Office of Health Policy
OPPORTUNITIES FOR ACTION
During his tenure, Secretary Thompson has hosted many roundtable discussions
and listening sessions with different stakeholders and interested parties.
Drawing on these meetings, research and other information, this section suggests
actions that specific stakeholders can take to promote health and prevent chronic
disease in all Americans. These steps are not meant to be prescriptive but
rather to identify starting points for individuals, families, communities and
other interested constituencies as they begin to work for better health and
wellness.
Individuals and families are the heart of healthy communities and provide the
foundation for a strong and vibrant America. Individuals and families must
adopt healthy habits and assume responsibility for living a healthy lifestyle.
- Be physically active. Strive
for at least 30 minutes of physical activity for adults and 60 minutes for
children each day. Play and be active as a family. Decrease time spent in
sedentary activities such as watching television.
- Eat a healthy diet. Consume
5 to 9 servings of fruits and vegetables each day. Consume fat and sugar
in moderation.
- Educate yourself about health
and risk factors for disease and chronic conditions such as obesity. Become
a student of healthy habits. Learn what constitutes a healthy diet and how
to read and use food labels.
- Set an example for your children
by being physically active and eating a healthy diet. Instill healthy habits
in children (e.g., play actively and eat healthy foods). Teach your children
about the importance of exercise and a healthy diet.
- Avoid risky behaviors. Limit
alcohol intake. If you smoke, quit; if you do not smoke, don’t start.
- Get recommended screenings
(such as pap smears and mammograms) and immunizations (such as influenza vaccinations).
Communities are the cornerstones for promoting healthy behaviors of their residents.
Partnerships within and among local private sector constituencies and stakeholders
can promote and reinforce healthy habits and environments for individuals and
families.
- Engage individuals, families,
policy makers, and community organizations in a process to enhance their understanding
of the importance of healthy diets and regular physical activity. Raise consumer
awareness about the adverse impact of inactivity and poor diets on overall
health and well-being. Highlight community programs that support healthful
food and physical activity.
- Acting through community coalitions
and partnerships, explore the creation of more community-based health promotion
and disease prevention programs and initiatives for individuals and families.
Empower individuals and families to manage weight and health through community
programs that encourage skill-building, active parenting and behavioral management.
- Consider providing for active
lifestyles when planning and engineering community development and creating
safe environments for physical activity, such as biking and walking trails,
sidewalks, and playgrounds.
Schools are an especially critical site for encouraging healthy behaviors in
youth. Most children spend a large portion of their time in school. In many
cases, life-long habits and behaviors, good and bad, are formed during the elementary
and middle school years. Schools, therefore, offer an opportunity to engage
children in healthy eating and regular physical activity and to reinforce important
health messages including those regarding avoidance of risky behaviors. Schools
can also provide a bridge to eliciting parental involvement in shaping children’s
habits and attitudes about healthy lifestyle choices.
- Encourage cooperation among
teachers, coaches, nurses, and food service staff to educate students about
the importance of proper nutrition and regular physical activity to lifelong
healthy weight maintenance.
- Reinforce healthy habits by
examples set by role models including teachers, coaches, and other school
personnel.
- Engage parents in a process
to enhance their understanding of the importance of healthy diets and the
benefits of exercise and engage them to reinforce this message in their homes.
- Provide age-appropriate extracurricular
physical activity and organized sports programs.
- Provide elementary school students
with daily recess periods for unstructured supervised play.
- Encourage regular physical
activity for all children (pre-school through 12th grade) in order
to develop the knowledge, skills, attitudes, behaviors, and confidence to
sustain life-long physically active lifestyles.
- Explore the possibility of
creating “before the bell” and after school physical fitness and nutrition
programs for students.
- Provide age-appropriate and
culturally appropriate instruction in health education.
- Provide healthy food and snack
options in school cafeterias and vending machines.
- Incorporate health-related
tasks, materials and examples in regular everyday instruction for preschool
to grade 12 education, including the topics of nutrition and the balance between
calories consumed and calories expended in physical activity.
Working adults spend many of their waking hours at their worksite. Thus,
the worksite is an important and convenient environment in which to foster healthier
habits. Moreover, companies are beginning to recognize that the health of the
individual employee is inseparable from the ‘health’ of the corporation. Employees
with chronic diseases and/or conditions, which may be prevented or attenuated
by diet and exercise, often have higher rates of absenteeism and health care
usage than healthy employees without chronic ailments. Thus, worksite programs
designed to promote health and prevent chronic disease are a wise investment
for employers.
