Modifications to Objectives and Subobjectives

The following discussion highlights the modifications, including changes, additions, and deletions, to this focus area's objectives and subobjectives as a result of the midcourse review.

Five developmental objectives became measurable, and subobjectives were added to all five to better reflect the available data: continuing education for public health personnel (23-10), performance standards for essential public health services (23-11), access to public health laboratory services (23-13), access to epidemiology services (23-14), and review and evaluation of public health laws (23-15).

Three subobjectives were added to continuing education for public health personnel (23-10) to monitor progress at the Tribal (23-10a), State (23-10b), and local (23-10c) levels. Subobjective 23-10a remained developmental; 23-10b and c became measurable.

The objective for performance standards for essential public health services (23-11) was changed to include four measurable subobjectives: State and local subobjectives on the number of public health systems using the National Public Health Performance Standards Program (23-11a and b) and the number of such systems that meet National Public Health Performance Standards (23-11c and d).

Access to public health laboratory services (23-13) was modified to reflect a new data source. Eleven measurable subobjectives related to different laboratory service fields, such as food safety (23-13e) and training and education (23-13j), were added.

Four subobjectives were added to access to epidemiology services (23-14). State epidemiologists with formal training in epidemiology (23-14a) became measurable. Subobjectives for increasing the number of public health agencies with comprehensive epidemiology services at the Tribal (23-14b), State (23-14c), and local (23-14d) levels remained developmental.

Two measurable subobjectives were added to model statutes related to review and evaluation of public health laws (23-15): using the Turning Point Model State Public Health Act (23-15a) and using the Model State Emergency Health Powers Act (23-15b), reflecting availability of a new data source.

Ten objectives were reworded: public access to information and surveillance data (23-2), use of geocoding in health data systems (23-3), competencies for public health workers (23-8), training in essential public health services (23-9), continuing education for public health personnel (23-10), performance standards for essential public health services (23-11), health improvement plans (23-12), access to public health laboratory services (23-13), review and evaluation of public health laws (23-15), and population-based prevention research (23-17).

Public access to information and surveillance data (23-2) and data for the Leading Health Indicators, the Health Status Indicators, and Priority Data Needs at Tribal, State, and local levels (23-5) were combined into objective 23-2. The wording of objective 23-2 was revised to "increase the proportion of Federal, Tribal, State, and local health agencies that have made information available for internal or external public use in the past year based on health indicators related to Healthy People 2010 objectives."

Use of geocoding in health data systems (23-3) was revised to include national but not State and local health data systems. The baseline was changed to 50 percent, and the target was set at 100 percent.

Subobjectives for competencies for public health workers (23-8) were added to reflect the Tribal and local, but not national, data available and to allow measurement of the extent to which the competencies have been incorporated into essential public health services. Furthermore, the wording was changed to incorporate competencies in the essential public health services into "job descriptions and performance evaluations" rather than "personnel systems." The revised language of competencies for public health workers (23-8) is "increase the proportion of Tribal and local agencies that incorporate core competencies in the essential public health services into job descriptions and performance evaluations."

Training in essential public health services (23-9) was modified to reflect competencies identified in 2001.^{1, 2, 3} The revised wording of the objective is "increase the proportion of Council on Education for Public Health (CEPH) accredited schools of public health, CEPH-accredited academic programs, and schools of nursing (with a public health or community health component) that integrate core competencies in the essential public health services into curricula."

Continuing education for public health personnel (23-10) was refocused to measure the proportion of agency personnel, rather than agencies, trained with continuing education, which includes the identified core competencies. The revised objective is "increase the proportion of Tribal, State, and local public health personnel who receive continuing education consistent with the core competencies in the essential public health services."

Health improvement plans (23-12) was modified to add a fourth subobjective to reflect a new data source. The new subobjective (23-12d) is "increase local jurisdictions that have linked health improvement plans to the State plans" and is developmental.

Population-based prevention research (23-17) was reworded to specify Tribal agencies, based on a new potential data source. The objective remained developmental.

As stated in Healthy People 2010: "Most developmental objectives have a potential data source with a reasonable expectation of data points by the year 2004 to facilitate setting 2010 targets in the mid-decade review. Developmental objectives with no baseline at the midcourse will be dropped." Accordingly, at the midcourse review some developmental objectives and subobjectives were deleted due to lack of a data source. However, the U.S. Department of Health and Human Services (HHS) and the agencies that serve as the leads for the Healthy People 2010 initiative will consider ways to ensure that these public health issues retain prominence despite their current lack of data.

Three objectives were deleted from the Public Health Infrastructure focus area due to a lack of a baseline: public health employee access to the Internet (23-1), data for the Leading Health Indicators, the Health Status Indicators, and Priority Data Needs at the Tribal, State, and local levels (23-5), and data on public health expenditures (23-16). As stated previously, parts of objective 23-5 were retained and incorporated into public access to information and surveillance data (23-2).

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