Fourth Meeting minutes: Appendix A

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	Fourth Meeting: July 30, 2008
Home Consortium Secretary's Advisory Committee 2009 Public Meetings Public Comment	Document #1 A Draft Outline for the Secretary's Advisory Committee's Report to the Secretary Executive Summary Introduction Background on the purpose and role of the Secretary’s Advisory Committee Secretary’s charge to Committee, timeline for efforts Historical context—how previous iterations of Healthy People were developed, and what has been learned overall from that experience (i.e., both development and use, or lack thereof) Revised processes and approaches for developing Healthy People 2020 objectives How this report fits into the overall context of plans to develop Healthy People 2020 Overview of this report and its structure Methodology Summary of Advisory Committee meetings (in-person and WebEx-based) Approach, activities, decisions Subcommittee contributions Roles of internal and external members How recommendations were relayed to the Advisory Committee as a whole Capturing and translating ideas generated by Committee discussions in this report Discussion at open meetings Efforts to integrate the work of subcommittees Formal approval of key concepts at open meetings Guidance about the Advisory Committee Recommendations What IS Healthy People 2020? What does Healthy People 2020 DO? What is its function? Who are its intended users? What is the intended “end-product” of Healthy People use? Overview of the recommended framework Mission, vision, goals, focus areas, objectives What are they? (Summary) How do they all fit together? Detailed explanation of mission and vision Detailed explanation of the goals How do goals relate to focus areas? How do focus areas relate to objectives? Three areas of emphasis for Healthy People 2020: the role and importance of each Prevention—(Language about the “value of prevention”) Health IT Preparedness Diagram(s) and narratives to explain them Conceptual model for Healthy People 2020 Process model for Healthy People 2020 Highlights: what’s new in these recommendations for Healthy People 2020? Dual focus on risk factors and determinants, as well as specific disease areas Emphasis on an ecological approach Inclusive—whenever there is a condition with a significant burden and good information on incidence/ prevalence and (hopefully) trends, reasonable objectives Inclusion of the general public as a primary target audience Inclusion of the concept of health equity (if Committee votes to include) Shift from paper-based format to an electronic format to make it more widely available to all interested parties Cross-cutting issues and how they fit into the framework An ecological perspective Definition of “the social and physical environment” Multi-level table illustrating how the HP 2020 conceptual model translates to action Health equity/ health disparities The concept of health equity defined (if Committee votes to include) The concept of health disparities defined How the concepts of ‘health equity’ and ‘health disparities’ mesh Operationalizing these terms Developmental/ life stages Why this is so important What it means to take a “life stages” approach How life stages should be clustered Population metrics for assessing healthy development Concrete examples of how a life stages approach can be applied to specific health issues Selection, organization, and prioritization of objectives Recommendation for the number of objectives Historical trend toward expansion Question of whether to limit Rationale for recommendation not to limit the number of objectives, except in cases where there is no data to justify their inclusion Implications of this recommendation for decisions about prioritization Recommendations for prioritizing objectives Criteria for prioritization Inclusion criteria: when should an objective be included in the list? Prioritization of objectives by user group Recommendation for the number and organization of focus areas Criteria for selecting and prioritizing focus areas Focus area topics Recommendations for Setting Goals / Objectives and their Targets Determine baseline How determined National data, as well as state and local data when they exist (—at least by reference) Setting Goals/ Objective Methods of calculation (provide rating based on priority scheme) Evidence-based objectives ( i.e., evaluate by criteria such as ameliorability) Extrapolation From prior historical trend By trend in disease risk factor(s) plus latency Expert advice—explain process Other (e.g., based on best practice in limited geographic area, etc.) Recommendations for Identifying Possible Interventions For each possible intervention, provide reference to systematic review source (grade each based on combination of potential change and cost-effectiveness Descriptions of potential interventions should offer: Type (e.g. clinical, community, etc.) Average effect size and standard error Populations in studies Date of review Who recommends (e.g., Community Guide, Clinical Guide etc., and year of recommendation) Economic data Cost Cost/ benefit or net cost Cost effectiveness Intended Users of Healthy People 2020 Specific target audiences: State and local public health Community members, advocacy groups, and others familiar w/ community needs Voluntary organizations Federal agencies Academics General public Business/ private sector Media Policy Entities, including Policy-formulating orgs. Policy-maker Associations Staffers Examples of how different users might query the Healthy People 2020 Database I am the director of a worksite wellness program but we have not seen much change in risk factors or disease rates despite our efforts to date. What are the most cost-effective interventions for me to reduce cardio-vascular disease and preventable/ screenable cancers? I am the director of chronic disease of a city of 100,000 with a mortality rate that is 10% higher than our state average. What are the highest priority policies that I should consider advocating to my city council consistent with the goal of reducing our overall mortality rate to national? State the 2020 goal by that year. I am a state senator in Indiana. I want to make my mark in the legislature by championing a few policies that could increase physical activity in my state. What are my best options based on good science, and what kind of effect would we likely see by adopting each of these? (Add an example of an individual seeking information/guidance from Healthy People 2020). Discussion Rationale for key decisions Pros/cons and limitations Resource considerations Conclusions Summary and overall recommendations Justification for these recommendations Recommended next steps Processes to obtain needed data Steps to create a tool that health departments can easily use to do a rational priority development process Appendices Preamble to the Healthy People 2020 Objectives
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