Comment On:
Framework and Goals of Healthy People 2010

DR. ELLIS: Good morning. Good morning. We are awake. It has been a very beautiful time that we have spent together.

One of the things we started off using was the first P, and that was participatory. That participatory effort has brought us together. We have had dialogue; we have had one socialization; we have done all those good things. As a direct result of that, I see Chris is smiling.

My name is Frank Ellis, and I am the regional health administrator for Region VII. It has been a very definite privilege for me to really be participating in the process that has gone on while we are here in Chicago.

We don't sometimes give full credit to the persons who are really in the vineyard, working very, very hard, in order to pull this conference off.

Thousands of individuals have been contacted. We saw the last, as we talked to Steve Potsic and George Rogers, they had 9,000 names available, and George Rogers has been doing this over X number of years.

I had the privilege of having him present to assist me, and more than likely he did it. Region VII was able to come up with around 1,500, but we couldn't compare to the 9,000 that George pulled together over the time.

A direct result of that is that we had over 500 individuals that registered, and we are very appreciative thus far of the things which have happened.

As we look at this, the year 2010, and Healthy People, what I also would like to do is acknowledge others who have participated.

I made mention of the regional health administrator, and also George Rogers. Dr. Linda Meyers has been very, very definitely one that has been in the vineyard, served in the background, came forward when necessary in order to assist us in moving forward.

She is the acting director of the Office of Disease Prevention and Health Promotion, and all of us were very appreciative of what has happened thus far.

During the fall of 1998, the United States Department of Health and Human Services convened, in its own concept of developing the program, five regional office meetings.

Three of those have already taken place. Region V still and Region VII still, we have pulled together, as you have heard me make mention of, that number of individuals.

Yes, this is the third meeting, and we hope that the remaining two meetings will be even better than the three that have already, or are in the process of being completed.

The purpose of today's session, however, is to hear your comments, to hear your comments on the draft of the Healthy People 2010, which is going to be made public as of September 15, 1998.

You input really is very vital. It is vital because we use the P of participatory. That will give us an input, as we begin to pull this together, that will be illustrative of how you provide those statements.

Oral statements now, but don't feel as if that is the only way. I encourage you also to submit written comments.

You can do this also in writing and submitting them either to the registration desk here, or submit them later by the way of Internet or e-mail. People who know me know that I don't like to read e-mail, but nevertheless, I will use the word. It made me stutter, and it even made me stop for a moment.

The thing that we would really like to do is to have this regional meeting be illustrative, as I said, of input from all of you.

A transcript of today's session will be made public and posted on the Healthy People web site.

In addition, all the written comments received between September 15 and December 15, 1998, will be posted and show on the web site.

The address for the web site is in your materials. Be sure, if you desire to do that, to look at that and turn it in.

To help assure a very fair opportunity for everyone to participate in today's hearing, we will be using the following procedure. Listen very carefully. It is not that we don't like you or love you, but these are really the processes that we will be going through.

First, each oral statement will be limited to three minutes, so that you can hear from the greatest number of participants, hopefully.

Second, each individual or organization will be limited to one oral statement. That is for the opening session in each of the areas in the focus area.

Third, if time permits, at the end of the concurrent sessions, the floor will be open for general comments.

From 8:20 to 9:00 o'clock, Dr. Potsic will be hearing your comments on the framework, goals, leading health indicators, for Healthy People 2010.

Then at 9:00 a.m., we will break and we will go into three concurrent sessions. The sessions will, in one, promote healthy behaviors and healthy, safe communities. This will be convened by Dr. Potsic and will be in the Acapulco Room on the ballroom floor.

The second session, session number two, improving systems of personal and public health, will be convened by Dr. Willis-Fillinger, and that will be in the Toronto Room. That also will be on the ballroom level.

The third session, preventing and reducing diseases and disorders, will be convened by me, and it will be held in the Regency Room on the ballroom floor, and that is in this room here.

I thank you very, very much. Dr. Potsic, I would like of you to take over, if you would. Thank you.

[Applause.]

DR. POTSIC: Thank you, Dr. Ellis. My name is Steve Potsic. I am the regional health administrator here in region V, which covers six states and is based here in Chicago.

I also welcome you, and good morning to all of you. It really is my privilege right now to recognize and invite the First Lady of Chicago, Mrs. Maggie Daley, to the podium, to give us a welcome on behalf of the city, and to provide some comments on the importance of today's session. Mrs. Daley?

[Applause.]

MRS. DALEY: Thank you very much. Well, on behalf of Mayor Daley and myself, and everyone, really, in the City of Chicago, we are delighted that you are here and we welcome you.

It is an honor for me to be here, to talk about some important things that are dear to my heart, and I know that many of you feel the same way.

