Detailed Information on the
Office of Disease Prevention and Health Promotion Assessment

Re-evaluate performance targets to ensure ambitiousness of performance measures which link performance accountability with health promotion.

Develop a new efficiency measure for ODPHP

Develop draft strategic framework and short and long term performance goals for each team within ODPHP.

Development of an updated ODPHP Action Plan

Measure: Percentage of customers satisfied with healthfinder

Explanation:ODPHP plans to conduct American Customer Satisfaction (ACS) survey every other year through the end of the decade.

Measure: Visits to ODPHP-supported Websites

Explanation:Annual targets are 7% increases from previous year. Numbers collected from the National Health Information Center service level reports.

Measure: The percentage of states that use the national objectives in their health planning processes.

Explanation:States will be contacted every two years until the end of the decade. The goal is to help shape prevention policy and have all states and the District of Columbia use the national disease prevention and health promotion objectives in their health planning process.

Measure: The percentage of Healthy People 2010 focus area progress review summaries that have been written, cleared, and posted on the internet within 16 weeks of the progress review date.

Explanation:Operational efficiency measure to promote increased productivity

Measure: Awareness of Dietary Guidelines for Americans for the general population

Explanation:The Dietary Guidelines for Americans (DGA) are published every five years. The 2005 DGA was released in January, 2005. ODPHP plan to field a survey (FDA Health and Diet Survey, 13 question supplemental) to measure awareness.

Measure: Increase the percentage of Healthy People 2010 objectives that have met the target or are moving in the right direction. These objectives are a comprehensive set of disease prevention and health promotion objectives for the Nation to achieve over the first decade of the new century. Created by scientists both inside and outside of government, they identify a wide range of public health priorities and specific, measurable objectives. (New measure, February 2007)

Explanation:The 467 health outcome measures of Healthy People 2010 are encompased in this single measure. The baseline measurement at 2005 is based on the Midcourse Review -- an assessment ODPHP made of the objectives in collaboration with the lead agencies and the National Center for Health Statistics. The 2010 target for the final review is based on historical experience, i.e., the percent of total HP 2000 objectives that had met the target or were moving in the right direction at the end of the decade and professional judgment

Measure: Increase the percentage of measurable racial/ethnic minority-specific Healthy People 2020 (HP2020) objectives and subobjectives that have met the target or are moving in the right direction. These objectives are a comprehensive set of disease prevention and health promotion objectives for the Nation to achieve over the second decade of this century. Created by scientists both inside and outside of government, they identify a wide range of public health priorities and specific, measurable objectives. (New measure, July 2008)

Explanation:This measure is the same as the Healthy People 2010 measure, concentrating on the HP2020 data. 2010 will be the baseline year, with targets being developed as part of reviews.

Is the program purpose clear?

Explanation: Congress established the Office of Health Information and Health Promotion, which later became the Office of Disease Prevention and Health Promotion (ODPHP), to address the lack of improvement in illness, disability, and premature death, despite the vast increase in health care expenditures and the greatly improved access to care on the part of most Americans. The mission of ODPHP is to provide leadership, coordination, and policy development for public health prevention activities by establishing and promoting national health objectives and Dietary Guidelines for Americans. ODPHP is within the Office of Public Health and Science (OPHS), a division within the Office of the Secretary.

Evidence: Its authorizing legislation (Title XVII, Section 1701 of the Public Health Service Act) gives ODPHP authority to establish national health objectives for the Nation and to establish a National Health Information Center. Special legislation (Public Law 101-445) establishes the role of the Secretaries of HHS and USDA in publishing the Dietary Guidelines for Americans every 5 years. Also: ODPHP mission statement; ODPHP and OPHS organizational charts. Authorities under Title XVII of the Public Health Service Act for prevention training have been delegated to the DASH (DPHP).

Does the program address a specific and existing problem, interest, or need?

Explanation: ODPHP focuses national attention on disease prevention and health promotion issues and keeps Americans informed of ways to reduce their risk of disease and increase years of healthy life. ODPHP provides leadership, coordination and policy development for disease prevention and health promotion programs by 1) providing a cohesive framework for the prevention activities of the Department; 2) serving as the focal point within HHS for nutrition policy development and coordination; 3) developing and promoting innovative approaches to communicating health information; and, 4) supporting health professions education, conducting policy research, and disseminating information specific to disease prevention and health promotion.

