PDF version [File size: 246 KB]

Introduction to the Focus Area Chapters

This section presents assessments of progress for each of the 28 focus areas of Healthy People 2010.  Each chapter begins with an introduction reviewing the focus area subject matter and its relationship to the Healthy People 2010 overarching goals to increase quality and years of healthy life and to eliminate health disparities.  The introduction is followed by a discussion of modifications (that is, changes, additions, and deletions) to the focus area’s objectives and subobjectives as a result of the midcourse review.

The chapters then present an assessment of progress toward the Healthy People 2010 targets.  These discussions highlight objectives that achieved their targets, moved toward their targets, demonstrated no change, moved away from their targets, and lacked data to assess progress.  Progress is illustrated in a Progress Quotient bar chart (presented as Figure 1 in each focus area), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

The next section of each chapter discusses progress toward the elimination of health disparities.  A Disparities Table (presented as Figure 2 in each focus area) is used to illustrate disparities among select populations for population-based objectives and subobjectives for which data were available.  Objectives and subobjectives based on schools, worksites, States, and numbers of events (that is, nonpopulation-based objectives) are not included in the disparities discussion.  The chapters conclude with discussions of opportunities, challenges, and emerging issues for each focus area.

A description of the Progress Quotient bar chart and a guide to the Disparities Table are presented in the following sections.  The techniques used to develop the charts are discussed in greater detail in the Technical Appendix.  A detailed discussion of the measurement of progress and disparities in Healthy People 2010 has also been published.¹

Measuring Progress Toward the Healthy People 2010 Targets

Progress toward the Healthy People 2010 targets at the midcourse is shown in a Progress Quotient bar chart for each focus area (Figure 1). This chart displays the percent of targeted change that has been achieved for each objective and subobjective. Targeted change is the difference between the baseline and the year 2010 target. The formula for the percent of targeted change achieved is as follows:

The percent of targeted change achieved is positive when the objective moved toward the target and negative when the objective moved away from the target. It can be used to compare how much of the targeted change has been achieved for an objective or subobjective relative to other objectives and subobjectives.

The objective and subobjective titles are listed on the left side of each bar chart, along with the year for the baseline and most recent data point, which appear in parentheses. The percent of targeted change achieved is shown for each objective and subobjective with data more recent than the baseline. The progress quotient is color coded: Objectives and subobjectives that moved away from the target are in red, moved toward the target are in light blue, and met or exceeded the targets are in dark blue. Objectives for which progress could not be assessed are identified in the footnotes. These notations occur in two general types of situations: (1) the objective or subobjective was deleted at midcourse, or (2) the objective or subobjective did not have a baseline or had a baseline value but no followup data. In a few cases, the percent of targeted change achieved cannot be precisely calculated, but the direction of the change can be determined. These cases occur when the target was met or exceeded at baseline. Such situations are treated separately in the footnotes and are discussed in more detail in the Technical Appendix.

The following observations may be helpful to the interpretation of the percent of targeted change achieved by a specific objective or subobjective and/or comparisons of progress among multiple objectives:

• The percent of targeted change achieved measures the percent of the difference between the baseline year and the 2010 target that has been eliminated. For example, a value of 25 percent indicates that a quarter of the difference between the baseline and the 2010 target was achieved.
  
  
• Since movement away from the target (that is, negative change) is expressed in terms of the original difference, very large percentages may be observed. However, when the probability that the target will be achieved by 2010 is considered, the magnitude of the negative change is less important than the simple fact that no progress was made. In general, movement away from the target, or no movement (that is, the percent of targeted change is 0), is a concern.

The use and interpretation of the progress quotient has limits. It is based on a calculation using only the Healthy People 2010 target, the baseline data point, and the most recent data point. Furthermore, it does not take into account the number of years that are included nor any fluctuations that may occur during the intervening years. The number of years included, which varies by objective and subobjective, may also vary within an objective or subobjective based on population data. Estimates of the progress quotient variability are not included in the midcourse review because the necessary information is not available for some objectives and subobjectives. It is too early in the Healthy People 2010 initiative for such estimates to be meaningfully applied. Methods and estimates of variability for the progress quotients are anticipated for assessing progress at the end of the decade. There are also situations in which the progress quotient cannot be calculated or does not accurately reflect change in an objective or subobjective. These situations include instances when the target was met at the baseline, when the amount of targeted change was small relative to the amount of actual change, or when the target was exceeded at baseline. Such situations are footnoted on the applicable charts.