I am here to talk to you about maybe an initiative that is not included right now in some of the words that are being written for this initiative.

The objectives by which our nation will measure the health status of our infants and our children and our adults are what we are here to talk about.

I would like to congratulate you and thank you, and all of you, the Department of Health and Human Services, and the Surgeon General's office and everyone, who have invested themselves in an enormous amount of time and effort to create a process for setting the nation's health agenda that encourages and fosters this public discussion and input.

As president of Pathways Awareness Foundation, I have been privileged to help raise awareness among parents and professionals about the importance of early detection and intervention for children with disabilities.

Fifty one million people in our country have disabilities, and that is about one in every five.

Ten percent of children under the age of 18 have chronic illness or disabilities as defined by the duration of three months and requiring multiple services.

By that definition, at least seven million children in this country have chronic illnesses and disabilities.

These children need national health policies that embrace them and allow them every opportunity to maximize their development and quality of life.

Early detection and intervention make an enormous difference for these children. Let me give you an example.

Five-year-old Marcel was born with cerebral palsy. From the time of Marcel's birth, his mother has been intimately involved in every aspect of his care.

Marcel's problems were detected early. He has had medical and surgical treatment. He has, and continues to have top notch physical, occupational, speech and language therapy.

Today, he is walking with a walker and attends kindergarten. Without treatment, Marcel would not be walking and he would require a wheelchair.

Without treatment, over time, he would require many more orthopedic surgical procedures.

Marcel was lucky. His mom knew what signs to look for. His disabilities were detected early. He had early intervention.

Now, Marcel is and can become a viable, independent, tax-paying member of society.

These breakthroughs happen time and time again. Yet, they don't happen enough. Many people don't know how to recognize the early signs of disability and delay. So, these children lose ground, valuable ground.

Since 1990, notable progress has been made with regard to the importance of meeting the special needs of people with disabilities.

However, we have not yet seen an emphasis on infants and children with disabilities, and their parents, who are their principal advocates.

The Healthy People 2010 section on maternal, infant and child health speaks to the importance of early detection, but its objectives do not include specific goals about early intervention for children with developmental delay.

That is why the following organizations -- and they are all going to be speaking today, and I have been working collaboratively with them, and am very proud to do so -- will be giving you testimony on this need for greater emphasis on the child.

Some of these groups that are working with us on this initiative are the Illinois Chapter of the American Academy of Pediatrics, Children's Memorial Hospital, El Valor, Family Voices, La Rabida Children's Hospital, the National Association of Children's Hospital, Pathways Awareness Foundation, United Cerebral Palsy Association of Greater Chicago, and the University of Chicago Children's Hospital, and of course, Voices for Illinois Children.

All of us believe that our infants and children, from infancy through grade 12, must be periodically screened, using observational, physical and postural assessment and medical diagnosis for early identification of these disabilities.

We believe that as a nation, we must ensure that all infants and children through grade 12 are periodically screened for language, sensory and vision processing difficulties that interfere with their learning.

Equally as important, we believe that every infant and child detected as having a disability must be referred for, and receive, therapeutic intervention, and medical care for their identified disabilities.

Finally, we believe that parents must receive education about the importance of early detection and intervention, as well as information about how to monitor their children's physical, social, emotional and cognitive development.

As a matter of fact, we at Pathways have a brochure called, Parents, Don't Delay. I understand this morning that the brochure is not here, but we will make sure that some are brought over so that you can see these.

It is now being distributed through 22 states to parents, and it is a wonderful, simple technique to distribute to parents so that, early on, in the first several months of their child's life, they may want to ask questions and demand some answers as well.

The Healthy People 2010 objectives appropriately require that all objectives must have data sets from which progress can be gauged.

Yet, data regarding children with special needs, well, it is fragmentary at best.

We look forward to working with the Centers for Disease Control and others to develop new data collection systems to track healthy objectives for specific geographic areas and subpopulations, including infants, children and adults with disabilities.

To discard these objectives because the data does not yet exist would be irresponsible stewardship of our nation's health, and poor public policy.

Beyond the Healthy People 2010 section on disability, it is essential that the great health needs and disparities of infants and children and adults with disabilities be reflected appropriately throughout the entire publication of the Healthy People 2010 objectives.

As adults, and as stewards of our nation's public policy, we must make sure that children, who cannot advocate for themselves, are protected.

Marian Wright Edelman has a prayer. I have heard her say this at gatherings. It seems fitting, as we draw the road map for our nation's health agenda.

Lord, help us to plant our children like trees by streams of water, so that they will yield full fruit in their season.

Let us make sure that our nation's health agenda offers a river of opportunity for our children, so that each child is given a chance to achieve his or her maximum potential.

Thank you all for your time and your leadership in helping to set the national agenda for health in this country. Thank you.