- Design worksites and work schedules
to provide opportunities for regular physical activity, including simple and
readily available activities such as stair climbing.
- Ensure that healthy food options
are available for employees.
- Consider creating exercise
facilities at the worksite or providing incentives for employees to join local
fitness centers.
- Consider providing health promotion
or wellness programs and disease management programs for employees as part
of their health benefits.
- Offer incentives to employees
to adopt documentable healthy behaviors (e.g., miles walked or weight goals
attained, obtaining recommended screenings, completion of a medically supervised
smoking cessation treatment program). [See Appendix F.]
- Engage employees in a process
to enhance their understanding of the importance of a healthy lifestyle.
- Actively partner with community
and other local entities/stakeholders to develop and implement community health
promotion and disease prevention initiatives.
- Examine the cost and benefits
of worksite health promotion and disease prevention efforts.
- Request health insurers to
develop appropriate information for employees to enhance health literacy.
- Include health literacy measures
in quality of care and outcomes assessments.
Health insurers can play a significant role in promoting health and preventing
or lessening the consequences of chronic diseases and conditions for individuals.
Insurers can design and offer innovative and comprehensive preventative services
benefit packages based on scientific evidence. In addition, insurers can disseminate
educational information about the importance of prevention to their customers/consumers.
- Offer insurance products that
include preventative services, disease management and wellness programs.
- Engage consumers in a process
to enhance their understanding of the importance of healthy habits and avoidance
of risky behavior.
- Encourage research evaluating
the efficacy and cost/benefit of strategies to change behavior and translate
research into clinical practice. Share this information with employers and
other purchasers of health care.
- Create incentives to encourage
individuals to adopt healthy behaviors. [See Appendix F.]
- Partner with communities and
other entities to promote and encourage healthy lifestyles.
- Include health literacy in
quality of care and outcomes assessments.
Health care providers/professionals are key for promoting healthy lifestyles
and reducing the impact of chronic diseases and conditions. In any year, most
Americans will interact with the health care system. Thus, health care providers
are strategically poised to intervene and influence individuals to adopt healthy
behaviors. Health care professionals can also provide critical leadership to
communities, state and local governments, schools and other interested stakeholders
to guide and catalyze health promotion and disease prevention efforts.
- Lead by example; live a healthy
lifestyle.
- Accrue and maintain state-of-the-art
knowledge about best practices and behavioral interventions to promote healthy
habits and reduce risky behaviors.
- Inform and educate individuals
(patients, parents, students, community leaders, other health professionals,
etc.) about the importance of healthy eating, regular physical activity, recommended
disease screening, and avoidance of risky behaviors (such as tobacco use)
to promote health and prevent chronic disease.
- Implement effective weight
reducing initiatives and smoking cessation programs.
- Direct or participate in studies
to explore the effectiveness of approaches to weight loss and healthy weight
maintenance and smoking cessation.
- Explore partnerships between
health care providers/professionals and schools, communities, faith-based
organizations, local and state governments, and other interested parties to
develop and implement health promotion and disease prevention initiatives.
- Seek out training in health
literacy and effective provider-patient communication.
- Practice evidence-based
prevention—adhere to evidence-based recommendations of the US Preventive Services
Task Force (USPSTF) on whether a clinical preventive service should be routinely
delivered www.preventiveservices.ahrq.gov.
- Identify individuals who are
ready to make important changes and take maximum advantage of the “teachable
moment” that often occurs in clinical care (e.g., counseling individuals who
have just had a heart attack or chest pain to quit smoking).
- Harness the power of health
information technology systems, including decision support systems, to remind
clinicians and patients when preventive services are needed. HHS has supported
much of the research that demonstrates the effectiveness of these systems
to improve the use of clinical preventive services.
Progress in health promotion and disease prevention necessarily depends on
continued research and knowledge generation and dissemination. Therefore, researchers
and health professions educators are critical in furthering our understanding
of the etiology of chronic conditions such as obesity and effective approaches
for prevention and treatment of these conditions. In addition, successful health
promotion and disease prevention requires translation and dissemination of scientific
findings into effective clinical practices to reach all individuals.
