The shape of the health of the US population is being imagined and planned for in the latest version of Healthy People 2020. The recommendations of the Secretary's (of HHS) Advisory Panel for the framework and format of Healthy People 2020 have just been posted, and this kicks off a set of activities in 2009 that will culminate in the blueprint for health and health promotion/disease prevention activities in the US over the next decade.
The goals of Healthy People 2020 they outline are to:
- Eliminate preventable disease, disability, injury, and premature death.
- Achieve health equity, eliminate disparities, and improve the health of all groups.
- Create social and physical environments that promote good health for all.
- Promote healthy development and healthy behaviors across every stage of life.
The recommendations focus on determinants of health and have an action orientation – a first for Healthy People. Healthy People 2020 must provide clear priorities for action (i.e., it should articulate "what" needs to be done) and focused strategies for addressing them (i.e., it should explain "how" this work should be carried out).
Rather than simply listing objectives for health in the next decade, the committee calls for A feedback loop of intervention, assessment, and dissemination of evidence and best practices [that] would enable achievement of Healthy People 2020 goals. The Action Model to Achieve Healthy People Goals [shown below] represents the impact of interventions (i.e., policies, programs, and information) on determinants of health at multiple levels (e.g., individual; social, family and community; living and working conditions; and broad social, economic, cultural, health, and environmental conditions) to improve outcomes. The results of such interventions can be demonstrated through assessment, monitoring, and evaluation. Through dissemination of evidence-based practices and best practices, these findings would feed back to intervention planning to enable the identification of effective prevention strategies in the future.
A list of priority users for Healthy People 2020 is expanded beyond the traditional Federal, state and local health agencies to include voluntary organizations, faith-based organizations, businesses, health care providers, decision-makers, researchers, community-based organizations, grass root advocates and other sectors whose actions have significant health consequences. This focus reflects a consensus that Healthy People must engage all sectors of society in order to improve health and achieve health equity, an engagement that has so far failed to take hold in previous years in any broad and systematic fashion.
The panel also recommends that Healthy People 2020 should assemble the best possible information on the determinants and other factors (for example, intervention effectiveness for various groups) for each health objective so that users can prioritize potential activities they could take to address them individually or in partnerships [Ed Note: And are these only evidence-based or will they also be practice-based as discussed in the NYT story on approaches to drug rehabilitation?].
Moving from a Healthy People report to a Healthy People database is suggested to permit a more user-friendly approach that would be organized into three broad categories - interventions, determinants and outcomes – rather than the previous approach of using focus areas under which to group similar health objectives. Again, the emphasis is on action, not just description.
The Panel also calls for transparency in the process of developing health objectives so that it is clear to users who, using what information, developed each objective.
Of note to us is the attention given to health communication and health information technology in the guidelines for implementation section of the report, an aspect of HP2020 we have been writing about here:
The Advisory Committee recommends that health information technology (IT) and health communication be mobilized to support the full implementation of Healthy People 2020. This would include building the public health IT infrastructure together with the national health information infrastructure; extending in time and scope the IT Strategic Plan developed by the HHS Office of the National Coordinator; integrating IT to meet the direct needs of Healthy People 2020 around measures and interventions; and building on current work on health literacy and health communication.
For this latter purpose, the Advisory Committee proposes a nation-wide health improvement platform, the Healthy People Community, which would be available and accessible to all. The Healthy People Community would be grounded in health literacy principles and would provide an electronic communication infrastructure to promote shared learning to achieve long, healthy lives for all. The Healthy People Community can play a direct role in addressing health determinants. The Advisory Committee will continue to explore these issues during its Phase II efforts.
To avoid deepening existing disparities in access to health and medical information, Healthy People 2020 must take steps to ensure that the information it provides is available to and accommodates all—including those who lack access to computers and the Internet. The term "digital divide" refers to the gap between individuals, households, businesses and geographic areas at different socio-economic levels and with different accommodation needs, in terms of both their opportunities to access information and communication technologies and their use of the Internet for a wide variety of activities. There continues to be a digital divide in access to computers and the Internet generally, as well as in access to high-speed, broadband connectivity.
Though generally viewed as an element of other social divides in the United States, the digital divide may be narrowing more quickly than others. Even so, one in five American adults in a 2005 survey reported that they had never used the Internet or email, and did not live in an Internet-connected household. This digital divide exists across age, race/ethnicity, and SES groups. The Advisory Committee recommends that Healthy People 2020 products be made available through multiple media for those who cannot or prefer not to access IT. Appropriate accommodations should be made for persons with disabilities.
Another key issue is that the public is confused about the most trustworthy sources of health information—especially on the Internet. Many existing sources are paid for or influenced by those with commercial interests. It is a responsibility of government to provide the most objective information available on how to improve personal and family health and well-being, as well as on how individuals can contribute to improving community health.
Working groups will be convened, likely in January 2009, to begin the process of developing objectives and recommended interventions. I encourage you to get involved in the process – this is the time and opportunity to include social marketing and related approaches in national health policy. I do not have the list of working groups or their contacts and I suggest you start with either the Healthy People 2020 home page or the previous Healthy People 2010 work group coordinators to find out how to get involved.
And make it a great 2009 (and 2020) for yourself, your work, your community and our cause!