[Applause.]

DR. POTSIC: Thank you, Mrs. Daley, for that wonderful welcome and those very excellent comments. We appreciate your visit with us today.

Now, I would like to formally open the public hearing on Healthy People 2010. During this session, I invite you to give your comments on the framework, goals and leading health indicators proposed for Healthy People 2010.

Now, this material is found in sections A and B in the draft for public comment. Now, I am supposed to hold this up, and I had to work this morning to do this. If you have it, it is section A and B.

I would now like to bring to the podium Dr. Linda Meyers, who is the acting director of the Office of Disease Prevention and Health Promotion, to listen to your comments as well.

She also would like to make a few brief opening statements before we hear the comments. Dr. Meyers?

[Applause.]

DR. MEYERS: Thank you. Good morning. There are some chairs at the sides for those of you who are standing at the back, if you want to sit down.

On behalf of the Office of Disease Prevention and Health Promotion, I would first like to thank Dr. Ellis and Dr. Potsic for allowing us to be part of this.

Also, thanks to you all for allowing us to listen to you. During this session we are listening to comments on the draft framework, and I have been asked to kind of tell you what that means or to jog your memory.

The draft framework is depicted in the schematic that is in your folder. If you notice, it includes two goals: to increase the quality and years of healthy life, and to eliminate health disparities. We welcome your comments on these two goals.

The goals are encircled by four major sections: promote healthy behaviors, promote healthy and safe communities, prevent and reduce diseases and disorders, and improve systems for personal and public health.

We also welcome your comments on these four sections. Are they appropriate? Can they be better stated? Do they communicate, and so forth.

Twenty-six focus areas are arrayed within the four sections, and as you know, they are listed in the front of your book but also on your agenda.

We also welcome your comments on these focus areas. Are they appropriate? Are there ways to array them differently, ways to combine them?

We welcome comments on these and any other comments on what we refer to as the introductory and framework material.

DR. POTSIC: Thank you, Linda. I also want to take this opportunity, before we go into the actual commentary period, to thank Linda and her staff. They really have done a marvelous job in the convening of these meetings.

They are always prepared. They anticipate our questions. The accommodations have been really wonderful. I have detected no snags in the meeting process.

I know that Dr. Ellis shares with me an appreciation for all their help and support. Thank you.

Now, I invite those of you with comments to come up behind each of the three microphones. For anyone with special needs, please raise your hand. If you would prefer to use a hand-held mike, the staff in the room do have hand-held mikes available, for those of you who would prefer to do that.

I will ask each of you to introduce yourself by name and state of residence. Also, please let us know if you are commenting on behalf of an organization or yourself as individuals.

Also, it is very important that after you comment, please sign your name at the table in the back of the room. This is one way that we have of making sure that we have the correct spelling and we have the correct information as far as your comments.

As has been mentioned, your comments will be placed on the web. This meeting is being transcribed. So, many people throughout the United States and elsewhere, will actually be able to see your comments.

Again, for fairness, each person will have three minutes for comments. When this light on the podium turns yellow, that means you only have one minute left.

Staff also have hooks in the room -- [Laughter.] When the light turns red, it is time to say good-bye.

Now, we will have, hopefully, a time in the concurrent session, so that if people are still remaining and want to speak, we definitely want to hear from you. Please feel free to come to the concurrent sessions to testify in these areas as well.

Now, we would like to start with the first person. Why don't we start over there? Please state your name for the record, your residence, and who you are representing.

DR. FRIZZELL: I am Dr. Linda Frizzell. I live and work on the Leach Lake Reservation in northern Minnesota, and I am representing the health division for the reservation.

I would specifically like to comment on the fact that, traditionally, tribes across the country have been neglected in seeking comment, in seeking consultation, and certainly collaboration.

I would like to publicly acknowledge and tell of our appreciation -- specifically, because I can only speak for our tribe -- the work that region V has done in helping us to negotiate with the state of Minnesota.

It has been a very rough road, I am here to tell you. We feel we have gotten some accomplishments under our belt right now, with the help of region V and with the national office.

If there are any other tribal people in here, that recognition is here now. We need to take advantage of that, and we need to get our comments in. We will be submitting specific comments via the Internet on the objectives and goals.

We need to recognize you people publicly and thank you, because this has never happened before.

[Applause.]

DR. POTSIC: Thank you very much.

MR. MARTIN: My name is Bob Martin. I am the director of the Center for Health Care Information, a medical information provider service.

I would like to address the issue of quality of care, particularly accessibility of quality information.

As you know, we are moving into a global health care society now, where we all have knowledge of alternative procedures in medicine. It is very confusing for many people.