Evidence: One of the most cited statistics is the imbalance of investments in medical treatment compared with prevention activities. Modifiable behaviors, such as tobacco use, poor nutrition, and physical inactivity, account for approximately 40 percent of annual deaths. According to a 2002 article in Health Affairs, ninety-five percent of the trillion dollars the United States spends on health goes to direct medical care services, while just 5 percent goes to prevention. Other evidence includes: Legislative history of the Title XVII of the Public Health Act; select scientific articles establishing the importance of disease prevention and health promotion and training activities. Dietary Guidelines for Americans, Healthy People, HealthierUS, Steps to a HealthierUS and the National Health Information Center address the existing problem.

Is the program designed so that it is not redundant or duplicative of any other Federal, state, local or private effort?

Explanation: Although placement of the management and leadership for associated health promotion and prevention activities in the Office of the Secretary ensures coordination across other federal agencies and departments as well as the public and private sectors, public health prevention programs and promotion activities are not unique solely unto ODPHP. For example, other HHS OPDIVs, Federal and State organizations also play a significant role in disease prevention and health promotion.

Evidence: The Dietary Guidelines for Americans are the standards on which other federal programs use for setting policy, such as the USDA school lunch, thus both play a role in promoting healthy behaviors. States have adopted promotion/prevention programs. A single google search on "disease prevention" returned over 3 million hits, covering state, local, and community organizations and activities, including the University of California Irvine's heart disease prevention program, the State of North Carolina's chronic disease and injury center, and the Department of Energy's beryllium prevention program.

Is the program design free of major flaws that would limit the program's effectiveness or efficiency?

Explanation: ODPHP operates by coordinating, integrating and leveraging HHS-wide prevention activities. However, the design fails to fully account for its reach and influence. By virtue of its design, there is no accountabilty mechanism for the work it does in response to its purpose and mission, especially in regard to the achievement of the Healthy People 2010 objectives, which is a major component. It does promote programs and encourge policies. Missing, however, is this level of accountability that is central to a coordinating body such as ODPHP.

Evidence: ODPHP, both through evidence and discussion, states that its role is one of leadership and coordination, not accountabilty, especially in regard to meeting the HP 2010 objectives.

Is the program design effectively targeted so that resources will address the program's purpose directly and will reach intended beneficiaries?

Explanation: ODPHP activities and products are targeted to reach the following beneficiaries: 1) federal agencies requiring a framework and coordination for health prevention/promotion initiatives; 2) individuals and organizations seeking information on disease prevention and health promotion; and 3) state and local communities interested in developing systems to improve the health of their citizens. ODPHP's products are based on extensive interaction with users, including federal agencies, states, communities and individuals. ODPHP maintains several listserves to reach target audiences.

Evidence: Several examples of targeting to reach beneficiaries include guides and toolkits to assist communities in using Healthy People 2010 to develop their own disease prevention and health promotion action plans. MOUs with organizations such as the American Academy of Orthopedic Surgeons, and the American Heart and Stroke Associations outline cooporative efforts for achieving targets set forth in Healthy People 2010 for those particular groups. Other partnership agreements around Healthy People, HealthierUS and the Dietary Guidelines for Americans leverage resources from the private sector to share publications and other resources to reach target audiences. ODPHP listserves regularly disseminate consumer and professional health information to the public.

Does the program have a limited number of specific long-term performance measures that focus on outcomes and meaningfully reflect the purpose of the program?

Explanation: ODPHP operates under three longer-term strategic goals. It does not, however, have long-term outcome performance measures which sufficiently link to the program purpose and mission, especially those measuring impact of health promotion and disease prevention activities.

Evidence: Strategic Goals include: 1) Shape prevention policy at the local, state and national level by increasing the number of organizations that incorporate disease prevention and health promotion objectives based on ODPHP policy development; 2) Communicate strategically by increasing the reach of ODPHP disease prevention and health promotion information and communications; 3) Strengthen the prevention science base by increasing knowledge about disease prevention and health promotion, including effective interventions and research needs.

Does the program have ambitious targets and timeframes for its long-term measures?

Explanation: ODPHP needs to develop overall long-term measures reflective of the purpose and mission and that capture performance expectations for its total portfolio of policy and programmatic responsibilities. Once these are in place, appropriate targets and timefames will be established.

Evidence: ODPHP's long-term strategic goals.

Does the program have a limited number of specific annual performance measures that can demonstrate progress toward achieving the program's long-term goals?

