department, so that any emerging threat is immediately recognized and addressed to protect the public's health. OPHS's essential role in achieving each priority is to provide leadership, assess national health trends and problems, stimulate serious debate, engender creative ideas, and give critical visibility to health problems, needs, and solutions. Building a Stronger Science Base
Influencing and Improving National Policy
protection issues which may arise in connection with national emergencies, including research issues which may arise in connection with these situations. Engaging in Strategic Communication
Promoting Effective Partnership Activities
FY 2001 Performance Summary OPHS is committed to assuring sustained progress and improved health outcomes within each priority through coordinated public and private efforts. The effectiveness of OPHS's activities are essential to the achievement of this ambitious goal, but the problems underlying OPHS's priorities are complex and reach beyond the control and responsibility of any one arena or effort. Achievement is dependent on various health programs and providers, all levels of government, and the efforts of the private sector as well as individual contributions. In FY 2001, OPHS continued to ensure a safe food and blood supply and monitor terrorism threats, through building a stronger science base, influencing national policy, promoting effective partnerships, and engaging in strategic communications. In the area of blood safety, FY 2001 marked the completion of the hepatitis C lookback, a program initiated by the Department to assure that as many individuals as possible who may have been inadvertently exposed to the hepatitis C virus by blood transfusion were informed of their potential exposure and of the recommended actions they should take in response to receiving this information. This activity was performed by the private sector, namely blood establishments that collected blood and transfusion services that distributed it, and supervised by OPHS. FDA Guidance suggested and subsequent Regulation required that blood establishments and transfusion services establish Standard Operating Procedures to implement the hepatitis C lookback. Subsequent to October 1, 2001, FDA has included examination of compliance with this Standard Operating Procedure in its regular inspections of blood establishments and transfusion services. As of this writing, no deviations from this Standard Operating Procedure have been reported by FDA. FY 2001 also marked the apparent completion of the almost decade-long revision and updating of blood donor deferral policies to reduce the risk of transmitting the various transmissible spongiform encephalopathies (TSEs) (including classical Creutzfeldt-Jakob disease, or CJD, and variant CJD, the human form of bovine spongiform encephalopathy, BSE, or Mad Cow disease) by blood transfusion. This and the hepatitis lookback were the two outstanding policy issues that the Department charged OPHS with supervising in 1995, when the Secretary designated the Assistant Secretary for Health to be the Blood Safety Director for the Department and created the Public Health Service Blood Safety Committee and the Department of Health and Human Services Advisory Committee on Blood Safety and Availability. An additional accomplishment of OPHS related to this issue was supervision of the development of the Department's BSE/TSE Action Plan, which was requested by the Secretary in February 2001 and approved by him in June 2001. FY 2001 was also the year that OPHS implemented the component of the DHHS/FDA Blood Action Plan that called for the Department to monitor the United States blood supply. OPHS monitoring of the supply of blood products, and the capacity of the supply to meet demand, became operational on August 15, 2001; monitoring the supply of plasma derivatives, and the capacity of the supply to meet demand, is expected to become operational on or about August 15, 2002. OPHS also helped coordinate the government's response to the demands placed on the United States blood supply by the events of September 11, 2001. OPHS activities in this area include preparation for a meeting of the DHHS Advisory Committee on Blood Safety and Availability on January 31 and February 1, 2002 to discuss what lessons can be learned from the events of September 11, 2001 that could improve the safety and availability of the United States blood supply. OPHS continued to address potential widespread public health threats, including the threat of an influenza pandemic. NVPO coordinated pandemic influenza planning to improve ongoing efforts for the prevention and control of influenza in the United States. Included in these efforts is the development of the Pandemic Influenza Action Plan. The goal of this plan is to limit the total burden of disease caused by an influenza pandemic, including social disruption and economic loss. To achieve this goal, three objectives are identified: strengthen global and domestic surveillance capabilities to increase the likelihood of early detection of an influenza pandemic and effective tracking of its spread, strengthen national readiness to respond to an influenza pandemic, and strengthen the infrastructure on which the plan depends. In addition to the threat of an influenza pandemic, OPHS continued to prepare for other potential public health disasters. The primary mission of the Office of Emergency Preparedness (OEP) is to assist in the management and coordination of the Federal health, medical and health-related social service response and recovery to major emergencies, federally declared disasters and terrorist acts. As such, OEP directs a major national initiative, the Metropolitan Medical Response System (MMRS) development program, which provides a mechanism to forge a local integrated response which links multiple local, state and Federal agencies as well as private health care institutions that will serve as the initial responders to any weapon of mass destruction (WMD) event. Metropolitan Medical Response Systems (MMRS) that address the health consequences of the release of a weapon of mass destruction (WMD) were initiated in 25 additional areas in 2001, bringing the total to 97. During FY 2001, 25 contract modifications were made to add funding for bioterrorism capabilities to the systems begun during FY 2000. Performance Measures