I am a proponent of freedom of information, freedom of choice, freedom of alternatives. The average consumer is very intelligent now, more sophisticated than ever before.

I would like to move forward the prospect of integrated health care as a 21^st Century issue, and let the information flow.

Thanks to the information highway system, people need to know what is accurate, what is not accurate.

There is a lot of misleading information. Part of the emerging technology is coming forward to help people make informed, intelligent decisions.

As an example, I would like to call to your attention a report that reflects that there are 16,000 questionable doctors still practicing. This information is withheld from the public.

The public has the right to know if their doctor is on this list. So, I would like to see if the national practitioners database, which holds this information, and which is funded with taxpayer dollars, is available to taxpayer. They have the right to know if their doctor is questionable.

Once again, I would like to see more quality information provided to the public, so they can make an informed, educated decision on what protocols to follow. Thank you.

[Applause.]

DR. POTSIC: Thank you.

MR. FALCON: My name is Adolph Falcon. I am vice president for policy and research at the National Coalition of Hispanic Health and Human Services Organizations, COSSMHO, Washington, D.C.

I am testifying on behalf of COSSMHO and our over 1,500 community based organizations and individual community members.

I have four brief overall comments. One is that COSSMHO as an organization would like to state its support of the goal of eliminating disparity.

In particular, in support of that goal, we would like to state that the race initiative goals should not be the only goals we seek but, as currently written, should be under all objectives seeking to eliminate the disparity.

If we followed only the race initiative goals, it would be an incomplete picture of the needs of Hispanic communities, in particular in regard to substance abuse and mental health, that are currently being specifically addressed under the race initiative.

Secondly, we would like to state our support for the better than best method of setting goals under Healthy People 2010.

We think this is a positive change for the nation. For the first time, it won't make white, non-Hispanic the standard for health of the nation, but instead, will make the group doing the best in the nation the standard for the nation.

We are particularly excited, because Hispanic groups would be the bench mark for certain outcomes, including birth outcomes and certain areas of nutrition where we are currently leading the nation.

Thirdly, we would like to call for the reporting of data for Hispanic under all objectives, as is currently in the draft of Healthy People 2010, and strongly support the current draft that calls for reporting when data is not available for individual racial and ethnic minority groups.

For the first time, this would give the most accurate picture of what we know about the health of the nation and individual racial and ethnic groups.

Finally, I would like to strongly encourage, during the review process, that consideration be given to the difficulties that community based organizations have in coming to the five regional meetings.

First of all, we congratulate the folks organizing Healthy People 2010 for making the effort to really pull in community comment by the regional process.

Nevertheless, it is still difficult for a lot of community groups to be able to get the funds to travel to the individual regional meetings.

We will propose that, when comments are received, that special attention be given to those comments that are received from community based organizations representing racial and ethnic minority groups, as it is the goal of Healthy People 2010 to eliminate disparity, and that these comments should not be overwhelmed by better financed interests.

Finally, I would like to say that this is the first time I have been obedient on time. Thanks.

DR. POTSIC: Thank you.

[Applause.]

MS. DAVIS: Hi. I am Margaret Davis, and I am with the Southside Health Consortium, Healthy Start Southeast Project, and the Chicago Chapter of the National Black Nurses Association.

I am in favor of the elimination of health disparities and not the reduction of health disparities.

I would also like for the statistical gathering to be done on all five of the people of color communities. If that is not available, then indicate that is not available.

I raise this question because if we do not know the instance of disease in our communities, we cannot have the money targeted for our communities.

I am a proponent of community-based revenue, coming into the community based on health indicators, showing excess death in certain communities.

One of the areas that is very weak, that I think will be a barrier to the achievement of the year 2010 goals, is the disparity in health professionals.

I think there should be mandated collaboration with AHECs throughout the nation to provide the pool of culturally competent, culturally sensitive practitioners to work in these communities.

In addition, I would like to advance the notion of advanced practice nurses. Many states have used these practitioners and have had very good outcomes in the areas of maternal/child and chronic illness.

Lastly, there is the notion of self-help and self-responsibility that goes into the promotion of health.

In order to foster that, given the dearth of health professionals in our communities, I would like to call for collaboration with the NIH Bureau of Alternative Medicine under Dr. Jonas.

We think that these health modalities, such as Yoga, therapeutic touch, spirituality, will go a long way toward enhancing people's self esteem and knowledge of their health indicators, so they will not be dependent on health professionals.

DR. POTSIC: Thank you very much.

[Applause.]

MS. BARGER: I am Jan Barger. I am a registered nurse and a certified lactation consultant. I am representing the International Lactation Consultant Association. I would like to talk about breast-feeding as a leading health indicator.