Explanation: ODPHP has systems in place for collecting annual performance information that can demonstrate progress toward achievement of its long-term goals. Various performance metrics are included in these measures. These performance metrics are designed to and will show progress toward achieving ODPHP's long-term goals.

Evidence: ODPHP annual measures; FY 2006 OPHS GPRA Plan; ODPHP Mission Statement

Does the program have baselines and ambitious targets for its annual measures?

Explanation: All annual measures have baseline measurements and methods for annual collection in place. Targets are ambitious and promote continuous improvement. For example, increasing by 7 percent each year visits to ODPHP-supported websites will become increasingly difficult as the market becomes more saturated. It will take creative marketing and continual technological improvements to meet this annual goal.

Evidence: ODPHP's performance measures plan; Usability Testing Proposal and Report for healthfinder.gov

Do all partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) commit to and work toward the annual and/or long-term goals of the program?

Explanation: Partners (such as other HHS and other Federal departments and independent health associations) are committed to and work toward the annual and long-term goals in a number of ways: through partnership agreements around Healthy People 2010, HealthierUS, Steps to a HealthierUS and the Dietary Guidelines for Americans; through adoption of the Healthy People 2010 objectives by states and local communities and through support and dissemination of the nutrition information in the Dietary Guidelines for Americans.

Evidence: MOU with the Boys and Girls Clubs of America, a HealthierUS MOU with USDA and DOE around Healthier Children and Youths; partnerships related to Healthy People 2010; the OCSC Scope of Work which includes a traveling exhibit program that supports distribution of ODPHP publications, and the Orientation to Grants Administration for Program Officials; state plans and companion documents that demonstrate community support for the Healthy People 2010 objectives. Also, an important addition to the Department's guidance for grants administration is the requirement that all HHS program announcements mention Healthy People 2010 and require that all grant applications include an explanation of how the grant supports the achievement of these objectives.

Are independent evaluations of sufficient scope and quality conducted on a regular basis or as needed to support program improvements and evaluate effectiveness and relevance to the problem, interest, or need?

Explanation: ODPHP contracted The National Opinion Research Center (the University of Chicago) to conduct an assessment of state, local, and tribal organizations. The study found high awareness and use of Healthy People 2010 and HealthierUS; two federal initiatives aimed at improving the health of the U.S. population. As a result, plans and funding are in place to engage a nationally recognized group of experts to provide recommendations to the Department on a process for the development of health objectives for the Nation beyond 2010. Also, ODPHP regularly conducts usability surveys of healthfinder.gov. A new Google upgrade is an example of an adjustment made on the basis of these results. Also, a stakeholder survey informed development of the Dietary Guidelines for Americans and a Toolkit for health professionals.

Evidence: Assessment of the Uses of HealthierUS and Helathy People 2010; stakeholder survey on the Dieatry Guidelines for Americans; American Diebetics Toolkit Survey; Usabilty Testing Proposal and Report for healthfinder.gov.

Are Budget requests explicitly tied to accomplishment of the annual and long-term performance goals, and are the resource needs presented in a complete and transparent manner in the program's budget?

Explanation: ODPHP's FY 2006 budget does not provide a presentation that clearly ties the impact of funding decisions to expected performance of long-term or annual meaures, or explains why the requested resources are appropriate. The request does present a detailed program description and accomplishments achieved to date.

Evidence: FY 2006 Justification of Estimates for Appropriations Committees

Has the program taken meaningful steps to correct its strategic planning deficiencies?

Explanation: The 2001 ODPHP Action Plan is out of date. It does not reflect the new responsibilities the Office assummed in 2002 for HealthierUS and Steps to a HealthierUS. A new, permanent director has, consequently, committed to a strategic planning process beginning with an office retreat in the Fall of 2005 to update the office's mission, structure, activities, and action plan.

Evidence: 2001 ODPHP Action Plan, demonstrated current planning meetings underway (retreat).

Does the agency regularly collect timely and credible performance information, including information from key program partners, and use it to manage the program and improve performance?

Explanation: ODPHP collects performance information from monthly progress reviews with key federal program partners on Healthy People 2010 focus areas; from users of healthfinder.gov through usability and customer satisfaction surveys; from contractors through workplans and monthly progress reviews; from participants attending the National Steps to a HealthierUS Prevention Summit; and from key program partners regarding communication needs and learning-related needs.