� Related HHS Strategic Goal
OPHS PRIORITY 3: ELIMINATE RACIAL AND ETHNIC DISPARITIES IN HEALTH STATUS AND HEALTH CARE ACCESS AND QUALITY The goal of eliminating racial disparities in health by 2010 was set with the Healthy People initiative, which sets the nation's health agenda every 10 years. For all the medical breakthroughs we have seen in the past century, we still see significant disparities in the medical conditions of racial groups in this country. What we have done through this initiative is to make a commitment - for the first time in the history of our government - to eliminate, not just reduce, some of the health disparities between majority and minority populations. We have selected six areas to bring our efforts into focus: infant mortality, child and adult immunizations, HIV/AIDS, cardiovascular disease, cancer screening and management, and diabetes. Eliminating disparities is not a zero-sum game. We are not taking anything from anyone when we ensure focus on the health needs of those most at-risk. We are operating on the premise upon which the Public Health Service was founded 200 years ago: The entire nation benefits when we protect the health of those most vulnerable. OPHS Contributing Offices Office of Minority Health, Office of the Surgeon General, Office of Disease Prevention and Health Promotion, President's Council on Physical Fitness and Sports, National Vaccine Program Office, Office of HIV/AIDS Policy, Office on Women's Health, Office of Population Affairs, Office of Military Liaison and Veterans Affairs, Office for Human Research Protections, and Office of Research Integrity. OPHS Role and Contributions OPHS's essential role in achieving each priority is to provide leadership, assess national health trends and problems, stimulate serious debate, engender creative ideas, and give critical visibility to health problems, needs, and solutions. Although the Office of Minority Health (OMH) serves as the focal point within HHS for addressing racial and ethnic health disparities, all OPHS offices, under the leadership of the ASH and in league with numerous other stakeholders and partners, contribute to the achievement of the six national goals under this strategic priority, through the following kinds of functions and activities: Building a Stronger Science Base
OPHS also administers a Bilingual/Bicultural Service Demonstration Grants Program to improve access to health care by reducing cultural and linguistic barriers, a Minority Community Health Coalition Demonstration Grants Program to address reductions of racial and ethnic disparities in health targeted under this priority area, and a Technical Assistance and Capacity Development Demonstration Program for HIV/AIDS-Related Strategies in Highly Impacted Minority Communities to foster the development of effective and durable service delivery capacity for HIV prevention and treatment among organizations closely linked with the minority populations highly impacted by HIV/AIDS. In addition, OPHS is supporting a study by the Institute of Medicine that will clarify our understanding of the underlying causes of racial and ethnic health disparities, provide approaches that would be effective in countering the impact of bias in medicine and health services, and identify policy changes, program initiatives, and resource requirements necessary for timely implementation. The Office of HIV/AIDS Policy developed and implemented the Crisis Response Team Initiative, joining qualitative and quantitative data collection methods in a new methodology known as RARE (Rapid Assessment, Response and Evaluation) which has been successfully piloted in 12 cities. The RARE methods complement traditional needs assessment procedures providing an enriched understanding of the context of risk and variables impacting prevention efforts, and acceptance and retention in care among hard to reach populations at high risk for HIV/AIDS. A training manual and guidance documents have been published, and trainings on RARE have been held for other State and local health departments requesting this information. Furthermore, OPHS establishes National Centers of Excellence in Women's Health and National Community Centers of Excellence in Women's Health, including centers focused specifically on minority women's health. OPHS provides leadership for the development of a departmental plan identifying infrastructure, research needs, and data commitment strategies for addressing health disparities related to sexual orientation. OPHS established the Minority Women's Health Panel of Experts (MWHPE) in response to the 1997 conference Bridging the Gap: Enhancing Partnerships to Improve Minority Women's Health. A comprehensive research document entitled, Improving Minority Women's Health Research: Minority Women, Gaps, Issues, and Assessment of Ongoing Research, Concerns and Recommendations will soon be available on the Office on Women's Health website and highlights current literature on research and data interpolation in regards to multiple populations of women of color across the lifespan, in terms of primary prevention and intervention strategies, involvement in clinical trials, data collections and interpretation, and political implications. Influencing and Improving National Policy