While health professionals, public health officials, the United States government, most parents and even the formula companies recognize that breast feeding is the most complete nutrition for infant, as well as conferring numerous health benefits for both nursling and breast-feeding mother, it is still seen by many as an infant feeding choice, rather than a healthy lifestyle decision.

Too often, women are not given complete information about the benefits of breast-feeding and the risks of infant formula, in an effort to not make them feeling guilty.

A prevailing attitude is that, while breast milk is the gold standard, many of us were brought up on formula and we turned out okay, so it couldn't be all that bad.

Given that studies have shown that formula fed infants have IQs up to 10 points lower than breast fed children, just think of the collective IQ points lost, because the United States has one of the worst breast feeding rates in the world.

Breast-feeding is a tremendously important health issue. The over-riding goal of this initiative is healthy people.

Breast-feeding gets a person off to the healthiest start possible. Breast-feeding can reduce the incidence of pre-menopausal breast cancer, osteoporosis, respiratory infections, GI infections, asthma, allergies and SIDS, among other short and long-term conditions.

Breast milk provides the infant with ongoing immunizations. It enhances the effectiveness of vaccines. It has even been shown to reduce the incidence of child abuse and abandonment.

It is estimated that approximately 500 infants in the United States die each year as a result of not being breast-fed.

Breast feeding, as we know, has become a political issue. Witness the number of bills that have sprung up in many states protecting a woman's right to breast feed in public, and requesting that employers give breast feeding women the time during the work day to either breast feed or express her milk.

Breast-feeding is a financial issue. Affordable health care begins with breast-feeding. One study estimated that the potential health care cost savings through breast-feeding, and only four medical diagnoses -- that of infant diarrhea, RSV, insulin-dependent diabetes and otitis media -- could result in an annual savings of $1.3 billion.

By breast-feeding, a family not only saves their own health care dollars, but from $1,000 to $3,000 a year in formula feeding costs.

If all the women on WIC breast fed their babies for only one month, the Federal Government could save millions of our tax dollars a year.

Healthy babies become health children and become healthy adults. Breast-feeding is low cost and low tech, but it requires a supportive government, businesses, professional and voluntary organizations and individuals.

The barriers to successful breast-feeding need to be broken down. That is why I believe that it needs to be on the list of leading health indicators. Thank you.

[Applause.]

DR. POTSIC: Thank you.

MS. SCHRAK: Good morning. My name is Karen Schrak. I am the executive director of Adult Well-being Services from the City of Detroit.

I should add that I spent the last 20 years of my life in the Michigan Department of Health.

My comments are very simple today. The agency that I am here representing serves older adults. In my review of this draft, I think older adults are neglected.

I would like to recommend that the elderly population be designated as a select population, in much the same way as we have identified women's health as an issue, adolescent and child health. I think the elderly in this country deserve special attention in this document.

The second comment I have is that, with respect to the two major goals we are discussing now -- eliminating disparities and increasing the quality of life -- I would like to suggest that unless the needs of older adults are more focused upon, we will not be able to achieve the objectives for the nation in those areas.

Within that area of eliminating disparities, I would like to point out that, in my quick reading of this document, it is very clear to me that older African Americans in particular, but other ethnic groups as well, continue to suffer in every measurable way, in much longer and stronger ways than other groups.

So, I think that older African Americans and older ethnic groups need to get some special attention.

So, I am here to speak to the concept of identifying older adults as a select group. One of my jobs at the state health department was as substance abuse director.

I cannot believe that there is not a single indicator in substance abuse, when we know that across this country they are affected significantly by substance abuse.

I would like the drafters to take those issues into consideration. Thank you.

DR. POTSIC: Thank you very much.

[Applause.]

DR. MEYER: Good morning. I am Dr. Diane Meyer. I am an audiologist from the city of Chicago. Today I represent the American Speech-Language, Health Association, or ASHA, in my comments.

ASHA is the scientific and credentialing organization for over 93,000 audiologists, speech-language pathologists, and speech and hearing scientists.

Firmly grounded in our professions' scopes of practice are prevention, early identification and treatment of hearing, communication and related disorders for children and adults.

ASHA is supportive of a new chapter devoted to disability and secondary conditions. The draft target objectives will be important in providing needed data on access to health care systems and providers by persons with disabilities.

However, we urge additional consideration that disability status as a special population be considered in all chapters throughout the document.

Prevention of secondary disabilities among a population already at risk, with potentially reduced access to health care, is essential. We will submit more detail on this point in our written comments. Thank you.

DR. POTSIC: Thank you.

[Applause.]

MS. STIDWILL: My name is Barbara Stidwill. I am a board member of Suicide Prevention Services in Aurora, Illinois. I live in St. Charles.

Healthy People's work is described in the document as a score card for monitoring health status in America.

I would like to suggest that suicide -- and there I have said the S word -- should be broken out from the mental health and mental disorders chapter and become a focus area on its own.