- Continue research into the
pathogenesis, etiology, epidemiology, prevention and treatment of chronic
diseases and conditions including obesity. Continue to explore optimal methods
to translate research findings into clinical practice to change human behavior
and foster healthy habits.
- Develop outcome measures for
health promotion and disease prevention activities, services, and practices.
- Encourage and adopt an interdisciplinary
approach to address chronic conditions such as obesity.
- Develop and assess innovative
methods to engage the public about the importance of health promotion and
disease prevention and the link between the risk for chronic conditions and
personal behaviors and choices such as physical activity and diet choices.
Information, communication, and education should encompass the lifespan beginning
in early childhood and continuing into older age.
- Focus on identifying effective
ways to improve the health literacy of all individuals to reinforce the importance
of health promotion and disease prevention for all segments of the population.
- Seek partnerships with community,
public or private entities to promote research and educational initiatives
regarding health promotion and disease prevention. Develop a multi-pronged
community approach involving all stakeholders to reach all individuals.
- Design curricula and testing
for health professionals (undergraduate and graduate) that comprehensively
cover the science of health promotion and disease prevention and that examine
and teach effective approaches to change individual behaviors. Integrate
health professional education and training across disciplines.
The power of the media should be harnessed to educate the public by disseminating
health information and to promote effective strategies to improve dietary and
exercise habits.
- Promote/conduct public awareness
campaigns of the health benefits of energy balance through regular physical
activity, and a healthy diet to maintain a healthy weight.
- Partner with medical professionals,
federal, state and local governments, and private sector and community entities
to help the public understand the importance of preventive screenings.
- Develop and disseminate appropriate
messages that encourage healthy habits and avoidance of risky behaviors in
youth.
- Showcase successful initiatives
and programs that promote health and prevent disease.
- Conduct or participate in consumer
research to study the appropriateness and effectiveness of media messages
promoting healthy lifestyles and avoidance of risky behaviors.
- Consider use of public access
networks to broadcast local conferences or training videos on various health
topics (e.g., exercise class for seniors).
State, local, and tribal governments can play a key role in coordinating an
approach to encourage healthy habits and prevent chronic diseases. State, local
and tribal governments can partner with, and provide guidance to, other organizations
and entities to facilitate health promotion initiatives. They can also act
as a bridge between Federal programs and community activities providing the
necessary infrastructure and support needed to maximize and coordinate efforts
among stakeholders. In addition, state, local, and tribal governments can create
and implement policies that encourage healthy behaviors.
- Review and design policies
to ensure that health promotion and disease prevention are priorities.
- Partner with communities and
other entities to create environments and implement initiatives that encourage
healthy lifestyles and habits.
- Disseminate audience-appropriate
information about the importance of healthy lifestyles and avoidance of risky
behaviors. Foster a consistent age and culturally appropriate message to
the public, especially high-risk groups, about the consequences of unhealthy
lifestyles and practices.
- Identify high-risk groups for
targeting prevention initiatives and activities.
- Provide guidance and support
for research on the efficacy of different interventions to prevent and treat
obesity, diabetes, and other chronic conditions and tobacco use.
HHS has a large number of current initiatives and programs underway to address
obesity and overweight. They include programs in education, communication and
outreach, intervention, diet and nutrition, physical activity and fitness, disease
surveillance, research, clinical preventive services and therapeutics, and policy
and web-based tools. The programs are targeted to a variety of populations
including infants and breastfeeding mothers, children and adolescents, women,
minorities, the elderly, the disabled, rural, and the general population. Additional
areas to target initiatives may include:
- Design and implement programs
that work with children and parents to prevent and treat obesity, since the
best opportunity to slow the U.S. obesity ‘epidemic’ may be in childhood.
- Evaluate effectiveness of treatment
and preventive programs to build a practical evidence base for new interventions.
Relevant research questions may include:
- Do certain populations (e.g., gender or age-related, racial/ethnic populations)
benefit more from certain therapies?
- What is the optimum amount of time to treat, and what is the optimum
level of weight loss to target?
- What evidence exists to support long-term weight loss and weight-maintenance,
e.g., over one year or five years?
- What is the safety and efficacy of certain therapies?
- What risks are associated with weight loss, especially for certain populations
such as the elderly, for example, who generally are at high risk for osteoporosis?
- Explore ways to increase awareness
and knowledge, especially in certain populations, about obesity and interventions
that may reduce obesity and promote healthy energy balance.