� Important examples of relatively new initiatives and activities targeting racial/ethnic health disparities, either led or co-led by OPHS offices and/or the ASH and/or the SG, include: staffing and leadership of the Departmental Minority Initiatives Coordinating Committee, and respective minority health initiatives (i.e., the HBCU initiative, the Hispanic Agenda for Action, the Tribal Colleges and Universities initiative, and the AAPI Action Agenda); coordination and staffing support to the Department's Public Health Council which serves as the steering group for the HHS Initiative to Eliminate Racial and Ethnic Disparities in Health; staffing of the Advisory Committee on Minority Health, established in FY 2001 to advise the Secretary and the Department on issues related to minority health and health disparities; creation of a Minority Women's Health Initiative to address the diversity in health needs and inconsistencies in health care delivery for women across the country; development of national standards for the provision of culturally and linguistically appropriate services in health care; and coordination of the Department's response to the Congressional Black Caucus regarding the development of effective strategies to reduce and prevent the heavy toll of the HIV/AIDS epidemic on communities of color. OPHS has led policy development and coordination for the Minority AIDS Initiative both internally across the Department's Operating Divisions, and externally with the Congressional Black Caucus and Congressional Hispanic Caucus, through the Steering Committee on Implementation and Evaluation. Central to this effort has been gaining an understanding of barriers to access to prevention and care for minority populations, and identifying new strategies to maximize the effectiveness of existing federal funding streams to reach and serve these populations. In addition, OPHS supports pilot projects addressing two persistent, ongoing gaps in services for women of color impacted by and living with HIV/AIDS: the Incarcerated Women with HIV/AIDS/STDs Program focuses on the development and implementation of pre-release and discharge planning processes that effectively link newly released women with appropriate HIV health care and support services; and the Model Mentorship Program for Technical Assistance to Women's Organizations Delivering HIV/AIDS Services to Women pairs well-established minority health organizations with young women's organizations and community-based organizations serving women affected by and infected with HIV/AIDS to help increase their organizational capacity and sustainability in rural and urban communities. Promoting Effective Partnership Activities
� The Leadership Campaign on AIDS (TLCA), in OHAP, targets HIV/AIDS in racial and ethnic minority communities by working with local and national leaders in communities of color, government officials, and business, civic, media, education, professional, advocacy and other community-based organizations to reduce stigma and discrimination related to HIV/AIDS. Particular focus has been placed on increasing the capacity of minority community-based organizations to develop effective and innovative partnerships at the local level to enhance HIV/AIDS services and education efforts. In addition, OPHS is currently planning the first of three "National Leadership Summits" for eliminating racial and ethnic disparities in health to take place over the current decade. The purpose of these summits is to serve as vehicles for highlighting, promoting, and applying the knowledge, experience, and expertise of hundreds of community-based organizations and partners across the Nation towards more strategic, concerted, and effective actions aimed at eliminating racial and ethnic disparities in health. Also, in response to the State Minority Health Infrastructure Study, OMH will conduct a National American Indian/Alaska Native Health Forum in late FY 2002. The purpose of this Forum is to identify strategies through which state, tribal, and Federal governments can complement and supplement their respective health systems to improve the health of Native Americans, including those who are not Federally recognized, and to identify strategies for the development of a coordinated plan for elimination of health disparities impacting American Indian/Alaska Native communities. Engaging in Strategic Communication