It should probably be grouped under the improving systems for personal and public health segment, but since it is at least the ninth major cause of death in the United States, and it is so under-reported that we can guess that it is probably much greater in incidence than that, we know that the number is very high. Suicides outnumber homicides in most communities.

This is a major health issue. It is a growing health issue among young people. It is the second cause of death among young people ages 15 to 24, and my 16-year-old daughter was one of those statistics in 1995.

It is also a growing problem among the elderly population. I suggest to you strongly that the work of Healthy People must also include efforts to de-glamorize it and to frankly take a little power away from the assisted suicide movement, which is very counter-productive.

As our young people and our elderly believe that the quality of life is the only thing that is important, it becomes much more of an option for them.

I would like to think that, since we are talking about life itself with suicide and not just quality of life, this would be a major focus area.

Suicide statistics, awareness and prevention should therefore be broken out as one of the major efforts.

I believe that this would be one of the most important things that this document could impress upon public health systems. Thank you.

DR. POTSIC: Thank you very much.

[Applause.]

DR. KIRSCH: My name is Thomas Kirsch. I am an emergency physician here on the south side of Chicago, and I am representing the American College of Emergency Physicians.

My argument is that I think the access to health care issue should be moved to possibly the primary leading indicator for this, based on personal experience.

I have worked in urban areas now for the last 10 years. On a daily basis I see what lack of access to health care does to people.

The emergency department sees 100 million visits per year, approximately, across the United States. Seventeen percent of these are for people with no insurance and, by default, we become the primary care provider for these people.

As you know, 41 million people in the United States now are uninsured. This is a number that has been increasing. That was a 1996 estimate. The estimates more recently are as high as 44 million. It is getting worse.

Like I said, it is the emergency department where these people often turn for their primary care. Although I like providing primary care, I don't personally think that is the appropriate source.

An example of that, in our emergency department on the south side, we did a survey of all our asthmatics.

Fifty-six percent of those who are moderate to severe asthmatics identified emergency departments as their primary source of care for their asthma.

That is unacceptable. I would like to make sure that the Healthy People 2010 recognizes the importance of access to care as being the thing that could possibly solve a majority of these problems. Thank you.

DR. POTSIC: Thank you.

[Applause.]

DR. ORSAY: My name is Elizabeth Orsay. I am from the University of Illinois in Chicago, and I, too, am an emergency physician.

I concur with Dr. Kirsch's comments that access to emergency health care is vital to our city and to our country.

I also want to make a plea for injury and violence objectives to also be included in the leading health indicators.

As we are all aware, injury and violence takes its toll in our country and is a leading cause of death in children and young people, and is a leading source of loss of potential productive life years.

You currently are visiting a state in which firearm injuries superseded motor vehicle trauma as a leading cause of death. This is a very sad statement.

Much of my research has been focused on injury in children and adolescents. In my review of statistics for Chicago and Illinois, it reveals that homicide supersedes motor vehicle trauma in many of our age groups -- actually, all of our age groups except the five to nine age groups -- and it is a sad comment on our society.

This is something that I witness every day in my practice in a major urban health care center on the near west side.

Injury affects all Americans, younger and older Americans alike, as a major source of disability for our elderly patients. It also affects our minorities much more disproportionately than others. So, I would like you to consider this as a leading health indicator. Thank you.

[Applause.]

DR. POTSIC: Thank you.

MS. DE KEMPER: Good morning. My name is Stephanie DeKemper. I am executive director of the Indiana Minority Health Coalition, which is a statewide minority community-based organization.

As I participated in the panel discussions on the elimination of disparities, I was reminded of Philippians 3:14 where Paul said, we must press on to the mark of the high calling.

Better than the best will only do. We may not get there by 2010. However, the final destination will be forever present in our minds as we plan and go about our work.

A single target for all the populations will promote equality and health parity. It will also encourage state policy makers to put minority health at the center of their agendas.

Data collection is critical if we are going to plan, implement and evaluate strategies. Where data doesn't exist, we need to identify that it is not available, and be committed to gathering it.

We must encourage state health agencies and their partners to collect race-specific data.

Finally, we cannot do enough to encourage community-based partnerships, even to the extent of requiring state health agencies to submit memorandums of collaboration, or agreements with their state health plans, when they seek federal funding.

My health is very personal. If you want people to change their behaviors, you must first convince them that you care about them, and that the information that you are providing to them is correct, and that they can trust in that.

When that happens, relationships are developed and change is more likely to occur. Community partners put names and faces to numbers. When that happens, our jobs become our missions, our complacency turns to motivation, our stagnation and indifference turns to action. Then, together, we can reach our goals. Thank you.

[Applause.]

