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Strategic Goal 3: Advance the Health, Safety, and Well-Being of the American People

Objective A:  Promote the safety, well-being, resilience, and healthy development of children and youth

Objective B:  Promote economic and social well-being for individuals, families, and communities

Objective C:  Improve the accessibility and quality of supportive services for people with disabilities and older adults

Objective D:  Promote prevention and wellness across the life span

Objective E:  Reduce the occurrence of infectious diseases

Objective F:  Protect Americans’ health and safety during emergencies, and foster resilience to withstand and respond to emergencies

Poverty, teen pregnancy, family disruptions, substance abuse, mental illness, limited health or financial literacy, violence, and trauma continue to be pervasive, harmful, and costly public health and social problems in the United States.  Extended periods of unemployment or disability can increase Americans’ need for safety net services.  As the U.S. population ages, increasing numbers of older adults are experiencing extended periods of frailty, affecting their ability to stay active and healthy and to live in the setting of their choice.  Naturally occurring and man-made disasters threaten Americans’ health, safety, and well-being.  In addition, protecting public health requires international cooperation on a host of issues, including ensuring the safety of imported products and combating global outbreaks of disease and illness.

HHS programs are addressing the unique needs of vulnerable populations through improved program coordination within HHS and across government agencies, through policy development, evidence-based practice, and research.

HHS invests in evaluations to understand the impacts of these programs on health, safety, and well-being across the life span.  These activities include an evaluation of interventions to prevent the maltreatment of older adults, an extensive examination of prevention efforts that focus on tobacco and obesity, and continuing work to monitor the effectiveness of the Head Start and Early Head Start programs.  Other efforts include assessing states’ progress and effectiveness in using evidence-based programs, policies, and practices to prevent substance abuse and mental illness; strengthening the surveillance infrastructure for children’s mental health programs; and encouraging child care settings to improve opportunities for physical activity and healthy food options.  HHS also is working to expand the evidence base on national health security and is setting priorities for research, evaluation, and quality improvement to improve public health and medical emergency preparedness, response, and recovery efforts.

Underlying each objective in this goal is a focus on prevention and preparedness — to support health, safety, and well-being across the life span; to strengthen communities; to mitigate the impacts of chronic and infectious disease; and to build capacity to respond to — and be resilient in the face of — emergencies.

Within HHS, the Administration for Children and Families (ACF), Administration for Community Living (ACL), Agency for Healthcare Research and Quality (AHRQ), Office of the Assistant Secretary for Planning and Evaluation (ASPE), Office of the Assistant Secretary for Preparedness and Response (ASPR), Centers for Medicare & Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), Health Resources and Services Administration (HRSA), Indian Health Service (IHS), National Institutes of Health (NIH), Office of the Assistant Secretary for Health (OASH), Office for Civil Rights (OCR), Office of Global Affairs (OGA), and Substance Abuse and Mental Health Services Administration (SAMHSA) are working, together and with other federal departments and agencies, to advance Americans’ health, safety, and well-being.

 

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Objective A:  Promote the safety, well-being, resilience, and healthy development of children and youth

Children and youth represented approximately 24% of the U.S. population in 2011, and they depend on the adults in their lives to keep them safe and to help them achieve their full potential.  Yet too many of our young people — our nation’s future parents, workforce, and leaders — are at risk of poor outcomes, including low educational attainment, teen pregnancy, poor health, violence, lack of labor market success, and premature death.

HHS collaborates with state, local, tribal, urban Indian, nongovernmental, and private sector partners to sustain an essential safety net of services that protect children and youth, promote their emotional health and resilience in the face of adversity or trauma, and ensure their healthy development from birth through the transition to adulthood.  Health and early intervention services such as home visiting programs ensure children get off to a good start from infancy.  Early childhood programs, including Head Start, Early Head Start, home visiting, and child care subsidy programs, support healthy child development, foster school readiness, and support working parents struggling to make ends meet.  The Administration is focusing on increasing access to high-quality early learning programs and services for children from low-income or disadvantaged families through the continued investment in these programs and the partnership with the U.S. Department of Education for the Race to the Top-Early Learning Challenge.

Child welfare services, including child abuse prevention activities, foster care, adoption assistance, and new assisted guardianship programs, work with families in which there are safety or neglect concerns, helping children and youth find safe, permanent homes.  To focus on social and emotional well-being is to attend to children’s behavioral, social, and emotional functioning — those skills, capacities, and characteristics that enable young people to understand and navigate their world in healthy and positive ways.  Services for mental and substance use disorders provide support for those with behavioral health care needs.  In each of these service sectors, incorporation of an evidence-based, trauma-informed service array is essential in order to achieve positive outcomes for these children and families.

Several programs across agencies also promote positive youth development and seek to prevent risky behaviors in youth.  Other key programs provide for research, training, and supports that enhance the lives of children and youth with disabilities, and their families.  These programs include interdisciplinary training to professionals on cutting-edge approaches to serving children with autism or support for postsecondary education opportunities for youth with developmental disabilities.  HHS partners with the U.S. Departments of Labor and Education and the Social Security Administration through the Federal Partners in Transition Interagency Workgroup to improve the transition to adulthood for youth with disabilities.  HHS also chairs the Interagency Working Group on Youth Programs, which brings together 12 federal departments and agencies to improve the coordination, effectiveness, and efficiency of youth-serving programs and to promote effective community-based efforts to reduce the factors that put youth at risk.