In FY 2002, OMH will develop a Minority Male Health Project to focus on support for local, community efforts to combat chronic diseases affecting minority men. This program will collect, compile, and disseminate information on best practices for influencing minority male health behavior and ways to improve minority male access to health care. Discussion of Performance Measures The performance measures used by OPHS under this priority area are selected from the set of objectives in Healthy People 2000 (for FY 1999 and FY 2000 plans) and in Healthy People 2010 (for FY 2001 and FY 2002), including relevant targets, data sources, and baselines. The specific measures selected from either version of Healthy People are those most directly related to the six health priority issue areas identified under the HHS Initiative to Eliminate Racial and Ethnic Disparities in Health; i.e., infant mortality, cancer screening and management (in particular, mammograms and pap tests), coronary heart disease and stroke mortality, diabetic complications (in particular, lower extremity amputations and end stage renal disease), HIV/AIDS, and childhood and adult immunizations. As the Healthy People 2010 documents replaced those for Healthy People 2000 at the end of the last decade, and as they have evolved over the past several years, the measures, targets, data sources, and baselines in the OPHS performance plans have had to be continually revised or updated to be consistent with their counterpart objectives in Healthy People 2010. The Conference Edition of Healthy People 2010 (released in January 2000), which was used as the basis for the draft version of the FY 2002 OPHS plan, has since been replaced by the Final Edition (released in mid-November 2000 at the annual meeting of the American Public Health Association in Boston, Massachusetts), and, again, there have been a number of changes made to the measures, targets, data sources, and baselines between editions. All of these changes are reflected in this particular plan. As in last year's plan, baseline data and appropriate targets are not yet available for all measures or all required racial and ethnic groups in each measure. "No data" indicators denote where data are not available either because the data are not currently collected (DNC), collected data have not yet been analyzed (DNA), or the data are statistically unreliable (DSU) because the population numbers are too small to be valid. If no baseline data are currently available for the particular objective or racial and ethnic group, then baselines and targets cannot be set and a "not set" indicator is presented. Final Healthy People 2010 targets are generally set at a "better than the best" level, allowing room for improvement for all racial and ethnic groups. For those measures, (e.g., the coronary heart disease and stroke mortality objectives) in which targets have been set at a level of improvement over the national average for the total population, baselines for one or more racial and ethnic group may be at or better than the target. In these cases, the target levels are expected to remain the same or improve over time. Interim targets for the end of fiscal years 2001, 2002 and 2003 reflect the average annual reduction in disparities needed over the decade for all racial and ethnic groups to reach parity with one another by 2010. Whether the targets have been set at a level of improvement over the national average for the total population or a "better than the best" level, any racial or ethnic group whose current status for a particular measure is at or better than the 2010 target is expected to retain or improve upon its current level of health; thus, interim targets for such a group or groups are set at that current level. For ease of target setting, if 2000 data are not yet available, data for the most recent year for which actual data are available (in most cases, 1999) are used as the baseline point for the beginning of the decade (2000). Lastly, although the Healthy People 2010 initiative allows racial and ethnic group data to be disaggregated in order to "unmask" further disparities in subgroups, only racial and ethnic categories identified in the Federal standards for collecting racial and ethnic data established by the Office of Management and Budget are presented in these measures, whether they are absent from, or other subgroups are identified in, the Healthy People 2010 objectives. � FY 2001 Performance Summary OPHS is committed to assuring sustained progress and improved health outcomes within each priority through coordinated public and private efforts. The effectiveness of OPHS's activities are essential to the achievement of this ambitious goal, but the problems underlying OPHS's priorities are complex and reach beyond the control and responsibility of any one arena or effort. Achievement is dependent on various health programs and providers, all levels of government, and the efforts of the private sector as well as individual contributions. In FY 2001, OPHS continued to eliminate racial and ethnic disparities in health status and health care access and quality, through building a stronger science base, influencing national policy, promoting effective partnerships, and engaging in strategic communications. Pivotal accomplishments of the past few years include coordination of a Department-wide initiative to reduce the racial disparities and burden of HIV/AIDS among minority populations. OHAP continues to provides leadership to the Congressional Black Caucus (CBC), Minority AIDS Initiative (MAI) which has as its goal a significant reduction of the incidence of HIV and AIDS diagnoses within racial and ethnic minority communities. The MAI has encouraged new program and project partnerships among HHS agencies and offices, and other federal government departments. In particular, OHAP has helped define new responses to both infrastructure and social context issues underlying the health disparities in HIV/AIDS. These approaches have been picked up as models for addressing other health disparities in vulnerable populations. In 2000 and 2001, OHAP piloted the Rapid Assessment Response and Evaluation (RARE) demonstration projects in 12 cities. In addition, workshops and presentations were presented at more than 15 national and regional conferences, conventions and forums. In 2002, Chief