- Develop interventions that
address needs of special populations.
- Focus further research on the
psychological and motivational aspects of weight maintenance, and on identifying
any demonstrable benefits for private or public health insurance programs.
- Enhance food labels to display
calorie count more prominently and to use meaningful serving sizes.
- Evaluate and recommend the
types of health communication activities that would most effectively support
the "Calories Count" message.
- Encourage restaurants to provide
meaningful nutritional information to consumers.
- Step up enforcement actions
concerning accuracy of food labels.
- Revise FDA guidance for developing
drugs to treat obesity.
- Work cooperatively with other
government agencies, non-profit organizations, industry, and academia on obesity
research.
- Incorporate the findings from
the recently released reports on health literacy from the Institute of Medicine
and AHRQ into overweight and obesity information and communication activities.
Action Steps for HHS/Diabetes
HHS agencies are pursuing vigorous programs in prevention that include basic
research, clinical trials, community health efforts, educational programs, translating
research into practice, efforts in special populations, and providing a new
Medicare benefit for diabetes testing. Through these comprehensive programs,
HHS agencies are continuing to pursue prevention studies to optimize and identify
additional intervention strategies. HHS also is improving methods to disseminate
and implement effective strategies into diverse community settings. Particular
opportunities for HHS action involve underserved or vulnerable populations and
include:
- To focus attention on the long-term implications of gestational diabetes
mellitus (GDM), the National Diabetes Information Clearinghouse of the NIDDK/NIH
will produce a new booklet entitled, “What I Need to Know about Gestational
Diabetes,” which will incorporate messages based on diabetes prevention research.
The National Diabetes Education Program’s Small Steps. Big Rewards. Prevent
Type 2 Diabetes campaign will also be expanded to include a specific focus
on GDM.
- · To analyze the effects of treatment
and ascertain the durability of these effects over time, a Diabetes Prevention
Program follow-up study of women with a history of GDM is in progress.
- Enhance the focus on women
with GDM in community health centers and Indian Health Service programs, and
through AHRQ’s Integrated Delivery System Research Network and Practice Based
Research Networks.
- Since there is a disproportionate
risk for the development of type 2 diabetes in persons with serious mental
illness, in general, and treatment with antipsychotic medications predispose
individuals to gain weight [49-54] , examine and apply evidence-based lifestyle
interventions in mental health settings that would reduce the rate of obesity
and prevent the development of type 2 diabetes in Americans with serious mental
illness.
- Since American Indians and
Alaska Natives have a higher incidence of diabetes, determine if diabetes
prevention activities previously demonstrated to be efficacious under well-controlled
conditions (such as the NIDDK-sponsored Diabetes Prevention Program
study) can be implemented with fidelity in a variety of Indian health settings
and through community-based human services providers.
- Evaluate whether a comprehensive
health system intervention delivered through Indian health programs can reduce
risk factors for cardiovascular disease in individuals with diabetes and/or
the metabolic syndrome ( characterized by insulin resistance and the presence
of obesity, abdominal fat, high blood sugar and triglycerides, high blood
cholesterol, and high blood pressure).
- Implement evidenced-based interventions
to prevent diabetes as part of the Primary Prevention of Diabetes Initiative
in 25-30 Health Service/Tribal/Urban (I/T/U) community sites of varying sizes
and types.
- Implement, as part of the Cardiovascular
Disease Risk Reduction Initiative, a comprehensive health system intervention
consisting of patient-, provider-, systems- and community-level components
in 25-30 clinical sites that participate in the IHS Diabetes Care and Outcomes
Audit.
- Consider utilizing the community
health center program Diabetes Prevention Collaborative and Health
Disparity Collaborative strategy and models to translate and disseminate
the results of Diabetes Prevention Program pilot into clinical practice.
- Incorporate the findings from
the recently released reports on health literacy from the Institute of Medicine
and AHRQ into diabetes information and communication activities.
- CMS should assess utilization
of the new Medicare benefits (beginning in 2005) establishing coverage of
an initial preventive physical exam, and diabetes and cardiovascular disease
screening tests, to ensure beneficiaries are taking advantage of these services
and getting the care they need to better manage their diabetes.
Prevention of the ill effects of tobacco is an essential part of the HHS mission,
and HHS is committed to working in a coordinated, comprehensive, and effective
manner to protect the public’s health from the harmful effects of tobacco use.
