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 11-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

Data to assess progress toward the targets were available for two objectives. The objective for households with Internet access (11-1) moved toward its target. For satisfaction with health care providers' communication skills (11-6), all four of its subobjectives moved away from their targets. The remaining four objectives could not be assessed at the time of the midcourse review.

Objectives that met or exceeded their targets. No objective for this focus area met or exceeded its target.

Objectives that moved toward their targets. The objective for households with Internet access (11-1) illustrates the uneven diffusion of Internet technology in society, known as the "digital divide." More than 50 percent of the desired progress was achieved for this objective by the midcourse review. Between 1998 and 2003, the proportion of American households with Internet access increased from 26 percent to 55 percent, moving toward the target of 80 percent. Internet access is critical to disease prevention, health promotion, and health care because of the increasing amount of information and services available via the Internet. When Internet access is not universal, some segments of the population are excluded from knowing about and therefore using many new tools and information sources; the result is additional disparities.¹

Numerous organizations have been working to increase Internet access in households, including Federal, State, and local government agencies; foundations; nonprofit organizations; community-based organizations; schools; and technology companies.² Some of these organizations are focused not only on increasing Internet connections but also on providing meaningful access. Meaningful access encompasses all the factors that make an Internet connection valuable, such as basic computer literacy, technical support, and relevant content.

The diffusion of Internet access in households is influenced by multiple factors, many of which are not health related. First, rapid changes in technology continually raise the standards for the minimum level of service, for example, computers with faster processors or broadband instead of dial-up Internet access.¹ Some individuals are uncomfortable with computer technologies and express limited interest in the Internet as a channel of information. Certain segments of the population may have difficulty obtaining access to computer skills training on up-to-date equipment. The costs of hardware, software, and Internet connections can also be barriers to access for some populations. Further progress will require closer attention to overcoming the challenges mentioned above.²

Objectives that moved away from their targets. Patient satisfaction with health care providers' communication skills (11-6) was tracked through four subobjectives: patients' perception of their health care providers' skills in listening to them (11-6a), providing understandable explanations (11-6b), showing respect for them (11-6c), and spending enough time with them (11-6d). For each of these four subobjectives, the proportion of patients who rated their health providers positively moved away from the target by 1 to 2 percentage points between 2000 and 2001. Because these small declines occurred during a 1-year period, they may not be indicative of a trend.

Increased attention has been focused on providers' communication skills since the beginning of the decade. Professional societies promote clear communication between providers and patients.^{3, 4} The National Board of Medical Examiners has instituted a clinical skills exam that assesses doctors' communication skills as part of the U.S. Medical Licensing Examination.⁵ Within the U.S. Department of Health and Human Services (HHS), the Office of Minority Health (OMH) has developed and disseminated National Standards for Culturally and Linguistically Appropriate Services that can inform initiatives to improve communication between providers and patients from racially and ethnically diverse backgrounds.⁶ Some States, such as California⁷ and Maryland,⁸ are considering or have passed legislation directing health professional schools to provide training in cultural competency and/or health literacy skills. New Jersey now requires physicians to take cultural competency training as a condition of licensure.⁹ These efforts, in addition to efforts by many of the same organizations mentioned above to raise awareness about health literacy issues, may produce progress toward the targets by the next data-collection point.

Objectives that could not be assessed. Progress could not be evaluated for health literacy (11-2), research and evaluation of communication programs (11-3), quality of Internet health information sources (11-4), and Centers of Excellence in Health Communication (11-5). For health literacy improvement
(11-2), HHS has a partnership with the U.S. Department of Education to collect applicable health literacy data as part of the 2003 National Assessment of Adult Literacy. The objective on Centers of Excellence in Health Communication (11-5) became measurable in early 2004, and the baseline reflects the four Centers of Excellence in Cancer Communication Research supported by the National Cancer Institute within HHS. An additional data measure is anticipated by the end of the decade, using the expert opinion method, to allow progress to be assessed.

Baseline data and targets for the objectives to increase research and evaluation of health communication activities (11-3) and increase the disclosure of information to assess health websites (11-4) are anticipated by the end of the decade. One additional measurement is planned for these objectives by the end of the decade in order to assess progress.

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