Elected Officials (ECO) and health departments directors from 14 jurisdictions have requested RARE demonstration projects. Small scale RARE demonstration projects are being planned for ten community-based organizations which requested this technical assistance. A Comprehensive Report on Phase I of the RARE project is in development and should be ready for release by Spring 2002. Several Field team coordinators from RARE Phase I are collaborating on an anthology of their experience implementing RARE demonstration projects. In addition, there has been interest in the HHS RARE project by the Canadian government; a request has come to OHAP from Health Canada to have several government employees participate in RARE training. Over the past two years, OHAP's TLCA has conducted activities resulting in 200,000 direct citizen contacts. The Campaign staff have coordinated and facilitated Leadership forums, partnerships with churches, service organizations, agencies that operate AIDS programs, and media and community outreach programs, and drafted opinion editorials, articles, and Public Service Announcements (audio and TV). TLCA also provided direct technical assistance through designing and implementing a program to train minority individuals to review HHS grant applications and requests for proposals. These events took place between August 1999 and September 2001. An example of expanded partnership and dialogue is TLCA activity with the National Council on Black Aged. Despite the growing number of elderly African Americans living with HIV/AIDS, the Council has no HIV/AIDS education program. Through partnership with TLCA, the Council hosted a two day national symposium on HIV/AIDS and the elderly in June 2001. In a similar vein, tribal leaders in the Native American community were reluctant to address the issue of HIV/AIDS, but TLCA's work helped them to find a way to talk about the epidemic in a culturally appropriate manner. TLCA's work with this group was discussed in the New York Times (November 28, 2001) and on the front page of Indian Country (November 2001) and several other Native American newspapers. TLCA has also expanded the capability of our public partners by sponsoring six Plain Language trainings during FYs 2000 and 2001 to over 100 Federal employees who are responsible for writing program announcements. By demystifying the Federal grants application process, TLCA helps to ensure that Federal dollars go where they are needed most, rather than only to those who can decode requests for proposals. OWH funds four National Centers of Leadership in Academic Medicine (COL), including one at Meharry Medical College, that serve as demonstration projects. These Centers have the following goals: (1) to foster gender equity in medicine, and (2) to promote the leadership advancement of junior faculty, who tend to be disproportionately women and minorities, into senior faculty positions. Over 100 professional publications/manuscripts, and presentations have been developed by the four Centers. By the end of their 3rd year, each Center has institutionalized their program by placing the administration of their programs in the Office of the Dean and by providing financial contributions to continue these programs. In 2002, the Center directors will serve as advisors on career development and mentoring for the National Centers of Excellence in Women's Health and other academic centers. This should foster the duplication of the COL model into other academic centers. Initial evaluation of the Centers has revealed that they have contributed to the retention and recruitment of faculty into their institutions and have contributed to career satisfaction amongst their faculty. The National Women's Health Information Center (NWHIC) created a specialty section on its 4woman.gov web site specifically geared to help women learn more about the leading health concerns of minority women. It puts a wealth of useful information together in one place for minority women, caretakers, health professionals, and researchers. This section does not deal only with illness and disease; it takes a proactive approach to health by featuring a "Nutrition and Wellness" section dealing with issues such as exercise and nutrition. The NWHIC Minority Women's Health section received 35,000 visitors in 2001. NWHIC also has a specialty section for Spanish speakers, which received 30,000 visitors in 2001; this section links to over 300 publications written in Spanish. NWHIC has also translated its specialty section for expectant mothers into Spanish and provided links to relevant Spanish resources. In addition, the NWHIC 1-800 number receives approximately 30 calls per month from Spanish speakers. Two Spanish-speaking Information and Referral staff are available to take and answer these calls. OPHS continued a number of activities to promote the collection of health data and the strengthening of data infrastructures, in order to enable the identification and monitoring of health status among US racial and ethnic minorities, the nature and extent of health disparities affecting them, and the effects of initiatives and interventions targeting their health problems. For example, OMH co-chairs the HHS Data Council's Working Group on Racial and Ethnic Data, the internal advisory group to the Secretary on minority health data and statistics. In FY 1999, OMH, through this working group, updated and expanded the HHS Directory of Minority Health and Human Services Data Resources (Inventory) of 182 major data collection systems sponsored by HHS. The Inventory provides a snapshot of the HHS