Vital research funded by agencies across HHS seeks to understand the risks to children’s safety, health, and well-being and to build evidence about effective interventions to mitigate these risks.  HHS tracks data on youth risk behaviors including dietary and physical activity habits, tobacco, alcohol, and other drug use, unprotected sexual activity, and injuries and violent deaths among children and youth.  HHS agencies collaborate to support the efficacy and effectiveness trials of child abuse and neglect interventions; the promotion of healthy behaviors and interventions to reduce childhood obesity; a review of the evidence base on teen pregnancy prevention to identify curriculum-based and youth development program models that reduce teen pregnancy and other behavioral risk factors; and a review of the evidence-base on home visiting program models to identify effective programs for mothers and children from birth to age 5.

In addition, HHS is working to improve the quality of human services through efforts to strengthen the nation’s human service workforce.  HHS provides training and technical assistance; uses data, monitoring, and evaluation efforts strategically; collaborates with other agencies; and promotes the adoption of evidence-based practices, as described earlier in the Plan.

Within HHS, ACF, ACL, CDC, HRSA, NIH, OASH, and SAMHSA will have roles in implementing the following strategies to achieve this objective.

Strategies

  • Enhance young children’s healthy growth, development, and identity formation through high-quality early care and education and evidence-based home visiting programs;
  • Promote school readiness and healthy child development through high-quality early education programs that utilize the best evidence-based practice;
  • Build the capacity of staff in local Head Start and Early Head Start programs to deliver high-quality, evidence-based services to children and families, and work with states to develop systems for training and ongoing professional development of early childhood educators;
  • Support parents, extended families, and communities to provide children with safe and stable homes and home environments, and help find permanent families for children whose birth parents cannot care for them safely;
  • Support the safety, well-being, and healthy development of children and youth, including children and youth who have been maltreated, who have disabilities, who are integrating into U.S. society, and who are experiencing homelessness, including lesbian, gay, bisexual, and transgender (LGBT) youth and other vulnerable populations;
  • Improve the early identification of developmental delays and disorders in early childhood, and increase access to evidence-based resources for children with or at risk for developmental delays and disorders;
  • Promote cultural competency training for social service providers in the unique needs and experiences of LGBT youth, especially youth in foster care, youth experiencing homelessness, youth in juvenile detention, and youth in congregate living facilities related to mental health and substance abuse issues;
  • Invest in research and rigorous evaluation of innovative public health strategies to promote child development and prevent developmental delays among children in poverty;
  • Support program development, research, and training that enhance the lives of children and youth with developmental and intellectual disabilities, and their families, such as demonstrating emerging and promising behavioral supports and practices in schools, providing interdisciplinary training to professionals on cutting-edge approaches to serving children with autism, or supporting postsecondary education opportunities for youth with developmental disabilities;
  • Encourage healthy behaviors and reduce risky behaviors among children and youth, and equip young people with the skills to make reasonable decisions about their health and well-being;
  • Implement evidence-based, evidence-informed, and medically accurate strategies, and test innovative approaches to reduce teen pregnancy and other associated sexual risk behaviors, decrease rates of sexually transmitted infections such as HIV, and reduce tobacco use, underage drinking, and drug use, including prescription drug abuse;
  • Provide evidence-based materials and information to families, schools, community-based organizations, and health care providers on how to develop healthy relationships, to promote an understanding of healthy relationships and human sexuality;
  • Promote strategies to keep children safe from unintentional medication overdoses;
  • Encourage access to drinking water and healthy, affordable foods in schools and communities, and increase physical activity among youth;
  • Disseminate information and provide technical assistance to promote understanding of the impact of trauma and toxic stress on brain development and subsequent physical, mental, and emotional health consequences, and utilization of screening and assessment to match needs to appropriate trauma interventions and trauma-informed strategies; and
  • Engage in research to expand the evidence base of effective trauma interventions and trauma-informed care, and implement evidence-based strategies to reduce the exposure to, build resilience to, and lessen the negative impact of violence and trauma on children, families, and communities.

Performance Goals

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Objective B:  Promote economic and social well-being for individuals, families, and communities

Strong individuals, families, and communities are the building blocks for a strong America.  Promoting economic and social well-being requires attention to a complex set of factors, through the collaborative efforts of agencies, policymakers, researchers, providers, community leaders, and service recipients.  With its partners, HHS is working to provide a path of opportunity to help families leave poverty and enter the middle class and to revitalize communities to become engines for economic growth and opportunity.

In 2012, 46.5 million Americans lived in poverty.  Some lack the skills needed to obtain good jobs, need supportive services to get or retain jobs, experience unstable family situations or unstable housing arrangements, or live in unsafe, unhealthy communities.  Distressed communities and poverty can reduce the social ties of residents.  Lack of employment opportunities and low levels of academic achievement can lead to juvenile delinquency, substance abuse, and criminal activity — major drivers of community violence and family disruption.  Unstable or violent couple relationships, lack of involvement by fathers, and disconnection from strong, supportive social networks increase the vulnerability of both adults and children and weaken communities.

