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 12-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

Seven objectives and two subobjectives moved toward or met their targets, and one objective showed no change from its baseline. One objective and one subobjective moved away from their targets. Six objectives lacked data to assess progress.

Objectives that met or exceeded their targets. High blood cholesterol levels (12-14) met its target of 17 percent. In 1999–2002, 17 percent of persons 20 years of age and older had high total blood cholesterol levels (greater than or equal to 240 mg/dL), down from 21 percent in 1988–1994. Persons with substantially elevated cholesterol levels are candidates for clinical care, as recommended in the Adult Treatment Panel III (ATP III) guidelines for cholesterol management, and increased use of cholesterol-lowering medication is likely to have had a large role in attaining this objective. In addition, populationwide dietary changes have contributed to meeting the target.^{5, 6, 7}

Objectives that moved toward their targets. Of the 16 objectives in the Heart Disease and Stroke focus area, 6 moved toward or met their targets: CHD death rate (12-1), stroke death rate (12-7), high blood pressure (BP) control (12-10), action to help control BP (12-11), mean total blood cholesterol levels (12-13), and blood cholesterol screening (12-15). Two subobjectives moved toward their targets: heart failure hospitalization among persons aged 65 to 74 years (12-6a) and among persons aged 85 years and older (12-6c).

Between 1999 and 2002, the CHD death rate (12-1) dropped from 203 deaths per 100,000 population to 180 per 100,000 population, moving toward the target of 162 per 100,000 population. Improvements in modifiable risk factors among adults, including decreases in cigarette smoking, increases in BP control rates, decreases in high blood cholesterol levels and in mean total cholesterol levels, and increases in leisure-time physical activity have contributed to this progress. Several of these factors can also help to reduce heart failure hospitalizations for persons aged 65 to 74 years (12-6a), which achieved 13 percent of the targeted change, and for persons aged 85 years and older (12-6c), which achieved 9 percent of the targeted change.

Fifty percent of the targeted change in the stroke death rate (12-7) was achieved. The observed reduction in the stroke death rate could be explained by improved management of high BP and better use of anticoagulation therapies in individuals with atrial fibrillation.^{8, 9, 10, 11, 12} These conditions contribute significantly to increased risk of stroke.^{13, 14, 15, 16, 17}

Sixteen percent of the targeted change was achieved for controlled BP (12-10). Sixty-four percent of the targeted change was achieved for taking action to control BP (12-11). More Americans are now taking antihypertensive medications to control their BP, and lifestyle approaches have been encouraged through the application of Dietary Approaches to Stop Hypertension (DASH).¹⁸ These changes have resulted in significantly increased high BP control rates in both white non-Hispanic and black non-Hispanic populations.^{19, 20}

Many initiatives foster movement of these objectives toward their targets. For example, Prevent and Control High Blood Pressure: Mission Possible²¹ provides up-to-date facts about the impact of high BP on the Nation, as well as materials that can be used by community organizations, corporate wellness programs, health care providers, schools, civic and faith-based organizations, insurance companies, managed care organizations, and grocery store chains to combat high BP nationwide.

In addition, The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII)²² guidelines summarize the latest scientific findings that allow health practitioners to better prevent, diagnose, and treat elevated BP. JNC VII also has established the new category of prehypertension—to identify people at elevated risk for high blood pressure, but who are not yet hypertensive—in order to encourage them to change their lifestyles before vascular disease occurs.²²

Forty-three percent of the targeted change for mean total blood cholesterol level in persons aged 20 years and older (12-13) was achieved. This progress occurred in the face of an increased rate of obesity, which would tend to raise blood cholesterol levels.^{23, 24} Several major influences have contributed to the decline in the mean total cholesterol level of the population. Increased use of cholesterol-lowering medication has likely played a major role, and populationwide dietary changes have also contributed to the decline in the mean total cholesterol level of the population.^{5, 20}

Forty-six percent of the targeted change for blood cholesterol screening within the past 5 years (12-15) was achieved. Several factors have played a role in increasing public awareness of the need to have cholesterol levels checked. For instance, participating organizations of NCEP⁵ educate health professionals and the public about the importance of cholesterol testing to help determine an individual's risk for CHD. Public awareness has further been increased through publicizing the results of cholesterol-lowering clinical trials, which have shown the benefits of lowering an elevated cholesterol level, and media attention to cholesterol issues.^{5, 25, 26, 27}

Objectives that demonstrated no change. One objective remained static. Between 1998 and 2003, BP monitoring in persons aged 18 years and older with high BP (12-12) remained constant at 90 percent.

Objectives that moved away from their targets. Heart failure hospitalizations for persons aged 75 to 84 years (12-6b) and the proportion of persons aged 20 years and older with high BP (12-9) moved away from their targets. Possible reasons for the increase in high BP include an increase in obesity.^{5, 24}

Objectives that could not be assessed. Baseline data became available to measure knowledge of heart attack symptoms and the importance of calling 9-1-1 (12-2), receipt of artery-opening therapy (12-3a), use of percutaneous intervention within 90 minutes (12-3b), CPR training (12-4), and knowledge of the early warning signs of stroke (12-8). These objectives were developmental at the beginning of the decade. Followup data to assess progress toward the targets are anticipated before the end of the decade. Two objectives remain developmental: out-of-hospital care for cardiac arrest (12-5) and LDL cholesterol levels in CHD patients (12-16).

<<  Previous—Modifications to Objectives and Subobjectives   |   Table of Contents  |  Next—Progress Toward Elimination of Health Disparities  >>