In 2000, HHS launched a roadmap for improving the health of all people in the
U.S. during the first decade of the 21st century, including objectives
for reducing the death and disease caused by tobacco use. In addition, the
Secretary’s Steps to a HealthierUS has as one of its major components
avoiding risky behaviors, such as using tobacco products, to promote good health
and save lives. There are many opportunities for strategic collaboration among
agencies to further reduce the health and economic impact of tobacco-related
diseases.
- Consider opportunities for
encouraging smoking cessation activities in a variety of programs and areas,
such as: the Federal workplace; among hospitalized cardiac patients; among
Americans who receive their health care through or with financing from the
Federal Government (Veteran’s Administration, Medicaid, Medicare, Older Americans
Act services provider network, Department of Defense, Indian Health Service);
or in the HRSA prevention collaborative.
- Examine ways to encourage use
of the Web site, www.smokefree.gov, which offers science-driven
tools, information, and other resources that have been found effective in
helping smokers quit.
- Consider opportunities for
incorporating tobacco use prevention messages into community-based shelters
for runaway and homeless youth and their families; and the National Youth
Sports Program youth camps for middle-school-aged, low-income youth.
- Examine opportunities for tobacco
use prevention and smoking cessation among Head Start and Early Head Start
staff and parents.
- Examine opportunities to enhance
the delivery of technical assistance on tobacco control through SAMHSA’s Center
for Substance Abuse Prevention (CSAP) Center for the Application of Prevention
Technologies.
- Consider opportunities to deliver
tobacco use and prevention messages to young people through sports and entertainment
media campaigns.
- Examine opportunities to enhance
SAMHSA Best Practices via the National Registry of Effective Prevention Programs
to include tobacco prevention programs.
- Examine opportunities to expand
the number of materials on tobacco prevention and control that are available
through the National Clearinghouse for Alcohol and Drug Information.
- Consider research that examines
the toxicity of current and new tobacco products.
- Incorporate the findings from
the recently released reports on health literacy from the Institute of Medicine
and AHRQ into tobacco information and communication activities.
- Highlight community-based programs
that provide rewards for young people who do not smoke.
- Evaluate and disseminate the
results of the Medicare Stop Smoking Program (a pilot currently underway in
seven states).
HHS has a vast number of individual initiatives, products and messages designed
to promote healthy behaviors and reduce illness and disability, such as the
national nutrition program, 5 A Day for Better Health Program, the Small
Steps program, and its accompanying advertising campaign (Healthy Lifestyles
and Disease Prevention), which encourages American families to take small,
manageable steps to ensure effective, long-term weight control.
- Identify a standard for clear
and effective communication for all information, forms, materials and communication
from HHS with the public.
- Update and change prevention
messages to maintain ‘freshness’ and reflect the state-of-the-art practices
and information.
- Research the information and
communication needs, characteristics, preferences, and environments to develop
effective messages.
- Coordinate prevention messages
to reduce the ‘noise’ of competing messages and to leverage resources.
- Integrate prevention messages
with prevention programs.
Health literacy and messaging are important aspects of HHS research and program
activities focusing on prevention. The Department’s agencies are engaged in
a variety of health literacy activities. HHS agencies are beginning to include
health literacy as a consideration in their research, assessment, training,
program operations, and communication with the public, but there are opportunities
for improvement.
- Continue research on multiple
aspects of health literacy including: the impact of limited health literacy
on health disparities; the nature and extent of limited health literacy in
different populations and for different topics and contexts; the interaction
of limited health literacy with other factors, such as age and disabilities;
the most effective health literacy interventions for different segments of
the population; and the impact of limited health literacy on the quality,
access and outcomes of health care and public health services.
- Develop health and program
information in a variety of languages.
- Emphasize the need to pre-test
publications designed for wide-spread dissemination with the target audience
prior to publication.
- Support the development of
an evidence-based approach to training a broad spectrum of healthcare and
public health professionals to communicate effectively with different types
of patients, including those with limited literacy.
- Develop and validate measures
of successful health literacy approaches.
- Provide leadership to identify
and build consensus for outcome measures needed to improve health literacy
across the population, in particular for the most vulnerable groups.
- Advise agencies to assess their
information, communication, and programmatic activities with their intended
audiences, particularly low literacy audiences.
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