HHS promotes economic and social well-being of families, children, and youth through income support,  financial education, job training and work activities, child support and paternity establishment,  relationship skill-building for couples and co-parents, support for individuals experiencing domestic violence, elder abuse and other forms of family violence, and assistance in paying for child care.  State Temporary Assistance for Needy Families (TANF) programs provide critical income assistance to some of the nation’s poorest families, while helping mothers and fathers prepare for and secure employment.  Child support programs ensure that noncustodial parents meet their financial obligations to their children, and such programs provide a substantial share of resources for families.  Supportive assistance to populations at risk includes assisting individuals experiencing homelessness in finding and keeping safe housing, enhancing the independence of nursing home residents, and connecting refugees and immigrants to mainstream resources.  HHS works to ensure that services are within reach of even the most vulnerable individuals and families and that each state program is accessible to all, regardless of race, color, national origin, or disability.

HHS agencies work together and collaborate across federal departments to maximize the potential benefits of various programs, services, and policies designed to improve the social and economic well-being of individuals, families, and communities.  HHS and the U.S. Department of Labor are developing strategies to integrate and enhance skills development opportunities to help low-income individuals enter and succeed in the workforce.  HHS collaborates with the U.S. Department of Agriculture to expand access to nutritional supports for low-income youth and families.  HHS works closely with the U.S. Department of Housing and Urban Development to integrate the nation’s housing, health, and human services delivery system, with particular emphasis on housing and homelessness, home- and community based services, community living, and environmentally safe and livable homes and communities.  HHS coordinates efforts with the U.S. Departments of Veterans Affairs and Justice to improve outcomes for ex-offenders and their families, including specialized approaches for fathers and veterans.

Within HHS, ACF, ACL, CDC, and SAMHSA will have roles in implementing the following strategies to achieve this objective.

Strategies

  • Advance individual and family economic security to reduce poverty;
  • Promote access to, and support employment in, quality jobs that provide a livable wage for individuals and families, especially those receiving assistance, and promote success in those jobs by connecting individuals with training and educational opportunities;
  • Provide supportive services, including health and behavioral health services and supports, and wraparound services like employment, housing, caregiver support, and peer recovery supports, to reduce and eliminate barriers to community living for vulnerable populations, including individuals with disabilities, older adults, the lesbian, gay, bisexual, and transgender (LGBT) community, refugees and immigrants, and individuals at risk for homelessness;
  • Help economically distressed communities to access federal programs and resources to address behavioral health needs;
  • Build and strengthen partnerships with federal, state, local, tribal, urban Indian organizations, and other nongovernmental stakeholders to promote culturally appropriate individual, family, and community well-being for vulnerable populations;
  • Provide legal supports, training, and advocacy support to individuals with disabilities and older adults to help protect them from all forms of abuse, including physical, mental, emotional, and financial abuse, and help ensure their ability to exercise their rights to make choices, contribute to society, and live independently;
  • Foster community partnerships with faith-based and community organizations to improve opportunities and delivery of services;
  • Advance applied research in supported employment, self-determination skills development, early intervention, and prevention for individuals with intellectual and developmental disabilities and their families;
  • Provide online and technological resources to help refugees, other immigrant populations, and service providers connect with mainstream resources to achieve self-sufficiency;
  • Identify and address substance abuse, mental illness, domestic violence, elder abuse, family violence, and trauma history early, to prevent more severe problems in the future;
  • Encourage responsible fatherhood, healthy relationships, parental responsibility, and family stability;
  • Promote and support the use of volunteers in areas such as nutrition and transportation;
  • Promote recruitment and retention strategies that attract qualified, competent, and diverse professionals to the human service workforce; and
  • Promote training including cross-system training, continuing education, and technical assistance for human service personnel to help them develop core competencies.

Performance Goals

  • Increase the recipiency targeting index score for Low Income Home Energy Assistance Program (LIHEAP) households having at least one member 60 years or older.
  • Increase the recipiency targeting index score for LIHEAP households having at least one member 5 years or younger.
  • Increase the percentage of Family Violence Prevention and Services Act state subgrant-funded domestic violence program clients who report improved knowledge of safety planning.
  • Increase the percentage of refugees who are not dependent on any cash assistance within the first six months (180 days) after arrival.
  • Increase the percentage of refugees entering employment through ACF-funded refugee employment services.
  • Maintain the Title IV-D (child support) collection rate for current support.
  • Increase the percentage of newly employed adult TANF recipients.
  • Increase the number of caregivers served through the National Family Caregiver Support Program.
  • Increase the percentage of homeless clients receiving services who were currently employed or engaged in productive activities.
  • Increase the percentage of homeless clients receiving services who had a permanent place to live in the community.

 

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Objective C:  Improve the accessibility and quality of supportive services for people with disabilities and older adults

Currently, while comprising only 27 percent of Medicaid enrollees, the elderly and individuals with disabilities account for an estimated 64 percent of all program spendingSite disclaimer icon.  According to Census Bureau projections, the older population of the nation will double in size by 2050, while also becoming more racially and ethnically diverse.  Alzheimer’s disease and related dementias affect as many as 5 million people and nearly 40 percent of the population aged 85 and older; the number of older Americans with Alzheimer’s disease and related dementias is projected to grow to 13.2 million by 2050.

