Strategic Plan
By Sherry Glied, Assistant Secretary for Planning and Evaluation
Over the last few decades, the Nation has made substantial advancements in ensuring the public health, safety, and well-being of the American people, but there is still more to be done. The draft HHS Strategic Plan Fiscal Years 2010–2015 describes the steps we will take to achieve our mission to enhance the health and well-being of Americans, by providing for effective health and human services, and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services. The draft Strategic Plan describes our strategic goals, objectives, and strategies, as well as performance measures we will use to track our progress.
Tell us what you think about the draft Strategic Plan. Comment – and read what others are saying. The public comment period runs until August 14.
You can begin reading and commenting on the draft Strategic Plan’s goals and objectives now. There is an opportunity to comment on the objectives and strategies at the bottom of each objective page. You can also make general comments on the Plan here.
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Note: Finding how to offer comments on-line at the bottom of each page of the plan is a challenge. It would be very helpful to explain in detail how to obtain access to this function. I tried hard to get my comments below to you by yesterday's deadline - but was unable to break the code. Comment: The goals and objectives of the HHS 2010-2015 Strategic Plan are well-formulated and ambitious. While we welcome the opportunity to comment on the entire document, our main focus is Goal 5: Strengthen the Nation's Health and Human Service Infrastructure and Workforce. Much of the focus of this segment of the document is on the need to enhance and extend the primary care manpower pool. This is an important target - and must address carefully targeted inpatient utilization, thoughtful management of patient transitions between sites of care and reframing past approaches to the right care at the right time and in the right place, especially for patients and families with multiple chronic, complex illness, especially our growing population of elders. To facilitate the process of change, it will be important to identify current providers who have adopted effective approaches to the challenges outlined. As a discipline, palliative care is well-positioned to contribute to the strategic plan purposes identified. The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families regardless of the stage of their disease or the need for other therapies. It is operationalized through effective management of pain and other distressing symptoms while incorporating psycho-social and spiritual care with consideration of patient/family needs, preferences, values, beliefs and culture. Excellent pain and symptom management, collaboration within an interdisciplinary team, coordination with other providers and communication with patients, families and care partners characterize palliative care services. Recently recognized by the American Board of Medical Specialties (ABMS), Hospice and Palliative Medicine was sponsored by the following disciplines: Anesthesiology, Emergency Medicine, Obstetrics and Gynecology, Pediatrics, Physical Medicine and Rehabilitation, Psychiatry and Neurology, Radiology and Surgery - the most inclusive sponsorship of any discipline. When considering the health care needs of the future, it will be important to recognize the many contributions to be realized from palliative care providers. Further, the paucity of current funding for graduate education, training and fellowships for current and future providers must be remedied, especially for physicians, nurse practitioners and physicians' assistants - all of whom are already in short supply. Resources allocated for these purposes will directly address the patient care and workforce needs articulated in the HHS 2010 - 2015 Strategic Plan.
I am encouraged to see that HHS is working to implement evidence based strategies to strengthen families and improve outcomes for children, adults and communities in goal 3, objective A. As a community anti-drug coalition leader, I know how important this is. I am especially pleased that HHS plans to undertake a strategy with the goal of reducing risky behaviors among children and youth. I am disappointed though, that there is not an explicit and discrete focus on substance use/abuse prevention – especially given the host of negative consequences that are associated specifically with substance use/abuse. Generalized prevention programs help youth make good and healthy decisions. However, as children get older, there is also a need to focus specifically on the individual, peer, family and community risk factors explicitly related to the initiation and use of alcohol, illegal drugs and the misuse of prescription and over the counter drugs and products. In order to be effective, substance use/abuse prevention must build skills in youth, parents and communities to deal with substance use/abuse issues effectively; raise awareness about the costs and consequences of ATOD; change attitudes, perceptions and norms about ATOD; enforce consequences for alcohol and drug related offenses; and reduce access to and availability of ATOD. Effective, targeted substance abuse prevention is unique and must be explicitly addressed in the HHS strategic plan or it will be ignored and subject to denial.