DR. POTSIC: Thank you very much.

DR. BRASE: Hi. I am Twila Brase from Citizens Council on Health Care in Minnesota. I would like to say that, while eliminating health disparities is a laudable goal, the drive to data collection by states and federal government is a serious concern that has not received much attention during this conference.

In addition, the average citizen who you would collect data on is not able to attend these meetings, to hear the plans for intrusion into their medical records, and ongoing assessment of their personal lives.

They do not even know the federal or state registries exist.

It has been made clear that data brings legislation and funding to states. Nonetheless, an individual's privacy is paramount to maintaining excellence and timeliness in medical care.

If your goal is improvement of health, the privacy of medical and personal information should be a goal as well.

In addition, I would add that access to health care is a concern and some of the points that could bring greater access to care include decreasing mandates to decrease the cost of health care, returning choice back to patients so they can decide what is necessary for them, moving back to insurance and away from expensive pre-paid health care, which is what managed care is, and disconnecting insurance from employment, through tax incentives. Thank you very much.

DR. POTSIC: Thank you.

[Applause.]

MS. SCHWARTZ: My name is Susette Schwartz. I am from Wichita, Kansas. I represent an urban Indian health program, a community health center and a health care for the homeless center. I am also a member of the board of the National Council of Urban Indian Health.

I would like to get the message across that, as we are in the process of eliminating health disparities, we work with, collaborate with, all American Indians.

It is important to remember that, regardless of where an American Indian lives, they are still tribal members, and they still need to be represented.

Currently, 65 percent of American Indians no longer live on reservations, because of relocation policies, because of promises of a better life in urban communities.

We need help. There are only two million American Indians left. Often, agencies -- the government, organizations -- will look at how many people we are dealing with, what the number is.

Instead of looking at the number, which has hurt us in the past, we need to look at the number remaining and do everything we can to improve their health. Thank you.

DR. POTSIC: Thank you.

[Applause.]

MS. WILSON: Good morning. I am Gail Wilson, director of the Chicago Healthy Steps program. I am here today representing the March of Dimes Birth Defects Foundation, with its mission to prevent birth defects and infant mortality.

We have been involved in the formation of the Healthy People 2010 objectives, and we are pleased to be able to continue to participate in these important regional meetings, and the public comment process.

The Healthy People initiative has provided a road map for the nation for the past two decades, to track the nation's disease prevention and health promotion agenda.

The March of Dimes strongly supports the aim of the Healthy People 2010, which is to promote healthy behaviors, promote healthy and safe communities, improve the systems for personal and public health, prevent and reduce disease and disorders, and to provide a tool for monitoring and tracking the health status, health risks, and the use of health services.

The March of Dimes applauds the expansion of the year 2010 objectives to focus on additional areas not previously addressed, including additional objectives in maternal and infant health, and strongly supports the major focus for the next 10 years, to close the gaps in health outcomes, particularly those disparities among racial and ethnic minorities, women, youth, the elderly, people of low income and education, and people with disabilities.

The March of Dimes will integrate the year 2010 framework at the federal, state and local levels in its health promotion and advocacy activities at the national and chapter levels, and within the various perinatal data projects it undertakes, as it has done for the year 2000 objectives.

Toward that end, I will have some additional comments that I will give regarding some of the specific objectives in written form. Thank you so much.

DR. POTSIC: Thank you; appreciate that.

[Applause.]

DR. OLDS: Good morning. I am Dr. Scott Olds from Kent State University. I am on the faculty in health education. I am speaking today as an academic, a public health professional, a volunteer, and a father.

I have three comments. Number one, I think that several of the objectives, particularly in the tobacco area, are unrealistic.

I think that it is important for us to aim high; yet, I would suggest that some of them are untenable, particularly given that it took over 50 years for us to reduce the tobacco prevalence from post-World War II to where we are today.

To suggest that we could reduce another 50 percent, for example, in some, 60 percent in others, 80 percent in even more, I think would be difficult for us to try to attain.

Therefore, I would ask that we try to continue to set the sights high, but at the same time perhaps be more realistic in doing so.

Secondly, I think that Healthy People 2010 has over 200 data gathering systems that have been identified in the framework. Tobacco alone has seven, the YRBS, the Monitoring the Future, the National Health Interview Survey, the NHANES survey, the BRFSS, Department of Defense Healthy Behaviors Initiative, and the National Household Survey on Drug Abuse.

I guess my question would be, is it necessary to have so many, and does the large variety of data sources create confusion.

I submit that they do because sometimes those data points, for example around tobacco, are not all measuring the same sorts of notions.

I guess I would encourage us to think about, at the same time, providing those different agencies the autonomy that I suspect that they desire, while also trying to provide some standardization and uniformity to data gathering.

