HRSA News Room - Marion County Health Department

	U.S. Department of Health & Human Services Health Resources and Services Administration HRSA Press Office: (301) 443-3376 http://newsroom.hrsa.gov

Remarks to the Marion County (Ind.) Health Department

Prepared Remarks of Eric Baumgartner, M.D., M.P.H.
Director of Community Access and State Planning Programs, Health Resources and Services Administration

Conference on “Healthy People 2010: A Challenge and An Opportunity”
Indianapolis, Ind.

April 4, 2001

Introduction

Since the beginning of the 20th century, the greatest improvements in life expectancy in the United States have resulted from public health interventions. In 1900, the average American could expect to live 48 years; today, in 2001, that average American lives to be about 77. Knowledgeable observers say that public health improvements caused 70 percent of this advance, curative medicine 30 percent.

Despite this remarkable record over the past 101 years, life expectancy in the United States still trails almost all of Europe and such disparate countries as Japan, Canada and Israel.

Too often people define health in terms of resolving bouts of illness, not in preventing avoidable illness and disease in the first place. So, with that in mind, how do we as a nation make sure that health promotion and disease prevention activities receive the prominence they deserve?

One way to do it is by setting explicit goals and objectives to improve the health of all Americans. In recent decades, the federal government has moved decisively to do just that.

Every 10 years since 1980, the federal government – and specifically, the department HRSA is part of, the Department of Health and Human Services -- has released a compilation of prevention-based initiatives called Healthy People. These initiatives set the nation's health goals for the next decade. The third and latest plan – called Healthy People 2010 – was announced in January of last year.

The Making of HP 2010

When HHS officials and staff started the process of compiling Healthy People 2010, we wanted to put it on a diet. There were 319 objectives in Healthy People 2000, but Healthy People 2010 has even more – 467 objectives. What happened?

Well, first of all, during the comment period, people and organizations that wrote in wanted to add objectives rather than delete them, by a ratio of 7:1. They wanted to see their issues included.

As a result, we added new focus areas in vision, hearing, respiratory diseases, public health infrastructure, arthritis, osteoporosis and chronic back conditions.

All are compelling public health concerns. They deserved to be added because they reflect America’s changing demographics and emerging health issues. But they greatly added to the document’s size.

Additionally, some focus areas were expanded. The current document’s chapter on access to quality health services addresses not only primary care prevention – as it did in HP 2000 -- but emergency medical services and long-term and rehabilitative services.

These examples explain why the Healthy People framework has grown.

We tried to cut through this complexity by selecting two broad, overarching goals for Healthy People 2010:

The first goal is to increase the years and the quality of life -- with an emphasis on quality. For the first time ever, Healthy People goals focus on areas such as alleviating chronic pain and disability and slowing down the progression of Alzheimer's.

The second goal is one that my agency, HRSA, has worked toward for several years: to eliminate health disparities based on race and ethnicity.

Now, to reach those broad goals, the nation needs coherent, easy-to-remember strategies to get us there. From that requirement we came up with 10 leading health indicators. These health indicators – which some people call “sentinel measures” -- respond to those who urged us to produce a limited set of objectives and a more precise focus on the major things Americans can do to promote health and prevent illness.

Five of the indicators are health systems initiatives. They focus on:

access to quality care – another of HRSA's key goals;

childhood immunizations;

violence and injury prevention;

mental health; and

environmental quality.

The other five indicators are lifestyle-related and deal with:

tobacco use;

overweight and obesity;

physical activity;

responsible sexual behavior; and

substance abuse.

So that is – in short – the structure of Healthy People 2010. Two overarching goals. Ten sentinel measures. And 467 health objectives that respond to important, but narrower, health issues.

In terms of a broad public health strategy, we should focus on the 10 sentinel indicators. They give the nation a solid foundation for the ongoing campaign to improve the length and quality of our lives and to eliminate health disparities.

We’re asking you to help us implement Healthy People 2010 by adopting the 10 leading health indicators as your own and by making the public aware of them as part of a broad national campaign.

Now, can a government report thick enough to use as a doorstop really have a dramatic impact on Americans’ health? Of course it can, if we get involved in spreading its message in our communities. Just look at two examples of how public health campaigns have changed America: the campaign against smoking and the drive to boost the childhood immunization rate.

Anti-smoking and pro-immunization campaigns

In the 1950s and 60s, many adults – especially men – smoked as much as they wanted, wherever they wanted.

Then, in 1964, Surgeon General Luther Terry released the landmark report that tied lung cancer and chronic bronchitis to cigarette smoking and suggested that emphysema, cardiovascular disease and various types of cancer also were caused by smoking.