data collection systems which make their data available to the public. The Inventory is produced for policymakers, administrators, researchers, and the public as a reference document on data resources within HHS and is available on OASPE's website (http://www.aspe.os.dhhs.gov/datacncl/datadirectory). In FY 2000, OMH conducted a preliminary review of state laws and regulations which prohibit the collection of racial and ethnic data by health insurers and HMOs in the private market. The findings were presented by OMH staff at two key meetings convened by the American Association of Health Plans and the HMO Research Network. Based on this preliminary work, OMH awarded a major contract from FY 2000 1% funds to the National Health Law Program to conduct a comprehensive review of state laws, regulations, and rules to determine the extent to which health insurers and managed care organizations (MCOs) are permitted to collect and report racial and ethnic information. The project's recommendations would continue the momentum of the HHS Initiative to Eliminate Racial and Ethnic Disparities in Health, as well as one of the overarching goals of Healthy People 2010, the Nation's health promotion and disease prevention objectives for the next decade. In FY 2001, Phase I of this project-involving the review of State laws, regulations, and other written policies regarding the collection of racial and ethnic data in health care-was completed. Subsequent phases, including site visits to selected States for further examination of relevant policies and practices, will be completed by the end of FY 2002 or early FY 2003. The Office of Minority Health is co-funding a comprehensive study of HHS data collection systems and practices relating to race and ethnicity data. The study is mandated by Title III of the "Minority Health and Disparities Research Education Act," which directs the Secretary to contract with the National Academy of Sciences to conduct a study and develop a report. The study will be completed in FY 2002. OMH will be central to the dissemination of findings and identifying opportunities for the implementation of recommendations. Also, in FY 2002, the Office of Minority Health will complete a study to develop and test a uniform information/data set (UDS) for evaluating and assessing the impacts of OMH-funded activities. In addition, a journal article on the UDS project will be published in FY 2002. OPHS continued in FY 2001 to foster service demonstration projects, evaluations, and other studies of interventions aimed at improving health and the health care system to strengthen and expand the science base for decision-making, determine model approaches and best practices, and identify and overcome barriers to health, as well as program and intervention effectiveness. During FY 2002, the Institute of Medicine will release its findings of an OMH-funded study entitled Understanding and Eliminating Racial and Ethnic Disparities in Health Care. This study is mandated by FY 2000 appropriations report language and is expected to clarify our understanding of the underlying causes of health disparities; identify approaches that would be effective in countering the impact of bias in medicine and health care; and identify policy changes, program initiatives, and resource requirements necessary for timely implementation. OMH has continued to support its principal demonstration grant programs. The Office funded 11 continuations and 9 new projects under the Bilingual/Bicultural Service Demonstration Program to improve the ability of health care providers and other health care professionals to deliver linguistically and culturally competent health services to limited-English-proficient minority populations. It also funded 6 continuations under the Minority Community Health Coalition Demonstration Program which supports projects that address socio-cultural barriers and demonstrate effective coordination of integrated community-based screening, outreach, and other enabling services. A competitive cycle for this program, renamed the Community Programs to Improve Minority Health Grant Program, was conducted in FY 2001 with 17 new awards made which will receive funding through FY 2003. In FY 2001, OMH established the Health Disparities Grants in Minority Health Program to support local pilot and small-scale projects which address a wide range of health problems and issues related to health disparities in local minority communities. Thirty awards were made. In FY 2002, OMH will expand this program to support local pilot and small-scale projects which address a wide range of health problems and issues related to health disparities in local minority communities. It is expected that the number of organizations supported will be increased from the 30 awards made in FY 2001 to approximately 40. OMH has also continued the programs funded by the Minority HIV/AIDS Initiative. Under the Technical Assistance/Capacity Development Demonstration Program (TA/CD) for HIV/AIDS-Related Services in Highly Impacted Minority Communities more than 150 minority community-based organizations received services in FY 2001 through six projects, including needs assessments, mentoring, workshops on proposal writing, and staff development. Under the State and Territorial Minority HIV/AIDS Demonstration Program, 15 minority health offices/entities in 13 states, the District of Columbia, and the Virgin Islands are coordinating statewide efforts to respond to the HIV/AIDS crisis in minority communities. Ten projects under the Minority Community Health Coalition Demonstration Program HIV/AIDS