I tried to add comments to the goals and objectives page but it seems to be gone so I am going to add them here. I oversee the Unified Prevention Coalition of Fairfax County. Our mission is to reduce alcohol and other drug abuse for youth in a county with over one million residents. Goal 3, Objective B Comments I am happy to see that HHS plans to execute a strategy in goal 3, objective B, to identify and address substance abuse early so that the likelihood of encountering more severe problems in the future is reduced. I strongly believe in the effectiveness of screening and brief intervention, but I also believe that in order to truly prevent substance use/abuse, we must stop use before it starts. In my experience at the school and community level, I have seen first hand that substance use/abuse impacts not only the individual, but also families, communities and the economy on multiple levels. I have also seen that the longer we can delay the age of initiation, the less likely it is that kids will ever become addicted. Furthermore, with the number of companies in my community and across the country that require pre-employment drug tests before they will hire someone, if we want our kids to grow up as healthy and productive adults who positively contribute to society, we need to ensure that they never start to use drugs in the first place. It is not enough to wait to intervene until after they have started using. Therefore, in addition to focusing on screening and brief intervention, I hope that the HHS strategic plan will also explicitly focus on preventing substance use/abuse before it ever starts. SAMHSA has clear evidence that Prevention Works. Goal 4, Objective C I am very happy to see that goal 4, objective C in the HHS strategic plan is to coordinate data collection and analysis of activities. In doing this, I hope that it will strengthen its data collection efforts as it relates to substance use/abuse and include an explicit mandate for all states to collect statewide survey data down to the local level for the core data set required to track drug trends, which includes: incidence, prevalence, age of onset, perception of harm, and perception of social disapproval of drug use (defined as underage drinking and the use of tobacco, illegal drugs and/or the misuse/abuse of over-the-counter and prescription medications and products). These drug trend data will provide national, state and local level health indicators as they relate to substance use/abuse that can be used in the Community Health Data Initiative and Data 2020. As a former recipient of funding from the State Grants portion of the Safe and Drug Free Schools and Communities program, I know first hand that if there is not such a requirement, most states and communities will lose their ability to track drug use, attitudes and trends over time and evaluate their progress. As a result, it will be increasingly difficult for HHS to capture this critical data and incorporate it into its new initiatives.
i would like to see breastfeeding supports and services included in hhs's goal#3 (objective A). as a pediatrician i understand that transforming the health of children requires a holistic approach and the use of numerous interdisciplinary services including the educational system, social services and the health care delivery system. one facet of the holistic approach to promoting early childhood health and development must include "tried-and-true" benefits of breastfeeding. world-renowned and respected organizations like the american academy of pediatrics (aap), american college of obstetrics and gynecology (acog), and world health organization (who), to name a few have long tauted the clear benefits of breastfeeding. simply put, it is an affordable, long-term health investment in the life of mother and baby.
The strategic plan is a needed step to improve the health of America. I am concerned that the plan does not address or work to reducing the harm of illegal drugs, underage consumption of alcohol, or the abuse of alcohol. Many of the problems that have been identified will be reduced by addressing alcohol and drug use. -Many states are losing more young adults to death from drug overdose than vehicle crashes. -Drug overdoses result in emergency room visits and hospital stays taking resources from other needs. -Underage drinking, illegal drugs, and the abuse of alcohol result in accidents, drownings, burn injuries from fires, and suicide. They reduce academic acheivement, limiting the future for our youth. Use results in AIDS, sexually transmitted diseases, and unwanted and/or underage pregnancy. -Long term use results in heart disease, stroke, liver disease, cancer, as well as other diseases, all of which are preventable. -In many communities more youth are smoking marijuana than than those smoking tobacco. The plan needs to address substance abuse prevention and build upon the resources There are proven strategies that are underutilized that can reduce healthcare costs. Our community anti-drug coalition has been effective in not only reducing drug use, especially among youth, but have saved healthcare costs. Our local hospital has realized that Drug-Free Noble County is effective and a low cost way to increase the public health. For that reaon, they are our largest contributor. Coalitions are able to identify new drug trends in the community that are detrtimental to the public health before statitstics can be complied and before the problem grows. A growing body of research shows the effectiveness of coalitions and has identified effective strategies. Addressing our nation's drug problem is "low hanging fruit" that has reap savings - in dollars and in lives. It is a pity that the plan of HHS ignores this strategy.
