Attachment A
Healthy People 2020 Proposed Framework (3.12.09)

The vision, mission and overarching goals provide structure and guidance for achieving the Healthy People 2020 objectives. While general in nature, they offer specific, important areas of emphasis where action must be taken if the United States is to achieve better health by the year 2020. Developed under the leadership of the Federal Interagency Workgroup, the Healthy People 2020 framework is the product of an exhaustive collaborative process among HHS and other Federal agencies, public stakeholders, and the advisory committee.

Framework Background

For three decades, Healthy People has provided a comprehensive set of national 10-year health promotion and disease prevention objectives aimed at improving the health of all Americans. It is grounded in the notion that establishing objectives and providing benchmarks to track and monitor progress over time can motivate, guide, and focus action. Healthy People 2020 will continue in the tradition of its predecessors to define the vision and strategy for building a healthier Nation.

I. Healthy People 2020 Development Process

The Healthy People 2020 framework consists of a vision, mission, and overarching goals. The framework uses a risk factors and determinants of health approach to inform and guide improvements in health. It builds on past iterations of Healthy People. It is the product of a multi-year process and reflects deliberative input from a diverse array of individuals and organizations, both within and outside the Federal government, with a common interest in improving the Nation's health. The framework constitutes Phase I of the Healthy People 2020 development process and provides the foundation for Phase II, the development of specific objectives and strategies to achieve them. The development process will culminate in 2010 with the launch of the objectives, their baselines and targets, and implementation strategies for achieving the targets.

Federal Interagency Workgroup

Within the Federal government, a Federal Interagency Workgroup (FIW) led the development effort. The FIW members include representatives from US Department of Health and Human Service agencies and offices as well as the US Departments of Agriculture, Education, Housing and Urban Development, Justice, Interior and Veterans Affairs, and the Environmental Protection Agency. The participation of other Federal entities is expected to expand throughout the development process. The FIW and its various subgroups met regularly and frequently over an 18-month period to develop the Healthy People 2020 framework. During its deliberations, the FIW drew on the diverse backgrounds and expertise of its member agencies, lessons learned from past Healthy People efforts, broad-based public comment, and the work of the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020.

Public Comment

Far reaching public input has been sought through a variety of mechanisms throughout the development process to ensure that Healthy People 2020 will reflect the needs and warrant the commitment of a broad spectrum of stakeholders. Stakeholders range from Federal, state and local government agencies to private sector organizations and businesses to public health professionals and policy makers. Public comment was received during a series of six regional meetings across the country, via a public comment website, during a public meeting of the advisory committee, and through a request for public comment published in the Federal Register.

Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives

HHS convened the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020 to aid in the development of Healthy People 2020. Its 13 members are nationally known experts with diverse expertise on different aspects of public health. The fully public-member advisory committee was charged with providing advice and consultation to the Secretary on the development and implementation of the national objectives. During the first phase of its work (January 2008 – October 2008), the advisory committee and its subcommittees produced recommendations for the Healthy people format, framework, and guidelines for implementation. Over the course of its deliberations, the advisory committee considered the work of the FIW, subject area experts, and public comment.

II. The Importance of an Ecological and Determinants Approach to Health Promotion and Disease Prevention

Health and health behaviors are determined by influences at multiple levels, including personal (i.e., biological, psychological), organizational/institutional, environmental (i.e., both social and physical), and policy levels. Because significant and dynamic inter-relationships exist among these different levels of health determinants, interventions are most likely to be effective when they address determinants at all levels. Historically, many health fields have focused on individual-level health determinants and interventions. Healthy People 2020 should therefore expand its focus to emphasize health-enhancing social and physical environments. Integrating prevention into the continuum of education—from the earliest ages on—is an integral part of this ecological and determinants approach.

III. The Role of Health Information Technology and Health Communication

Health IT and health communication should be encouraged and supported as being an integral part of the implementation and success of Healthy People 2020. Efforts should include building and integrating, where feasible, the public health IT infrastructure in conjunction with the National Health Information Network; extending the ONC-Coordinated Federal Health IT Strategic Plan: 2008-2012 developed by the HHS Office of the National Coordinator; integrating the various aspects of IT to meet the direct needs of Healthy People 2020 for measures and interventions; building on current health literacy and health communication efforts.

IV. Addressing "All Hazards" Preparedness as a Public Health Issue

Since the 2000 launch of Healthy People 2010, the attacks of September 11, 2001, the subsequent anthrax attacks, the devastating effects of natural disasters such as hurricanes Katrina and Ike, and concerns about an Influenza pandemic have added urgency to the importance of preparedness as a public health issue.  Being prepared for any emergency must be a high priority for public health in the coming decade, and Healthy People 2020 should highlight this issue. Because preparedness for all emergencies involves common elements, an "all hazards" approach is necessary.

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This page last updated on: March 12, 2009

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