Over the past decade, policy reforms and initiatives have improved the effectiveness of efforts to promote home- and community-based services and to decrease unnecessary reliance on institutional care.  The Supreme Court’s landmark 1999 Olmstead ruling requires states to place qualified individuals with disabilities in community settings — whenever such placements are appropriate, the person does not oppose such placement, and the state can reasonably accommodate the placement.  The Americans with Disabilities Act (P.L. 101-336) “integration regulation” requires that individuals with disabilities receive services in the most integrated setting appropriate to their needs, consistent with the Supreme Court’s decision in Olmstead. HHS collaborates with the U.S. Department of Justice to advance civil rights enforcement of the Americans with Disabilities Act and the Olmstead decision.

HHS is working to improve access to, reduce the financial cost of, and enhance the quality of long-term services and supports for older adults and people with disabilities.  HHS works to ensure that individuals with disabilities and their families have access to culturally competent services and supports that promote independence, productivity, integration, and inclusion in the community.  HHS will work to scale and sustain evidence-based health programs for older adults and persons with disabilities.  These programs foster self-management and reduce the symptoms and consequences of multiple chronic conditions Site disclaimer icon and are delivered effectively in community settings.  Some of these programs have the potential to reduce health care costs.  HHS also funds various programs and projects to assist family caregivers.

HHS provides a range of long-term services and supports for seniors and people with disabilities, including child care, education, transitional services, health care, employment, transportation, supportive services, nutrition services, preventive health services, supportive services to family caregivers, elder abuse and violence prevention, consumer rights and protection services, nutrition and supportive services, and a national toll-free telephone service that helps callers find senior services in their communities throughout the country.  Other programs also work to promote health equity, promote equal treatment for LGBT older adults and people with disabilities, improve the accessibility of resources and the quality of life for individuals with disabilities, increase the use of preventive services, build emergency preparedness planning, and conduct state-level surveillance and monitoring activities for people with disabilities.  Aging and disability resource centers provide a single point-of-entry to state long-term services and supports and nursing home diversion programs to give consumers a greater role in determining the types of services they receive and the manner in which they receive them.

An efficient long-term services and supports system cannot exist without a workforce to care for the population in need. A direct care labor force that is well-trained to address the needs of older adults and persons with disabilities, including individuals with Alzheimer’s disease, is in high demand.  Under the Affordable Care Act, HHS is improving direct care worker training and competencies, encouraging career pathways for existing workers, and providing funding for a nationwide program for national and state background checks on long-term services and supports employees.

HHS is working to strengthen long-term services and supports through research, examining residential care models to understand the changing dynamics of publicly financed long-term services and supports, and studying administrative data to produce representative national and state estimates of the supply, use, and characteristics of this population.

Within HHS, ACL, AHRQ, ASPE, CDC, CMS, OCR, OASH, and SAMHSA will have roles in implementing the following strategies to achieve this objective.

Strategies

  • Collaborate across systems to improve access for individuals with disabilities across the life span to a full complement of inclusive, integrated services and supports;
  • Leverage public and private resources to enhance home- and community-based services for older individuals, persons with disabilities, and their caregivers, as well as supports for elder justice systems for the protection of the rights of vulnerable individuals, and prevention of abuse, neglect, and exploitation of older adults and individuals with disabilities;
  • Assist state, tribal, and local programs in designing and implementing improvements to community-based support systems that enable people with disabilities, older adults, and others with long-term illnesses to live and participate in the community, including improving the coordination of physical and behavioral health services;
  • In partnership with state and local health departments, implement public health actions to address cognitive health and cognitive impairment for individuals and their care partners;
  • Encourage and support efforts to include people with disabilities and older adults in human services planning and implementation efforts, such as the planning and delivery of coordinated transportation services, to improve access to employment, health care services, and participation in the community;
  • Work closely with states, territories, tribes, tribal organizations, urban Indian organizations, and other programs to explore flexibilities in the Medicaid program through specific demonstration projects, grant programs, incentives programs, other Medicaid programmatic and funding mechanisms, and policy changes;
  • Provide technical assistance to tribes in the development of long-term services and supports for elders and persons with disabilities across the life span;
  • Expand options to help consumers prevent and delay the need for institutionalization, including integrating acute, behavioral health, and long-term services and supports to enable home- and community-based services to be more effective at preventing and delaying the need for institutionalization;
  • In partnership with states, implement programs and policies that help states balance their Medicaid long-term service delivery systems by expanding access to an array of home- and community-based services and by reducing dependence on institutional care;
  • Improve the delivery of community living services in a more uniform, efficient way by strengthening the reach and effectiveness of state “no wrong door” systems and increasing the quality and scope of existing systems that serve people with disabilities and older adults, including individuals with Alzheimer’s disease;
  • Enhance coordination to improve services for individuals enrolled in both Medicare and Medicaid, including individuals with chronic conditions and functional impairments;
  • Develop options for housing combined with services to enhance aging in place for older adults, and promote the coordination of housing assistance, health care, and supportive services to assist chronically homeless individuals and families with special needs;
  • Enhance the choice and independence of residents of nursing homes, board and care homes, assisted-living facilities, and similar adult care facilities through ombudsman services and supports;
  • Support access to accessible and affordable transportation options;
  • Expand access to supports for family caregivers to maximize the health and well-being of the caregivers and the people for whom they provide care;
  • Work to identify how to prevent Alzheimer’s disease and related dementias and to address the challenges faced by people with these conditions and their caregivers;
  • Promote access to plain language, accessible health information for individuals with disabilities and their caregivers;
  • Devise culturally appropriate prevention and intervention strategies for abuse, neglect, and exploitation of older adults and individuals with disabilities in community, clinical, and long-term care settings; and
  • Enforce federal laws prohibiting discrimination on the basis of disability that require individuals with disabilities to receive services in the most integrated setting appropriate to their needs, consistent with the Supreme Court’s decision in Olmstead, and improve coordination with the U.S. Department of Housing and Urban Development regarding Olmstead matters.