Overall, the broad goals and strategies laid out by Secretary Sebellius are commendable. I would like to see some of the evidence-based screenings and services mentioned in this strategy further delineated: "Ensure the delivery of recommended evidence-based preventive screenings and services with no copayment, through all public and private health plans." Too often, advocacy efforts with insurers rely on their intepretation of what CMS intends. It should be made clear exactly which services and screenings are to be provided (e.g., immunizations, EPSDT services, lactation support services and supplies, nutritional counseling). These examples are just a few that pertain to the field of pediatrics. In the current health care system, it is challenging for child healthcare providers to continue to provide expensive, newly developed and approved vaccines that may be life-saving with reimbursement rates for these vaccines and their administration lagging far behind the costs of purchasing, storing and administering them. The strategic plan should also contain a mechanism to ensure that primary care providers and specialists needed to provide such services (e.g., board-certified lactation consultants) are adequately reimbursed for such services by insurance providers.
I agree completely with the comments of Marsha Walker. Breastfeeding education and promotion of breastfeeding is essential for the health of our population. It impacts both the health of the mother and the infant on a short term and long term basis. Lactation consultants are in a unique position to help make this happen. We are already educated on lactation, we are already present in many communities, and we are enthusiastic to share our evidence based knowledge with the healthcare community and with breastfeeding families everywhere. Please don't forget the importance of including this valuable resource in your strategic planning!
The research on the loss of infants as well as the cost of children's health was recently published in Pediatrics that the low rates of breastfeeding in the U.S. come with a high price—911 lives and $13 billion annually. This does NOT take into account MATERNAL health as well as the physical difference that occurs in infant oral development and the psychological difference in developing a relationship based on the NORMAL give and take that occurs during a breastfeeding between a mother and her baby. Many mothers are deciding to breastfeed only to be told to stop breastfeeding by their health care providers because (a list of statements given to mothers of a support group last night): - your body retains fluids so you need to stop breastfeeding (8 month old) - babies HAVE to learn to sleep alone - stop breastfeeding (6 week old) - you cannot take medications so you must wean (1 year old) - babies don't need so much human milk, they can have formula - so stop pumping (4 month old) Without requirements imposed by the government, false and incorrect inforamtion will continue to be shared with families. PLEASE require that those who are in contact with breastfeeding mothers MUST be knowledgeable in evidence-based, research-supported information in order to protect the right of infants to human milk. Jeanette Panchula, RN, PHN, IBCLC
Where is the section regarding starting off with a great start by promoting and encouraging breastfeeding and making giving formula as bad an option as smoking and excessively drinking during pregnancy and early postpartum period?
CADCA commends HHS for its draft strategic plan and for recognizing the critical role that prevention plays in ensuring the overall health and wellness of this country. Alcohol abuse kills approximately 100,000 Americans every year, and is the third leading preventable cause of death in the United States (McGinnis, JM, Foege, WH, 1993). The estimated total cost of medical consequences (including hospital and ambulatory care, drug-exposed infants; tuberculosis; HIV/AIDS; Hepatitis B and C; crime victim health care costs; and health insurance administration) associated with drug abuse in the United States was $5.7 billion (ONDCP, 2001). Alcohol and drug addiction is a chronic disease for which there are effective community-based prevention and wellness programs, strategies and activities. When delivered in a comprehensive community-wide context, every dollar invested in these programs, strategies and activities has the potential to save up to $7 in areas such as substance abuse treatment and criminal justice system costs, not to mention the wider impact on the trajectory of young lives and their families and communities (NIDA, 2007). Therefore, while CADCA appreciates the emphasis that the HHS strategic plan places on general prevention efforts, it also urges HHS to recognize that explicit substance use/abuse prevention (defined as the prevention of underage drinking, tobacco, illegal drugs and/or the misuse/abuse of over-the-counter and prescription medications and products) programming and dedicated funding must be a major and discrete priority for federal emphasis and funding within the Department of HHS. The draft HHS strategic plan specifically addresses tobacco prevention, separate and apart from other