Progress Toward Healthy People 2010 Targets

The following discussion highlights objectives that met or exceeded their 2010 targets; moved toward the targets, demonstrated no change, or moved away from the targets; and those that lacked data to assess progress. Progress is illustrated in the Progress Quotient bar chart (see Figure 28-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

Data were available to assess progress for vision impairment in children and adolescents (28-4), newborn hearing screening, evaluation, and intervention (28-11a, b, and c), otitis media (28-12), and hearing examination (28-14a and b). One subobjective met its target. Four objectives and subobjectives moved toward their targets, and two subobjectives moved away from their targets. Data were unavailable to assess progress for the remaining 21 objectives and subobjectives.

Objectives that met or exceeded their targets. One subobjective─hearing examinations for persons aged 70 years and older (28-14b)─met its target of 40 percent.

Objectives that moved toward their targets. Progress was made for blindness and visual impairment in children and adolescents under 18 years of age (28-4), with 50 percent of the targeted change achieved. Several factors may influence meeting the target by 2010. For example, better treatment options may lead to improved compliance in amblyopia, a common eye disorder in children. The increased use of effective amblyopia screening tests will also help ensure that more children are detected and treated at an early stage when therapy is most effective.

Reductions in otitis media (inflammation of the middle ear) in children and adolescents under 18 years of age (28-12) met 82 percent of its targeted change. From a baseline of 345 cases per 1,000 children and adolescents under 18 years of age in 1997, the rate fell to 303 cases in 2002. The introduction of heptavalent pneumococcal conjugate vaccine (PCV7) in the United States in 2000 may have led to a reduction of otitis media in children under 2 years of age.^{3, 4} Because recent shortages restricted full access to the vaccine, guidelines have been issued to target the available supply to high-risk children (for example, children with sickle cell disease or anatomic asplenia, with chronic illness, or who are immunosuppressed, including those with HIV infection).⁵ Contributing to this objective's progress are improved patient and physician education initiatives, such as health information fact sheets written in plain and linguistically appropriate language concerning risk factors for otitis media. A group of primary care physicians and experts in the fields of otolaryngology, epidemiology, and infectious disease has developed the Clinical Practice Guideline: Diagnosis and Management of Acute Otitis Media to address pain management, initial observation versus antibacterial treatment, appropriate choices of antibacterials, and preventive measures for acute otitis media (AOM).⁶ The guideline lists factors associated with early or recurrent AOM; for example, genetic predisposition, premature birth, male gender, Native American/Inuit ethnicity, family history of recurrent otitis media, presence of siblings in the household, and low socioeconomic status.

Finally, the objective for hearing examinations achieved 20 percent of the targeted change for the population aged 20 to 69 years (28-14a). Initiatives that are contributing to efforts to increase the proportion of adults of all age groups (aged 20 years and older) having had recent hearing examinations (28-14) are the "WISE EARS!^®" public awareness campaign relating to preventable causes of hearing impairment⁷; informative news articles, such as "Bring Those Babies Back"⁸ and "Pointers for Parents,"⁹ written in both English and Spanish; and other media coverage on hearing loss and advances in hearing aids, cochlear implants, and other assistive listening devices.

A host of national activities and organizations support the improvement of vision and hearing health. For example, more than 240 organizations belong to the Healthy Vision Consortium,¹⁰ an alliance of organizations committed to the eye health of all Americans by supporting the vision objectives of Healthy People 2010. These organizations consist of key national, State, and local organizations representing the professional, voluntary, and business sectors.

In May 2003, the National Eye Institute (NEI) within HHS established the first annual Healthy Vision Month (HVM) Observance.¹¹ Each year, HVM focuses on a different Healthy People 2010 vision objective and engages partners in activities to further progress toward the selected objective. Partner activities include community-based programs and events, journal articles and editorials, and web-based information.

Objectives that demonstrated mixed movement toward and away from their targets. One objective—newborn hearing screening, evaluation, and intervention (28-11)—showed varying movement toward and away from targeted changes based on individual subobjectives. Newborns who receive a hearing screening before the age of 1 month (28-11a) moved to 71 percent of its targeted change—from a 2001 baseline of 66 percent of this population to 83 percent in 2002. Infants with possible hearing loss who receive audiologic evaluation before 3 months of age (28-11b) and intervention services before 6 months of age (28-11c) both moved away from their targets. The proportion of infants with hearing loss who received an evaluation before age 3 months (28-11b) decreased from 56 percent in 2001 to 52 percent in 2002, while the proportion who received intervention services before age 6 months (28-11c) decreased from 57 percent to 43 percent. In 2002, 46 States provided data for hearing screening before 1 month of age (28-11a), while only 27 States provided data for audiologic evaluation before 3 months of age (28-11b), and 26 States provided data for intervention services before 6 months of age (28-11c). This difference in reporting may affect the comparability of rates.¹² Baseline data did not become available until 2001, and the only other data point available was for 2002. The 1-year interval between the two data points does not provide much time for programs to influence the trend toward the target. With time, many more States are expected to provide information for subobjectives 28-11b and c, which will result in more reliable trend estimation.

Multiple factors have contributed to improvements in newborn hearing screening, evaluation, and intervention. Research and technologic advances have made screening easier and more cost effective. Several Federal agencies have promoted universal newborn hearing screening. For example, the Centers for Disease Control and Prevention's (CDC's) Early Hearing Detection and Intervention Program has worked cooperatively with the States to track progress in the implementation of universal newborn hearing screening.¹³ The lack of progress concerning hearing loss evaluation and intervention in infants under 1 year of age suggests the need for improved followup methods and treatment of infants who fail their initial screening.

Objectives that demonstrated no change. No vision or hearing objectives remained static at the midcourse review.

Objectives that moved away from their targets. Two subobjectives moved away from their targets: receipt of audiologic evaluation before 3 months of age among infants with possible hearing loss (28-11b) and enrollment of infants with confirmed hearing loss for intervention services before 6 months of age (28-11c).

Objectives that could not be assessed. Several objectives lacked sufficient data to assess progress: dilated eye examinations (28-1); vision screening for children aged 5 years and under (28-2); vision impairment due to refractive errors (28-3), diabetic retinopathy (28-5), glaucoma (28-6), and cataract (28-7); occupational eye injury (28-8); use of protective eyewear (28-9); vision rehabilitation services and devices (28-10); hearing aids, assistive listening devices, and cochlear implants (28-13); hearing protection (28-16); and noise-induced hearing loss in adolescents aged 12 to 19 years (28-17) and adults aged 20 to 69 years (28-18). Data are anticipated for these objectives by the end of the decade.

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