Healthy People Consortium Meeting
"Implementing Healthy People 2010"
November 11, 2000

Summary of Breakout Group Discussion Concerning:
Immunization and Infectious Diseases

1. What does implementing Healthy People 2010 mean to you? 

• Creates focus and credibility to efforts.
• Helps to document progress and the need for resources.
• Opportunity to develop new partnerships.
• Opportunity to consider how to implement new public health measures (like new vaccines).

2. How do you suggest we work with local community groups in implementing the Healthy People 2010 objectives?

• Engage local health departments and work with local health departments to facilitate addressing local issues.
• Communicate what resources are available to assist local community groups.
• Recognize that different relationships and networks exist, with varying effectiveness.
• Recognize the value and role of non-public health groups like public housing agencies and faith-based organizations.
• Serve as conveners, finding the organizations to pull together a coalition around an issue.

3. What are the challenges/barriers to meeting the Healthy People 2010 objectives? And how do you suggest we work to overcome them? 

• Information and Communication
  • There are information flow issues. Some States do a good job of sharing information, and some States don't. CDC communicates with the organizations it funds, but other groups still need information, and they often receive it secondhand.
  • Information is not passed down to the people who are really involved. It's also not prioritized in the way it's communicated.
  • Communication across all levels is needed.
  • Increased outreach to providers and their staff is required.
  • Communications and resources, like the ACIP recommendations, should be provided through formats/sources where they are easily accessible (e.g., in addition to MMWRs, they should be reprinted in major journals like JAMA, NEJM).
  • Develop a vocabulary so there is consistency between groups.
    
• Commitment and Consistency of Funding
  • Different levels of interest/concern/commitment to implementing Healthy People 2010 exist across Federal agencies and across State and local health departments.
  • Greater leadership and coordination are needed (in general and for data collection, specifically).
  • The needs and expectations associated with Healthy People are increasing, but the funds are decreasing,
  • There is a lack of integration of projects and of funding streams.
  • It's difficult for States to maintain programs when funding is inconsistent or unreliable, or terminated before the completion of a project.
  • Preventive Health Block Grants are suggested as a resource to support implementing Healthy People, but at the same time funding was cut by 10 percent so there is no discretionary money to tackle 2010.
  • The true dollars that reach the communities have decreased dramatically. When a crisis occurs, communities may receive information and increased guidance about what activities/interventions are needed, but they do not receive the financial support necessary to address the issue.
    
• Data
  • The collection and availability of data vary across States and are not always comparable.
  • Consistent or standardized electronic medical records are needed that facilitate reminder/recall approaches for patients due or overdue for vaccinations.
    
• Work Through Partnerships
  • Identifying partners and building credibility are two big challenges.
  • Implementation time frames immediately begin to monitor progress toward established performance measures, but do not incorporate time for relationship building.
  • Rivalries and a lack of coordination (Federal-State-local and public-private) make work difficult.
  • Key, credible partners at the local level need to be identified.
  • To increase legitimacy at the local level, engage community leaders as a part of the process and share decision making with them.
  • Facilitate community-based research to provide evidence on what actually will change behavior.
    
• Competing Priorities
  • Recognize that we are competing with other interests.
  • Increase the public health/preventive health orientation of providers. For example, with adults, there are many other acute care health issues to treat, therefore, vaccination is not always a priority. In contrast, pediatricians have a preventive medicine orientation in the first place, so vaccination fits more naturally into their practice.
  • To decrease misuse of antibiotics, we need to change societal and cultural perspectives so that patients do not always expect antibiotic prescriptions (e.g., a patient will accept a provider's opinion that antibiotics are not indicated).
  • Greater consideration of future issues, like emerging infectious diseases, is needed.
  • To ensure that the standard of care is provided, it must be defined and endorsed across all levels, and appropriate incentives for implementing the standard should be offered.

4. What can we do to support the elimination of health disparities among racial and ethnic population groups?

• Reach out into the community to identify key leaders ("voices") in that community, obtain their support, and involve them in problem solving.
• Identify the community's concerns and needs, and then work to address those issues.
• Support community-based communication/outreach with money and resources, but remember that providers are more likely to change a person's behavior than a lot of information is.
• Recognize that we are competing for scarce resources and that providers have to pick and choose which messages they focus on in the limited time they have during a patient encounter.
• Reach out not just to providers but also to the office staff as well.

5. How do we measure progress of Healthy People 2010 in the future? And what is progress?

• Need to be able to demonstrate the effect at the community level.
• Identify priority areas that have not met previously established goals and focus on those areas.
• Develop new infrastructure elements/components.

6. How can we work more effectively with the media in implementing the Healthy People 2010 objectives?

• We need to develop a strong voice and a systematic coordinated approach for responding to questions/concerns. We must also recognize that the source of the information (including who delivers the message) can make a big difference in the credibility and impact of the information.
• Information materials must be developed and readily accessible. People must know where these resources are available.
• Messages should be tailored according to the issue and concerned population/community.
• We need to do a better job of addressing concerns about vaccine safety, including providing more information about the safety and benefits of vaccination.
• To promote adult immunization: while cost-savings data are useful for policymakers, the public needs to know that the vaccines are safe and cost effective, and that more people die from complications of pneumonia and influenza than from other vaccine-preventable diseases.
• Help people to understand their insurance benefits with respect to vaccination services.

General Comment

• We need to incorporate infrastructure into the body of the objectives across the focus areas.

Participant List


Facilitators: Nicole Smith and Jennifer Brooks 
Recorder: Sarah Foster 

Bonnie Jameson
South Dakota Department of Health
bonniejameson@state.sd.us

Nancy A. Nix
CDC/National Immunization Program
nnix@salud.gov.pr

Kathy Kines
American Association of Retired Persons
kkines@aarp.org

David Arday
HCFA/Office of Clinical Standards and Quality
darday@hcfa.gov

Jimm Murray
Wyoming Department of Health
jmurra@state.wy.us

Michael Meit
National Association of County and City Health Officials
mmeit@naccho.org

Leslie Gurowitz
American College of Physicians-American Society of Internal Medicine
igurowitz@mail.acponline.org

Pam Eason
HRSA/Division of Vaccine Injury Compensation
peason@hrsa.gov

Jon Mark Hirshon
American College of Emergency Physicians
jhirshon@welchlink.welch.jhu.edu

Joe Iser
Regional Health Advisor Region 11, DHHS
jiser@osophs.dhhs.gov

Deborah Arrindell
American Social Health Association
debarrindell@aol.com

Tom Coleman
Florida Medical Quality Assurance, Inc.
tcoleman@sdps.org

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