Performance Goals

  • Reduce the percentage of caregivers who participate in the National Family Caregiver Support Program who report difficulty in obtaining services.
  • Increase the percentage of older persons with severe disabilities who receive home-delivered meals.
  • Maintain at 90% or higher the percentage of clients receiving home-delivered meals who rate services good to excellent.
  • Maintain at 90% or higher the percentage of clients receiving transportation services who rate services good to excellent.
  • Maintain at 90% or higher the percentage of clients receiving Family Caregiver Support Services who rate services good to excellent.
  • Increase the number of Projects for Assistance in Transition from Homelessness (PATH) providers trained on Supplemental Security Income/Social Security Disability Insurance (SSI/SSDI) Outreach, Access, and Recovery (SOAR) to ensure eligible homeless clients are receiving benefits.
  • Increase the percentage of complaints of alleged abuse, neglect, and rights violations substantiated and not withdrawn by the client that resulted in positive change through the restoration of client rights, expansion or maintenance of personal decision-making, and elimination of other barriers to personal decision-making, as a result of Protection and Advocacy for Individuals with Mental Illness (PAIMI) service involvement.

 

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Objective D:  Promote prevention and wellness across the life span

With an average life span of about 78 years, the average American can only expect to live in good health for about 69 of them.  Chronic illnesses cause Americans to miss a collective 2.5 billion days of work each year, totaling about $1 trillion in lost productivity. Nationally, about 30 percent of all deaths are caused by heart disease and stroke.

HHS works to promote prevention and wellness across its programs and agencies by addressing chronic diseases and related risk factors, including tobacco use, harmful alcohol use, unhealthy diet, and physical inactivity through population and community health activities.  HHS also works to support state, local, and tribal public health agencies; promote health through education and self-management; and conduct outreach to vulnerable populations.  HHS works with its partners to educate and empower individuals and families to lead healthy lifestyles and to adopt behaviors that can prevent or delay chronic disease, disability, and secondary conditions, increasing quality of life and reducing the need for more costly medical interventions. 

HHS’s focus continues to align with the National Prevention Strategy, an interdepartmental effort required by the Affordable Care Act, which aims to encourage the federal government, states, and localities to create environments that promote healthy conditions and combat the behaviors that result in the most deaths, disability, and costs.  Efforts like implementing the National Prevention Strategy enable HHS to do more to create healthy communities; raise awareness about, and increase adoption of, prevention strategies; promote services for pregnant women; and strengthen our nation’s public health infrastructure to support these efforts.

Within HHS, ACF, ACL, AHRQ, CDC, FDA, HRSA, IHS, NIH, OASH, and SAMHSA will have roles in implementing the following key strategies to achieve this objective.