Evidence: Focus area progress review summaries and the midcourse review showing progress with HP 2010; information evaluation of focus area progress reviews; results of the dietary guidelines stakeholder survey which led to the development of a tool kit for health professionals; evaluation results from the Steps Prevention Summit that led to improvements in the registration system and marketing to increase attendence at last year's Summit; healthfinder.gov usability and customer satisfaction survey results. All of this information is used to make program adjustments. As one example, usability testing of healthfinder.gov revealed the need for navigation improvements which were addressed by a Google upgrade this year.

Are Federal managers and program partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) held accountable for cost, schedule and performance results?

Explanation: The Assistant Secretary for Health (ASH) and the Deputy Assistant Secretary for Health (DASH), Disease Prevention and Health Promotion are held accountable for operations of ODPHP, including performance results, through their annual performance plans. Project officers are held accountable for monitoring the office's contracts. ODPHP contractors and grantees are held accountable for cost, schedule and performance results in their annual reports, which are tied to funding for subsequent years. The Department, in grant guidance, requires that all grant applications include an explanation of how the grant supports the achievement of Healthy People objectives.

Evidence: Performance contracts for the ASH and DASH which include goals such as coordinating 12 HP 2010 reviews, providing support for the Dietary Guidelines; Departmental grant guidance; OCSC (communication support center) monthly review of contract tasks and deliverables and NHIC quarterly reports on service levels.

Are funds (Federal and partners') obligated in a timely manner and spent for the intended purpose?

Explanation: More than half of ODPHP's annual budget supports staff salaries and overhead expenses. Another 31 percent supports the two major task order contracts and the ATPM cooperative agreement. For the remaining 16 percent of the ODPHP budget, the senior staff develop a funding plan to ensure that funds are obligated in a timely manner and support the office's mission. Year end obligations have historically reflected a low lapsed balance (0.06 percent in FY 2002; 0.43 percent in FY 2003 and 0.03 percent in FY 2004).

Evidence: ARC Report quarterly report (status of funds); budget tracking report; FY 2004 close out report; FY 2004 close out report for ODPHP.

Does the program have procedures (e.g. competitive sourcing/cost comparisons, IT improvements, appropriate incentives) to measure and achieve efficiencies and cost effectiveness in program execution?

Explanation: ODPHP uses competitive contracts to support the National Health Information Center and the ODPHP communications support activities, including publication development, warehousing and the traveling exhibit program. In FY 2004 and FY 2005, ODPHP made investments in two IT applications which have improved efficiency. One was the design of a data system to collect and organize pubic comments on the report of the Dietary Guidelines Advisory Committee. The data system decreased staff time dedicated to filing and copying public comments. The second investment was a collaboration with the Assoication of Teachers of Preventative Medicine to utilize proven technology that is familiar in the scientific community for submission of abstracts for the annual prevention summit. Last year these tasks were done by ODPHP staff with a data system that required a significant amount of manual imput, consuming resources of 4 FTEs for a period of 2 months (now, staff resource time is essentially zero). The timeliness of quality products is of paramount importance for ODPHP. To that end, it monitors timeliness through its measure of efficiency, which supports its longer-term goal of ensuring timely issuance of disease prevention and health promotion products.

Evidence: 2005 Dietary Guidelines Advisory Committee Report View Online Comment Submission; ODPHP visiting scholar information; www.healthypeople.gov (for viewing progress reports)

Does the program collaborate and coordinate effectively with related programs?

Explanation: The placement of ODPHP in the Office of the Secretary facilitates communication, collaboration and coordination. ODPHP's three core activities -- Healthy People, Dietary Guidelines for Americans, and healthfinder.gov -- involve not only the Department and other federal agencies but the private sector as well. Healthy People activities are coordinated in several ways: through a Federal Steering Committee; through a private sector consortium; through state health departments; through ODPHP staff who serve as liaisons for each focus area; and through the work of ODPHP as lead agency for the Health Communication focus area. A healthfinder.gov Steering Committee provides coordination across Federal health information Websites.

Evidence: An intrinsic part of the development of the Dietary Guidelines for Americans was collaboration and coordination with USDA, FDA, NIH and the DGA Committee (Advisory Committee Timeline). Healthy People 2010 Secretary's Council provided links to private sector to ensure involvement during development process. Other evidence: various focus group materials; Joint Executive Review Panel memo; healthfinder steering committee.

Does the program use strong financial management practices?

Explanation: The Office of the Inspector General audit of the financial statement for the Department of Health and Human Services in FY 2004 reflects an unqualified audit for the Department. This is the sixth consecutive year the Department received a "clean" audit. The audit does not cite any material internal control weaknesses specific to ODPHP. ODPHP has routine senior staff monitor overall expenditures through quarterly budget reviews and monthly commitment registers. Spending plans guide the timely obligation of funds.