Finally, I would reiterate number three, the earlier comments that were made regarding accessibility to health information.

I, too, think that open access is critical. It helps consumers make important decisions. Specifically, I would recommend that Healthy People 2010 work toward giving consumers access to batting averages, if you will, in the context of outcomes research, so that consumers can make true decisions about the quality of services that they seek. Thank you.

DR. POTSIC: Thank you.

[Applause.]

MS. O'NEIL: Good morning. I am Terry Jo O'Neil from Circle Family Care. Circle Family Care is a community health center and a social service agency on the west side of Chicago.

I am also representing the United Power for Justice and Action, which I am a leader.

I would just like to make a couple of points. Our other points will be made via Internet and written.

We support the better than best approach. This gives us a more realistic look at the disparities, and places us in the role of eliminating them.

The elimination of health disparities, not the reduction, is what we support.

Targets should be set so that there will be improvements with all segments of the population. We do not agree with the no data proposal.

Our goal should also be finding ways to ensure the uninsured. We will address other segments of the objectives via the Internet. Thank you.

DR. POTSIC: Thank you very much.

[Applause.]

DR. SCHILD-WILKINSON: Good morning. I am Deborah Schild-Wilkinson. I am a professor in the school for social welfare at the University of Kansas in Lawrence. I am not here representing the school in any way, or the state. I am speaking for myself, as a public health social worker.

Yesterday, I received the draft for the first time and had an opportunity to take a look at the draft of Healthy People 2010.

I glanced through it. I cannot say I read it with great thoroughness, as any one of you knows that that is not a document that one can read rapidly.

I did take the time to look to see whether there were objectives that addressed the sociodemographic factors that we know underlie the health disparities in our nation.

I was disturbed to find that, with the exception of objective 4.1, which calls for the increase of high school graduation to 90 percent, that in fact, there were no objectives that address poverty, racism, unemployment, lack of proper education and training for employment, and under-employment in our country.

I think that if we want to address and eliminate health disparities, we need to address the causes, and the causes do lie very much in these sociodemographic characteristics.

It is essential that we include such objectives. There was an objective in Healthy People 2000 to reduce child poverty. This objective has disappeared from the current draft, and I hope that it will be included.

In fact, I would like to see us have an objective to reduce poverty overall, and not just for children.

We need objectives to address employment issues, education, training, and so forth. Unless we do that, we will not achieve this overall goal, this essential goal, to eliminate the disparity in health in the various communities in our nation. Thank you.

DR. POTSIC: Thank you.

[Applause.]

DR. POTSIC: We are coming to a point where we are going to have to close shortly. What I am going to do is, I am going to recognize the two remaining standing speakers, and then we are going to have to close this session.

MS. MAGALHAES: Thank you. Good morning. My name is Rebecca Magalhaes. I am director of the International Action and Development Department at the organization called La Leche League International.

We would like to go on record as proposing that breast-feeding be placed as one of the leading health indicators for, basically, all the reasons that were just wonderfully stated by Jan Barger for the International Lactation Consultant Association.

We believe that breast-feeding is the first step toward lifelong health. Further comments will be provided via the Internet. Thank you.

DR. POTSIC: Thank you.

[Applause.]

MR. RUZICKA: My name is Mark Ruzicka. I am from The Night Ministry, a homeless outreach in Chicago, and I have two points.

First, the access to health care and preventive medicine is of supreme importance, and we respect that. We especially say that we would like that to be toward hard-to-reach populations, such as the homeless and people on the streets at night.

Secondly, the fact that someone does not have a home is also a public health risk. This should be included in the section to prevent diseases and disorders, especially due to the fact that the average age of the homeless person today is nine years old.

We know that there are health risks such as emotional, mental, and behavioral risk, just from the fact of not having a home.

DR. POTSIC: Thank you.

[Applause.]

DR. POTSIC: We can all tell by the comments today how important health is to our daily lives and the well-being of our communities.

Also, we can also tell by the comments today how health is very personal to all of us and to our families. So, I want to thank all of you for your thoughtful comments.

They will be very helpful as we finalize Healthy People 2010 over the next few months.

I would like to invite all of you now to participate in one of the concurrent sessions. Again, this is an opportunity to share your comments, in order to shape this very important document.

Session I, promoting healthy behaviors and healthy and safe communities, will be convened by myself in the Acapulco Room on this floor.

Session II, improving systems for personal and public health, will be convened by Dr. Willis-Fillinger in the Toronto Room, again on this floor.

Session III, preventing diseases and disorders, will be convened by Dr. Ellis in this room.

I thank you very much for your participation, and officially, this session is adjourned.

[Whereupon, at 10:15 a.m., the plenary session was adjourned.]

Chicago Transcripts and Summaries