Strategies

  • Monitor Healthy People 2020, the nation’s health objectives for the next decade, and promote achievement of the objectives through networks of federal, state, local, and tribal partners.
  • Implement the National Prevention Strategy Site disclaimer icon to improve the health and quality of life for individuals, families, and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness;
  • Implement comprehensive, sustained, and evidence-based tobacco control efforts aligned with the Tobacco Control Strategic Action Plan Site disclaimer icon;
  • Increase access and coverage for important evidence-based preventive services, including chronic disease screenings, behavioral health screenings, adult immunizations, well-woman visits, human papillomavirus DNA testing for women 30 years and older, sexually transmitted infection counseling, HIV screening and counseling, viral hepatitis screening, cancer screening, genetic counseling and testing, and FDA-approved contraception and contraceptive counseling;
  • Prevent substance abuse, binge and underage drinking, illegal drug use, and abuse of over-the-counter and prescription medications, using evidence-based strategies, such as those recommended by the U.S. Preventive Services Task Force, the Community Preventive Services Task Force, and the National Registry of Evidence-based Programs and Practices;
  • Prevent 1 million heart attacks and strokes by aligning public and private initiatives across the United States; emphasizing cardiovascular health for patients, providers, communities, and other stakeholders; improving performance on the ABCS — aspirin when appropriate, blood pressure control, cholesterol management, and smoking cessation — and improving clinical performance;
  • Help people with chronic conditions, including those with multiple chronic conditions, manage their symptoms (“self-management”);
  • Increase access of families and communities to injury prevention information, model programs, and other resources;
  • Prevent mental illness and foster resilience, with a special focus on at-risk populations;
  • Help American children and adults achieve and maintain healthy weight, focusing on where they live, work, learn, play, and worship;
  • Educate and empower Americans to adopt regular physical activity and good nutrition through policies and programs that support the recommendations of the Dietary Guidelines for Americans and Physical Activity Guidelines for Americans, reducing the risk of chronic disease, falls, and obesity;
  • Through the Environmental Justice Strategy, build healthy and resilient communities, reduce disparities in health and well-being associated with environmental factors, identify and address disproportionately high and adverse human health and environmental effects on minority and low-income populations and American Indians and Alaska Natives, and encourage the fair treatment and meaningful involvement of affected parties;
  • Promote effective community and building design strategies for promoting physical activity and reducing exposures to environmental health threats;
  • Promote effective community strategies for preventing tooth decay, including school-based dental sealant programs and community water fluoridation;
  • Promote and implement effective community strategies for preventing vision loss and blindness among persons with the greatest risk, including children, older adults, and minorities, through public education and awareness, community- and school-based vision screening and referral to eye care programs, and other public health interventions;
  • Support breastfeeding and remove barriers that hinder women who choose to breastfeed, working with hospitals, communities, clinicians, and employers;
  • Implement prevention policies, programming, and interventions to prevent and respond to individuals, families, and communities impacted by domestic violence, elder abuse, suicide, and other forms of violence and trauma;
  • Leverage community-based prevention efforts to reduce chronic disease and health disparities, such as the Community Transformation Grants, to expand the evidence-base and knowledge about what works;
  • Disseminate public health research and practice through Public Health Reports to improve public health practice in communities;
  • Promote healthfinder.gov and its collection of prevention and wellness information and tools;
  • Expand and sustain successes achieved in prevention and public health through the Prevention and Public Health Fund;
  • Incorporate culturally competent materials and strategies into all efforts to educate and empower individuals and families to lead healthy lifestyles; and
  • Adopt meaningful clinical quality measures that are consistent with national initiatives to assess the appropriate use of evidence-based clinical preventive services to improve the delivery of care.

Performance Goals

  • Increase the percentage of Early Head Start children completing all medical screenings.
  • Reduce the proportion of adults (aged 18 and over) who are current cigarette smokers.
  • Reduce the proportion of adolescents (grades 9 through 12) who are current cigarette smokers.
  • Increase the total number of tobacco compliance check inspections of retail establishments in States under contract.
  • Increase the number of American Indian and Alaska Native patients, 22 and older, with coronary heart disease who are assessed for five cardiovascular disease risk factors.
  • Increase the number of calls answered by the suicide hotline.
  • Increase the percentage of adults with severe mental illness receiving homeless support services who report positive functioning at six-month follow-up.
  • Reduce the annual adult combustible tobacco consumption in the United States (cigarette equivalents per capita)
  • Increase the number of individuals referred to mental health or related services.
  • Statin therapy for the prevention and treatment of cardiovascular disease among American Indians and Alaska Natives.

Related Topics

 

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Objective E:  Reduce the occurrence of infectious diseases

Because microbes continually evolve, adapt, and develop resistance to drugs over time, infectious diseases remain a significant health threat in the United States and around the world.  Infectious diseases include, but are not limited to, vaccine-preventable diseases; foodborne illnesses; HIV and AIDS and associated sexually transmitted infections; hepatitis A, B, and C; tuberculosis; infections acquired in health care settings, such as methicillin-resistant staphylococcus aureus (MRSA); threats to health security such as novel influenza viruses and bioterrorism agents; fungal infections; waterborne diseases; and infections transmitted by animals and insects.  Rapid global travel, importation of foods, and changing demographics have increased the ability of these infectious agents to spread quickly.  The 2009 H1N1 influenza pandemic exemplifies the speed at which an infectious agent can spread from one location to nearly every corner of the globe.

HHS coordinates and ensures collaboration among the many federal agencies involved in vaccine and immunization activities.  The National Vaccine Plan provides a framework for pursuing the prevention of infectious diseases through immunizations and articulates priority actions for a number of HHS operating and staff divisions.  To fulfill its responsibility for reducing the occurrence and spread of infectious diseases in the U.S. population, HHS provides significant support to state and local governments; works to strengthen infectious disease surveillance, diagnosis, and treatment; and collaborates with federal and international partners to reduce the burden of infectious diseases throughout the world.  Basic and applied research, a critical element of the National Vaccine Plan and a priority for HHS, underpins the science behind products and supports our understanding and development of control measures against a wide array of infectious agents.

HHS also supports programs to reduce HIV, hepatitis, and other infectious diseases associated with substance abuse.  HHS is responsible for overseeing the coordination of the National HIV/AIDS Strategy and the Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis Site disclaimer icon, which provide a comprehensive vision of combating potentially fatal infectious diseases.  HHS is one of the principal U.S. government agencies implementing the President’s Emergency Plan for AIDS Relief (PEPFAR) and works with international drug regulatory authorities to expedite the review of generic antiretroviral drugs under PEPFAR.  HHS helps to implement the President’s Malaria Initiative to reduce the burden of malaria globally.

