Select Populations:
Children (under age 15)

General:
A general question was posed by the moderator about the objectives related to children, are there gaps? Are there places in the objectives that are duplicative or frivolous?

American Obesity Association representative:
Had some concern about gaps in the document and scattered objectives. Strongly felt that childhood obesity and obesity in general are neglected in the document. Although it's in nutrition and fitness, believes that it should stand out on its own as it is a major problem in the US and internationally.

Breastfeeding and Lactation Consultants representative:
Breastfeeding is an underpinning for good health and there's not enough of a clinical support component.

Strategies that have failed in the past are reiterated in the document, would like to see document go one step further than laying out strategy—major problem is the lack of integration of one piece of health care promotion with another piece of health care promotion.

Specific Issue in Environmental Health Section:
Everyone's in favor of decreasing poison exposure and fatalities, but the data imported in the document aren't used as they could be and the toxicologists were not consulted. What is listed is the most common, but not the most dangerous poisons. For example, decreasing exposure to plants is not going to save lives; cleaning substances are high on the list, but not the most dangerous substances; simply lifting data doesn't accurately reflect real issue of poison exposures in the data.

Recommends—consultation with the American Association of Toxicologists for interpretation of data, that would allow refinement of the objectives to address serious morbidity and mortality issues. Environmental Health Objective, 5.19

School Nurses:
In favor of objectives under school based health programs, but it is highly important that nurses are in all the schools. Thus, need for nurses in school based health centers, but would like to see it revised to include all schools.

NY State Representative:

As a 'consumer' the state is getting multiple products such as GPRA, etc. that are not linked to HP 2010 but are linked to his grants and funding sources. Anything with measures or requirements linked to his funding sources he will do and not HP 2010 if they're not coincident, e.g. performance measures for CDC; can't expect the use of HP 2010 unless the federal agencies' performance measurements are brought together. Issues of integration and alignment of federal agency data outcome objectives are not consistent.

Problem with consistency in performance measures in these agencies: population planning

Maternal Infant and Child Health
Federal education for early intervention CDC

Social Service—TANF

Oral Health:
Issue in oral health is that we have data that shows low income kids that have access to better dental coverage does not necessarily equate to better oral health.

Physical Activity:
Mainly written for grades 9-12 and 18+, and doesn't address younger children (explained based on YRBS data). Comment that SHPPS does address all levels of children; concern about amounts of Physical education; also emphasis is on vigorous versus moderate exercise.

Specific obj. 10 (on pg. 1-15): 50% of activity should be physical (not certain how obj. reads) but issue is doesn't assume quality, it's an isolated variable that may not be related to quality.

Nutrition:
Similar issue in nutrition, school lunches should be health promoting, what will get us to the outcome.

Health challenges that require more attention:
Children with disabilities; low income vulnerable kids that are a minority of the population.

Overall sense that there are too many objectives and nothing is prioritized. Should reduce by at least 20% HP 2010 objectives, at a minimum.

Would like to see a chapter on Special Populations. It's difficult to figure out how to get information on special populations, what are the top 10 issues for each population.

American Association of Public Health Doctors:
global issues, what % of our population is going to get health care? Child abuse and domestic violence aren't adequately addressed in HP 2010:

• adequate prenatal history
• drug use by mother
• atmosphere child is born into
• mental health evaluation of mothers
• adequate parenting skills of mothers

Objective: every state have requirement for physical exam upon entry into school

Objective: parenting education