Evidence: FY 2004 Federal Manager's Financial Integrity Act Report; Independent Auditor's Report on Financial Statements and Management Response; FY 2004 close out report.

Has the program taken meaningful steps to address its management deficiencies?

Explanation: The new director of ODPHP has made good office management a key priority. She uses her weekly senior staff meetings to address management improvements. Each of the 3 team leaders holds weekly staff meetings and has made improving quality and performance a priority as well. The ODPHP Director has identified the lack of an overall office strategic plan for the office as a major management deficiency and has scheduled an office-wide retreat in early November to develop a current plan for the office. The ODPHP Performance Measures will serve as a framework, but the plan will be broader in setting future directions for the office. Another deficiency is the lack of coordination across the three teams in the office. The new director is making cross collaboration between the teams a priority.

Evidence: OPHS Senior Staff Advance PowerPoint presentation in October 2004 illustrates the goal of working toward a business model to better serve customers and ensure more effective management of program resources

Has the program demonstrated adequate progress in achieving its long-term performance goals?

Explanation: Adequate outcome measures are unavailable and thus, it is not possible to measure the program's progress in achieving its long-term performance goals. (Program received a No on 2.1)

Evidence: FY 2006 Congressional Justificaiton. Also, as ODPHP takes leadership in shaping prevention policy, the responsibility for meeting the national Healthy People 2010 objectives is shared. Thus ODPHP, through varies tools, encourages communitites to adopt the Helathy People 2010 objectives. It does not, however, have a mechanism in place to count these. Non-federal partners, who have used the national objectives to tailor plans for their states and communities, are critical partners. Being able to accurately measure these partners' usage would result in a more accurate picture of ODPHP's prevention reach.

Does the program (including program partners) achieve its annual performance goals?

Explanation: ODPHP has achieved adequate progress in achieving its goals. It has made progress on measures related to shaping prevention by increasing the number of states which are using the Healthy People 2010 objectives in their disease prevention and health promotion action plans. Through various mechanisms, it is furthering the long-term goals of communicating strategically and strengthening the prevention science base.

Evidence: ODPHP's has made progress with its annual measures, and is on track to making progress this year. This progress, in-turn, supports its existing longer-term goals. Continued development and demonstrated involvement from partners will strengthen ODPHP's results and reach.

Does the program demonstrate improved efficiencies or cost effectiveness in achieving program goals each year?

Explanation: ODPHP has demonstrated its ability to continue and improve its efficiencies by taking on additional assignments with minimal, if any, additional resources. ODPHP took on newly assigned leadership on the HealthierUS and Steps to a HealthierUS initiative. IT improvements have also resulted in increased efficiencies (see question 3.4)resulting in increased productivity, and thus overall cost efficiencies.

Evidence: FY 2006 justification materials; various IT improvements re: Dietary Guidelines; GSA Bill for Space and Services, August 2004. Example of internal cost efficiency: In August 2004, ODPHP relocated from office space in Washington, D.C. to space in Rockville, Maryland, which has allowed ODPHP to reduce by one-half the office overhead costs.

Does the performance of this program compare favorably to other programs, including government, private, etc., with similar purpose and goals?

Explanation: Without a clearly defined set on long-term performance goals, it is difficult to compare ODPHP's performance to other programs with similar purpose and goals. ODPHP does; however, compare favorably in program areas that have similar counterparts, both at the state and federal levels. This is based on stakeholder feedback and qualitative comparisons.

Evidence: State adaption of HP 2010 in own activities and initiatives; Steps to a HealthierUS Program; school nutrition programs; discussions with with staff suggest this program compares favorably through comparisons to other prevention-type programs at state and federal levels.

Do independent evaluations of sufficient scope and quality indicate that the program is effective and achieving results?

Explanation: Several independent evaluations of broad scope show that ODPHP is effective and achieving results. The National Opinion Research Center evaluation of HealthierUS and HealthyPeople 2010 show high awareness and use of the initiative, especially by states. Several studies have shown that adherence to the 2000 Dietary Guidelines for Americans resulted in better health outcomes.

Evidence: Preliminary draft results of Assessment of the Uses of HealthierUS and Healthy People 2010; evaluation research articles showing adherence to the 2000 Dietary Guidelines for Americans resulted in better health outcomes.