The Food Safety Modernization Act (P.L. 111-353) enables HHS to better protect public health by strengthening the food safety system to reduce the incidence of foodborne disease.  HHS works with domestic and international partners to prevent and control foodborne illness outbreaks. For example, the Partnership for Food Protection (PFP), a domestically focused collaboration of professionals from HHS, other federal agencies including USDA/FSIS, and state and local government agencies, developed the PFP Strategic Plan for 2015-2020, to implement recommendations from a workshop that convened all 50 states on food safety topics.

In addition, HHS regularly partners with other federal agencies including USDA and EPA to improve food safety and defense capabilities by supporting the Food Emergency Response Network as well as the National Antimicrobial Resistance Monitoring System.  Under the Canada- United States Regulatory Cooperation Council (RCC), HHS has worked with the Canadian Food Inspection Agency (CFIA) in several areas including food safety, laboratory cooperation, information sharing, and animal drugs.   The RCC Joint Action Plan contains, among other things, a plan for HHS and CFIA to finalize the assessment of each other’s food safety systems (excluding meat, poultry and egg products) and establish a food safety “systems recognition” arrangement based on the results.

ASPR’s Biomedical Advanced Research and Development Authority (BARDA) coordinates interagency efforts to define and rank requirements for public health medical emergency countermeasures, research, and product development and procurement related to infectious disease threats.

Within HHS, ASPR, CDC, FDA, HRSA, IHS, NIH, OASH, OGA, and SAMHSA will have roles in implementing the following strategies to achieve this objective.

Strategies

  • Prevent the spread of infectious diseases through maintaining strong public health and response systems at home and abroad, expediting the development and approval of vaccines and other biologics, and creating incentives to encourage the development of products to prevent, detect, diagnose, and treat emerging infectious diseases and bioterrorism threats, as well as antibiotic-resistant infections;
  • Support state and tribal infectious disease and epidemiology capacity-building programs to prevent, investigate, and control health care-associated infections, disease outbreaks, and other health care threats;
  • Implement strategies to prevent and reduce health care-associated infections, as articulated in the National Action Plan to Prevent Health Care-Associated Infections and related strategic documents;
  • Support state, local, and tribal efforts to reduce health care-associated infections by providing data to detect infections and evidence-based  guidelines to improve the quality of care and protect patients;
  • Work with state and federal partners to detect emerging and spreading antimicrobial resistance and respond rapidly to prevent local spread;
  • Work with federal partners to continue to develop, implement, and support laboratory biosafety and biosecurity policies, guidance, and standards to prevent misuse, theft, or loss of biological agents and toxins;
  • Enhance and strengthen the vaccine safety system to rapidly identify adverse events after vaccination;
  • Remove financial and other barriers to routine immunizations for children, adolescents, and adults;
  • Prevent the spread of HIV infection, and increase efforts to make people aware of their status and to enable them to access the full cascade of HIV care and treatment, using innovative, culturally appropriate means, as articulated in the National HIV/AIDS Strategy;
  • Prevent and control the spread of viral hepatitis as detailed in the Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis Site disclaimer icon;
  • Work with federal and global health partners to achieve polio eradication; reduce the spread of HIV, hepatitis A and B, tuberculosis, malaria, and other infectious diseases; build country public health capacity; and improve capabilities to prepare and respond to infectious diseases, other emerging threats, and public health emergencies, under the principles of the HHS Global Health Strategy and the CDC Global Health Strategy; and
  • Implement a public health-focused, risk-based approach to food and feed safety to secure high rates of compliance with science-based standards, set priorities for prevention, strengthen surveillance and enforcement, and improve response and recovery to protect the safety and security of foods for humans and animals.

Performance Goals

  • Achieve and sustain immunization coverage in children 19 to 35 months of age for one dose of measles, mumps and rubella (MMR) vaccine.
  • Increase the percentage of adults aged 18 years and older who are vaccinated annually against seasonal influenza.
  • Increase the proportion of American Indian and Alaska Native patients, aged 19 to 35 months, who receive the following childhood immunizations: 4 DTaP (diphtheria, tetanus, and acellular pertussis); 3 IPV (polio); 1 MMR (measles, mumps, and rubella); 3 or 4 Hib (Haemophilus influenzae type b); 3 HepB (hepatitis B); 1 varicella (chicken pox); and 4 pneumococcal conjugate.
  • Increase the number of adults and children internationally with advanced HIV infection receiving antiretroviral therapy (ART).
  • Reduce the proportion of persons with an HIV diagnosis at later stages of disease within three months of diagnosis.
  • Decrease the rate of cases of tuberculosis among U.S.-born persons (per 100,000 population).
  • Reduce the incidence (per 100,000 population) of health care-associated invasive MRSA infections.
  • Decrease the rate of Salmonella Enteritidis illness in the population.
  • Reduce the incidence of infection with key foodborne pathogens: Listeria monocytogenes.

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Objective F:  Protect Americans’ health and safety during emergencies, and foster resilience to withstand and respond to emergencies

Over the past decade, our nation has renewed its efforts to address incidents that have threatened health security, such as natural disasters, disease outbreaks, and terrorism.  Working with its federal, state, local, tribal, and international partners, HHS has supported capacity-building efforts and strengthened linkages between government, nongovernmental organizations, and the private sector to promote health security at home and abroad.  HHS has improved and exercised response capabilities, developed and licensed medical countermeasures, and promoted recovery planning and services.  HHS has prioritized the safety and well-being of the nation’s at-risk populations in the wake of disasters and public health emergencies.