Measuring Disparities

Information about disparities among select populations is shown in the Disparities Table (Figure 2). The population-based objectives and subobjectives are listed on the left side of the chart. The baseline data year is shown in parentheses and, when more recent data were available, the most recent data year is also shown.

Characteristics of the population (such as race, ethnicity, and gender) are depicted across the top of Figure 2. In general, characteristics applicable to each objective were designated in the original Healthy People 2010 document.^* Characteristics that were not designated for a particular objective or subobjective are heavily shaded. When a characteristic was not applicable for any of the objectives in a focus area, it is omitted from the table for that focus area. When data were not available for a particular population or for a particular characteristic, the corresponding boxes are lightly shaded (see the fourth section of the legend reproduced below). If there were no characteristic-specific data available for an objective, the objective is excluded from the table and referenced in a footnote.

Disparities are measured as the percent difference from the best group rate for each characteristic. For example, racial and ethnic disparities are measured as the percent difference between the best racial and ethnic group rate and each of the other racial and ethnic group rates. Gender disparities are measured as the percent difference between the better group rate (that is, male or female) and the rate for the other gender group.

The group with the best or most favorable rate is identified for each characteristic in the chart by a "B." In the few instances when two groups had identical best rates, both groups are identified by a "B." In some cases, the most favorable rate was not sufficiently reliable to be used as the best rate. In these situations, a small letter "b" is included in the cell, and the next most favorable group rate with sufficient reliability is identified with a "B" as the best group. When there was only one group with sufficiently reliable data, a best group is not identified for purposes of measuring disparity, and the cells for all groups with data are blank, indicating that disparities could not be assessed. These symbols are described in the legend that accompanies each of these figures (see below).

The best group rate at the most recent data point.		The group with the best rate for specified characteristic.		Most favorable group rate for specified characteristic, but reliability criterion not met.		Best group rate reliability criterion not met.
	Percent difference from the best group rate
Disparity from the best group rate at the most recent data point.		Less than 10 percent or not statistically significant		10-49 percent		50-99 percent		100 percent or more
			Increase in disparity (percentage points)
Changes in disparity over time are shown when the change is greater than or equal to 10 percentage points and statistically significant, or when the change is greater than or equal to 10 percentage points and estimates of variability were not available.				10-49		50-99		100 or more
			Decrease in disparity (percentage points)
				10-49		50-99		100 or more
Availability of data.		Data not available.		Characteristic not selected for this objective.

A color gradient is used to represent the size of the percent difference between each group rate and the best group rate at the most recent data point. In some cases, baseline data might be the only data available. The color gradient is shown in the second section of the legend.

When data were available for a data point more recent than the baseline, changes in disparity over time are measured by subtracting the percent difference at the baseline from the percent difference at the most recent data point. The change is expressed in percentage points; positive differences represent an increase in disparity, and negative differences represent a decrease in disparity.

When possible, a test of statistical significance was performed, and significant differences are indicated using the color gradient and arrows as shown in the legend. Otherwise, disparities at the most recent data point and changes in disparity are indicated by arrows based on the size of the change alone. Footnotes indicate whether statistical testing was performed.

Disparities are measured as the percent difference between the best group rate and other related group rates. When there are more than two groups associated with a population characteristic (for example, race and ethnicity, income, and education), a summary index provides a way to determine whether the disparity from the best group rate was increasing or decreasing on average. These comparisons are made only when data were available for exactly the same groups at the baseline and at the most recent data point. The statistical significance of disparity at the most recent data point and changes in the index over time are assessed when possible. The magnitude of disparity at the most recent data point and the magnitude and direction of changes are indicated by the color gradient and arrow symbols. More detail on measuring health disparities can be found in the Technical Appendix.

References

<< Previous—Executive Summary  |  Table of Contents