are providing education and outreach on HIV/AIDS. These coalitions involve minority CBOs, in partnership with ASOs and non-traditional organizations, fostering community dialogue and providing linguistically and culturally appropriate HIV/AIDS information. More than 60 organizations are involved in these partnerships. OMH also anticipates conducting competitive cycles in FY 2002 for the Technical Assistance/Capacity Development Demonstration Program (TA/CD) for HIV/AIDS-Related Services in Highly Impacted Minority Communities, and the Minority Community Health Coalition Demonstration Program HIV/AIDS. OPHS continues to support special projects addressing health disparities. In August 2000, OMH awarded a 17-month contract to the Institute of Medicine for a study entitled Understanding and Eliminating Racial and Ethnic Disparities in Health Care. This study was mandated by the Congress in report language in the FY 2000 appropriations. The contract is for $825,140. The purpose of the study is to "assess the extent of differences in the kinds and quality of health care received by US racial and ethnic minorities and non-minorities, explore factors that may contribute to differences, and recommend policies and practices that eliminate inequities." The results of this study are expected to be released in February 2002. OPHS continues to affect policies, programs and practices to address health disparities. OMH established an effective mechanism for coordinating the various departmental minority initiatives through the Departmental Minority Initiatives Coordinating Committee (DMICC) which the DASMH chairs. The DMICC serves as the coordinating body for the HBCU Initiative, the Hispanic Agenda for Action, the Tribal Colleges and Universities Initiative, and the AAPI Initiative. In FY 2001, the Advisory Committee on Minority Health was established to advise the Secretary and the Department on issues related to minority health and health disparities. The advisory committee is chaired by the Honorable Louis Stokes and met twice in FY 2001. OMH has led the Department in the development of a snapshot of Departmental programs, an inventory of Departmental efforts targeted to AAPIs, and FY 2001 agency plans for implementing Executive Order 13125, Increasing Participation of Asian Americans and Pacific Islanders in Federal Programs. In addition, in FY 2001, with the use of 1% evaluation funds, OPHS completed a project to develop recommended national standards for culturally and linguistically appropriate services (CLAS) in health care. These standards were published in the Federal Register on December 22, 2000 after a 120-day public comment period which included three regional meetings on the standards. The CLAS standards now provide health care stakeholders with a conceptual framework for providing CLAS in health care to diverse populations. To build upon the CLAS standards, OMH initiated two new evaluation projects at the end of FY 2001 to pilot test the standards and develop cultural competency curriculum models for training health care professionals in the implementation of these standards. These projects will be completed in FY 2003 with the results to be disseminated to a wide range of health providers, health care organizations, and consumers. OPHS has also moved to increase awareness and understanding of the major health problems and needs of racial and ethnic minorities and the nature and extent of health disparities between racial/ethnic groups in the US through a wide range of informational and educational efforts aimed at decision-makers, health professionals, those serving racial/ethnic minority communities, and the general public. OMH has also continued to produce high quality and highly sought after publications that appeal to consumers, universities, state offices of minority health, health educators, researchers, and administrators. During the past two years, OMH produced more than a dozen issues of Closing the Gap, a newsletter available both electronically through the Office of Minority Health Resource Center (OMH-RC) web site and in print. Popular issues included Cultural Competency and Oral Health. In addition, as part of the Congressional Black Caucus (CBC) Initiative, OMH launched HIV Impact, a quarterly publication of Closing the Gap, which addresses HIV/AIDS-related topics as they affect minority populations. These publications have more than 30,000 subscribers. OMH has also reprinted 1999 and 2000 editions of The Pocket Guide to Minority Health Resources. This guide is the single most requested publication originated by OMH. The popular Breast Cancer Resource Guide for Minority Women was also reprinted by OMH. Now in its second edition, the publication contains a wealth of resources for minority women with breast cancer, their families, and health professionals who treat breast cancer. Since its inception in 1987, the Office of Minority Health Resource Center (OMH-RC) in OPHS has become one of the nation's largest sources of minority health information. The OMH-RC collects, distributes, and facilitates the exchange of information on a variety of health topics. In FY 2000 and 2001, OMH continued to produce high-quality and highly-sought-after publications appealing to consumers, health educators, researchers, health providers, administrators, and state and local government officials. The monthly newsletter, Closing the Gap and the quarterly HIV Impact have more than 30,000 subscribers. In FY 2000 and 2001, there were 21,000 inquiries from health professionals, consumers, and government agencies. Most inquiries were in English (16,500). There were 600 inquiries in Spanish. More than 113,941 documents were distributed by OMH-RC in FY 2000 and 2001. More than 7,500 individuals asked to be added to the mailing list. In addition, in response to results of an evaluation of the OMH-RC, OMH completely redesigned and expanded its website to improve information delivery to professional and community audiences working in minority health. As a result, hits on the website grew from 1 million in FY 2000 to a projected 2.2 million in FY 2001, and web visits grew from nearly 200,000 to more than 330,000 in this period. Furthermore, in February 2000, OMH launched a website dedicated to the Department's Minority HIV/AIDS Initiative. This web site provides information on current news, funding, technical assistance, prevention and living with HIV/AIDS, and includes links to reports, archives, and both federal and non-federal sites. A special page on the 20th anniversary of the first reported cases of AIDS was created in May 2001 and provided a tool kit for local organizations to plan and implement commemorative efforts. This special page received more than 10,000 hits in its first two months of operation. In FY 2000, under the Minority HIV/AIDS Initiative, the OMH-RC expanded technical assistance to minority community-based organizations (CBOs) and AIDS service organizations (ASOs). A national technical assistance campaign was conducted in 6 cities, focusing on organization development and sustainability of CBOs and ASOs. Nearly 400 persons representing 168 organizations participated in skills-building workshops. Direct technical assistance site visits to an additional 35 organizations, and telephone and mail consultations with another 40 organizations, were provided in FY 2001. In September 2001, OPHS in collaboration with OASPA, initiated a new partnership with the ABC Radio Networks and ABC Radio's Urban Advantage Network to inform minority communities on ways to achieve better health and close the health gaps between them and the rest of the U.S. population. This partnership aims to inform and educate African Americans about the health gap and empower individuals to adopt healthier lifestyles through a health information and education campaign entitled "Closing the Health Gap: Reducing Health Disparities Affecting African Americans." OMH has continued to establish and strengthen networks, coalitions, and partnerships to identify and solve health problems and concerns affecting racial and ethnic minorities. Under the State Partnership Initiative, designed to assist State minority health entities to develop or expand their existing infrastructure and capacity to address health disparities, the OMH awarded contracts to 12 State minority health entities in FY 2000. In addition, in FY 2001, OMH began to implement a number of recommendations of its study on the State minority health infrastructure and capacity to address health disparities (completed in early FY 2000), including awards to four State minority health entities and funds to the ten PHS Regional offices. On December 3-5, 2001, the OWH Regional Women's Health Coordinators and the State and Territorial Women's Health Coordinators attended a joint summit conference entitled Women's Health - Cycles of Life, in Washington, DC. The agenda reflected the most up-to-date topics of interest based on the Surgeon General's leading health indicators and guidelines from Eliminating Health Disparities. OMH has continued to support and manage umbrella cooperative agreements and standard cooperative agreements. The umbrella cooperative agreements establish broad programmatic frameworks for multiple projects. They afford the opportunity for HHS and other federal agencies to collaborate and jointly fund individual projects. Projects include 18 funded under the Minority HIV/AIDS Initiative. These projects target minority populations that are most at risk or hardly reached, e.g., inmates, homeless, women at risk, youth or those in rural areas. In FY 2001, OMH supported 27 umbrella cooperative agreements and two standard cooperative agreements. As directed by FY 2001 appropriations language, OMH provided funding to 11 organizations to conduct activities initiated by each organization. For example, the Donald R. Watkins Memorial Foundation in Houston, Texas, will enhance care for African American and low income individuals with HIV/AIDS by coordinating services and expanding outreach efforts. The Fresno Community Hospital and Medical Center of California will support diabetes care and outreach for Hispanic Americans and low-income individuals. Performance Measures
DSU = Data statistically unreliable DNA = Data not analyzed DNC= Data not collected **Recall that FY 2000 targets were set using a different baseline. Related HHS Strategic Goals
1. Verification and validation methods and procedures for these national data are available in HHS Publication No. (PHS) 98-1256. 3. For the purposes of this performance report, OPHS has retained targets for FY 2000 that are consistent with Healthy People 2000, even in areas like this where achievement is unlikely. Targets for 2001 have been recalibrated based on Healthy People 2010 objectives. 4. For the purposes of this performance report, OPHS has retained targets for FY 2000 that are consistent with Healthy People 2000, even in areas like this where achievement is unlikely. Targets for 2001 have been recalibrated based on Healthy People 2010 objectives. 5. Actual performance numbers represent contracts obligated. � Last revised: March 29, 2002 |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