To guide its work, HHS developed the first National Health Security Strategy (NHSS), a comprehensive framework for how the nation must coordinate efforts to protect people’s health in the case of an emergency.  The NHSS articulates a systems approach for preparedness and response, including identifying responsibilities for all levels of government, communities, families, and individuals as well as private sector and nongovernmental organizations.  HHS uses the NHSS to guide what should be done at the federal level to improve federal efforts and best integrate with and support state, local, and tribal efforts.  HHS is working with its federal, state, local, tribal, and international partners to build community resilience and to strengthen and sustain health and human services emergency response systems, two primary goals of the NHSS.  This effort includes strengthening and integrating bystander, community, and emergency medical services, public health services, and health care emergency management, response, and recovery capability.

This objective is intricately linked with other objectives that focus on modernizing and improving the access, safety, and quality of health care. Resilient communities and robust systems are important not just for emergencies but for use every day. Similarly, strategies that focus on prevention, integrated systems, and equitable practices will support both preparedness and routine use objectives.

ASPR serves as the Secretary’s principal advisor on matters related to chemical, biological, radiological, nuclear, and explosive terrorist events and other public health emergencies.  ASPR also coordinates interagency activities between HHS, other federal partners, and state, local, and tribal officials responsible for emergency preparedness and the protection of the civilian population in emergencies.  Working toward this objective, ASPR, in collaboration with the U.S. Department of Homeland Security, the Federal Emergency Management Agency, and other federal departments and agencies, is addressing the requirements of Presidential Policy Directive 8 (PPD-8):  National Preparedness.  The goal of PPD-8 is to strengthen U.S. security and resilience through systematic preparation for threats among all levels of government, the private and nonprofit sectors, and individual citizens so that everyone can contribute to safeguarding the nation from harm.  The Department also maintains and supports the Commissioned Corps of the U.S. Public Health Service, a unique, deployable cadre of more than 6,500 uniformed officers with expertise in public health and emergency response.  Corps officers stand ready to deploy to national and international emergencies in support of Departmental priorities.

Within HHS, ACF, ACL, AHRQ, ASA, ASPR, CDC, CMS, FDA, HRSA, NIH, OASH, OCR, and SAMHSA will have roles in implementing the following strategies to achieve this objective.

Strategies

  • Strengthen the capability of hospitals,  health care coalitions (including hospitals, long-term services, Federally funded Health Centers, and other health care organizations and providers), and human service organizations to plan for, respond to, and recover from natural and man-made emergencies by integrating preparedness efforts into the day-to-day functioning across these organizations and systems;
  • Modernize federal medical and public health response and recovery strategies and operations to be flexible, fast, efficient, innovative, and responsive to the unique context of each community and each disaster, and improve integration with health and emergency response systems;
  • Upgrade state, local, and tribal human services and public health preparedness, response, and recovery capacity;
  • Build strong, sustainable, resilient health care systems through strategic policy initiatives, including emergency medical services, emergency departments, hospitals, public health agencies, ambulatory care centers, primary care settings, and long-term services and supports facilities;
  • Promote an accessible, integrated, efficient, and prepared emergency care system that is patient- and community-centered;
  • Provide expertise and tools to health care facilities to strengthen their capability to provide safe health care services during emergencies where local or widespread events might compromise normal functions or when health care is delivered in altered settings; and
  • Build a medical countermeasure enterprise to produce medical countermeasures quickly, in the face of any threat, by supporting innovation in development and transformative technologies, increasing domestic manufacturing capacity, facilitating regulatory review, improving stockpiling and distribution, and consulting end users to understand their needs;
  • Ensure that the needs of vulnerable populations, including children, individuals with Limited English Proficiency, individuals with disabilities, older adults, refugees, and individuals with diverse cultural origins, are met in emergencies, through effective integration of these populations into planning, response, and recovery efforts;
  • Promote the use of science-based communication practices to ensure that health care providers and affected or vulnerable populations have accurate, consistent, actionable, and up-to-date information critical for supporting individual and population health protection, especially during novel outbreaks or emerging health threats;
  • Develop a research agenda, evaluation framework, and quality improvement methods for systematically ensuring that exemplary practices are used efficiently and effectively;
  • Develop evidence-based interventions and recommendations, such as personal protective equipment guidance, to protect the nation’s first responders from injury, disease, and death during emergency responses; and
  • Enhance response to foodborne outbreaks with more rapid tracing of contaminated foods.

Performance Goals

  • Increase the percentage of public health agencies that directly receive CDC Public Health Emergency Preparedness funding that can convene within 60 minutes of notification a team of trained staff who can make decisions about appropriate response and interaction with partners.
  • Increase laboratory surge capacity in the event of terrorist attack on the food supply (measured by radiological and chemical samples per week).
  • Increase the number of new Chemical, Biological, Radiological, and Nuclear (CBRN) threats and emerging infectious disease (EID) medical countermeasures (MCMs) under Emergency Use Authority (EUA) or licensed.
  • Enhance influenza vaccine production.

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Content created by Assistant Secretary for Planning and Evaluation (ASPE)
Content last reviewed on February 9, 2016