behavioral health issues due to the unique set of risk factors, which include access, availability, norms and enforcement, associated with it. These same risk factors also apply to substance use/abuse prevention. Therefore, substance use/abuse prevention should be treated similarly in the strategic plan – with a separate and explicit focus – rather than being subsumed and homogenized with other behavioral health issues. Absent a separate and explicit focus, substance use/abuse will be subject to denial and usage rates will increase. An explicit focus on substance use/abuse is of critical importance now more than ever, especially given the fact that drug use is on the rise. Pride Surveys 2009 National Summary of Adolescent Alcohol and Drug Use shows small, but significant increases in 30-day prevalence for all drug categories in all grades 6 through 12. Additionally, according to the 2009 National Youth Risk Behavior Surveillance Survey, past 30 day use of marijuana among high school students increased at a rate of 5.6%, from 19.7% to 20.8% percent between 2007 and 2009. At the same time, attitudes about the dangers of drugs are softening. For example, according to the most recent Monitoring the Future (MTF) Survey, among 8th graders, fewer students believe that smoking marijuana occasionally and regularly is dangerous; among 10th graders, fewer students believe that smoking marijuana occasionally and regularly; trying ecstasy once, twice or occasionally; having five or more drinks one to two times in a weekend; and using smokeless tobacco regularly is dangerous; and among 12th graders, fewer students believe trying ecstasy once or twice is dangerous. It is therefore critical to sharpen the focus on substance abuse prevention efforts within HHS because research demonstrates that illegal drug use among youth increases as attitudes soften. We are already beginning to see theses increases, as past 30-day marijuana use among 10th and 12th graders has eclipsed that of tobacco and is equal to tobacco use among 8th graders; and 47% of high school seniors reported being drunk in the past 30 days (MTF, 2009). If an explicit and discrete focus on substance abuse prevention efforts is not maintained and enhanced, this trend will continue. Research has proven that the environmental and population based strategies used to reduce tobacco use have achieved success and are cost effective. Environmental and population based strategies are also implemented by the substance use/abuse prevention field, and must be maintained and enhanced. There is a critical need to focus specifically on the individual, peer, family and community risk factors explicitly related to the initiation/use and abuse of alcohol, illegal drugs and the misuse/abuse of prescription and over the counter drugs and products. In order to achieve population level ATOD outcomes, interventions need to occur throughout all sectors of states and communities, and deal with changes to laws, ordinances, policies and norms. The public health model, which involves data-based planning and targeted implementation in all community sectors with comprehensive strategies to change community environments and norms that lead to population level outcomes has been used broadly by the community-based substance abuse prevention field and has achieved documented results. The Drug Free Communities (DFC) program, which program focuses on implementing environmental strategies to ensure the entire community, rather than just a select number of individuals, is targeted with the implementation of comprehensive strategies across all community sectors to lower drug use and underage drinking; as well as the Community Based Coalition Enhancement Grants that are part of the Sober Truth on Preventing Underage Drinking (STOP) Act and are provided to current and former DFC coalitions to prevent and reduce underage drinking, embody this model. So too does the Strategic Prevention Framework (SPF), which defines and supports the roles, responsibilities, infrastructure and capacity needed at the state and sub-state levels to increase the number of youth who do not use alcohol, tobacco or drugs. The SPF provides states and communities with the tools they need to systematically ) assess their prevention needs based on epidemiological data; 2) build their prevention capacity; 3) develop a strategic plan; 4) implement effective community prevention programs, policies and practices; and 5) evaluate their efforts for outcomes. Due to the data driven, multi-sector, environmental strategies that grantees of each of these programs implement, they have achieved population level changes in drug use and underage drinking – often to levels lower than the national average. Similar to what it has done with tobacco use, our nation needs to make a substantial investment in ensuring that drug use rates decline by focusing on the unique risk factors associated with substance use/abuse. Absent federal attention and funding, this will not happen. The most cost effective way to do so is to build on the preexisting infrastructure of programs such as the DFC STOP Act, and SPF programs, rather than to create parallel programs with much too broad a focus.