Congress reacted by forcing cigarette manufacturers to put warning labels on their product. Lawmakers in states and localities across the nation listened to the concerns of their constituents and imposed bans on smoking in restaurants and public places. Old habits disappeared almost entirely over the course of a generation.

The fight against smoking continues, and we can’t claim victory yet. But it is clear that this is one public health campaign that really changed the culture of a nation and measurably benefited Americans in every corner of the nation.

Another, more recent public health effort has been more unambiguously successful: the campaign to immunize 2-year-olds.

In the early 1990s, the federal government established a Childhood Immunization Initiative to boost overall immunization rates and close disturbing gaps in rates among racial and ethnic groups.

Federal efforts were aided by the service organization Kiwanis, which launched a public-service radio series that was distributed to stations throughout North America. The slogan of the campaign, "All Their Shots, While They're Tots," urged immunization of children by age 2. The radio campaign was supported by a billboard and poster program with the same theme.

The impact of this public-private teamwork has been impressive.

In the mid-1980s, childhood immunization rates in most states were about 60 percent.   But since 1993, immunization rates have reached all-time highs, with 90 percent or more of America's toddlers receiving the most critical doses of children’s vaccines by age 2.

In addition, reported levels of disease were at or near record lows in 1998. For the most critical childhood vaccines, vaccination levels are nearly the same for preschool children of all racial and ethnic groups, narrowing a gap that was estimated to be as wide as 26 percentage points a generation ago.

Public Health Responsibilities

In working to make Healthy People 2010 a success, we all have a role to play – health professionals, community leaders and individual citizens.

Doctors, nurses and other health professionals, for example, have a responsibility to:

administer immunizations;

counsel patients on ways to stop smoking and abusing drugs and avoiding unwanted pregnancies;

tell them how important diet, exercise, dental health are to their overall health; and

screen for health problems emphasized in the 10 health indicators – sexually transmitted diseases, depression and obesity and the problems often related to it: high blood pressure, high cholesterol and a lack of exercise.

Communities have a responsibility to:

reach out to residents and employers in making sure they know about the 10 sentinel measures;

work to expand access to health care by local residents – one of the campaign’s main goals; and

see that health education classes taught in local schools emphasize issues in Healthy People 2010 that impact so many of our young people: substance abuse, injury prevention, sexual health and unwanted pregnancies.

Teachers and those of you in supervisory positions in health departments can use HP 2010 as a teaching tool. Its goals and objectives can help you redesign curricula or restructure work assignments. Some schools already use it as a textbook. And since the entire document is on the Internet at web.health.gov/healthypeople, everyone with a computer can access it directly.

Researchers can use it as the foundation of a research agenda. We have no baseline data on about a third of the 467 objectives, but people felt very strongly during the consultation that it was important to measure them from now on. We need help in identifying ways to measure many of these objectives. And we need to explore ways to credibly document health disparities by race and ethnicity, sexual orientation, and for people with disabilities.

These health objectives provide a framework that can serve as landmarks for federal, state and local policymakers in developing the most healthy policies – policies that can improve not only a community’s health but its quality of life, growth and sustainability.

Finally, of course, individuals shoulder a great deal of responsibility for learning how to promote and maintain good health.

They should educate themselves about Healthy People 2010 by:

listening carefully to and following the advice they receive from health professionals;

taking advantage of resources provided by their community; and by

gathering information from reputable sources in newspapers, magazines, television and the Web.

Additionally, they should know what is recommended for them at their age, weight, height and family background in terms of nutrition, exercise and avoiding risky behavior.

And they should know when certain health screenings and checkups are called for.

Conclusion

One challenge for all of us is figuring out how we can give “booster shots” to Healthy People 2010 over the coming decade. We need to consider how to roll out HP 2010 products over the next several years to keep it in the public eye.

We probably don’t have to worry about whether Healthy People 2010 will be the last in the series. In its 20-plus years of life, the Healthy People movement has not just survived, it has grown.

Healthy People transcends politics. It is seen as good public policy and good for the American people regardless of which party is in power. It’s accepted and honored as a tool for good public health, a way to measure the progress we make in promoting healthy behavior and preventing disease.

That is, by itself, a cause for celebration and a great step forward.

To all of you in the audience who work on health promotion and disease prevention issues, I salute you and I thank you for inviting me be with you.

You’re doing a great job. Hoosiers, like other Americans, are living longer than ever before.   But you can’t stop yet -- they’re still not living as long as they can live. Thank you and, again, congratulations on the important work you do.