1. Healthy People 2020: Preparing for a New Decade
Geri Tebo
Office of Disease Prevention and Health Promotion, HHS
January 20, 2011 1

2. What is Healthy People?
National agenda that communicates a vision, mission and overarching goals, supported by topic areas and specific objectives for improving the population’s health.
Good morning everyone. I will start us off with the big picture – so share with you information about Healthy People in general then move into what’s been consuming most of our time these days, and the last many weeks, months and years, Healthy People 2020.
One of the Department of Health and Human Services flagship prevention initiatives that’s been around for almost 30 years.
It’s a decades-long initiative that, for each decade, establishes a set of goals and objectives that address a range of high-priority, public health issues that are designed to improve the population’s health. 2

3. Aligned Effort Strategic Goals
Healthy People: Aligns Strategic Public Health Goals and Efforts Across the Nation
Non-Aligned Effort
Aligned Effort Strategic Goals
Random Acts of Innovation
Healthy People
So what are we trying to accomplish? The ultimate outcomes of the initiative are healthier people, healthier communities, and a healthier nation. There are a lot of public health efforts already going on in communities and across various sectors and Healthy People serves as a structure or framework to help align them so that we are on the same page aiming for the same things.
As state and territorial coordinators, you must feel inundated with different initiatives. Healthy People, because of its depth and breadth, encompasses many topic areas and has already aligned with many federal initiatives.

4. *39 Topic areas with objectives
Evolution of Healthy People
Target Year
1990
2000
2010
2020
Overarching Goals
Decrease mortality: infants-adults
Increase independence among older adults
Increase span of healthy life
Reduce health disparities
Achieve access to preventive services for all
Increase quality and years of healthy life
Eliminate health disparities
Attain high quality, longer lives free of preventable disease…
Achieve health equity, eliminate disparities…
Create social and physical environments that promote good health…
Promote quality of life, healthy development, healthy behaviors across life stages…
Topic Areas 15 22 28
42*
# Objectives
226
312
467
> 580
Here is the 30-year span, starting with the objectives for the decade all the way up to where we are now with Healthy People 2010, which will be winding down in the next few months.
1979 – ASH/SG Dr. Julius Richmond establishes 1st national prevention agenda: Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention
HP 1990 – Promoting Health/Preventing Disease: Objectives for the Nation
HP 2000 – Healthy People 2000: National Health Promotion and Disease Prevention Objectives
HP2010 – Healthy People 2010: Objectives for Improving Health
HP topic areas with objectives
Always a fun slide to show because it highlights the growth of Healthy People over those past 30 years. And with each decade, there’s always attention given to size. You can see from the first iteration that it’s only gotten bigger, not so much with the goals but certainly with the number of topic areas and objectives and we are continuing that trend for HP2020.
One reason for the growth is that new public health priorities come up – like emergency preparedness or healthcare-associated infections that reach the level of national significance and need to be monitored.
*39 Topic areas with objectives

5. Key Features of Healthy People
Creates a comprehensive strategic framework uniting health promotion and disease prevention issues under a single umbrella.
Requires tracking of data-driven outcomes to monitor progress and to motivate, guide, and focus action.
Engages a network of multi-disciplinary, multi-sectoral stakeholders at all levels.
Guides national research on public health.
Establishes accountability requiring all PHS grants to demonstrate support of Healthy People objectives.
And so the framework, along with these key features, really gives users confidence in using the goals and objectives as the basis for their activities. 5

6. Healthy People 2010: Pros and Cons
Strengths
Collaboration and consensus
Diverse users
Public access to data via internet
Science- and evidence-based
Data-driven: measurable objectives with targets
Challenges
Encyclopedic approach versus targeted effort
Data source funding and development
Implementation plan
Technical assistance
The history, process and key features all contribute to the strength of Healthy People and we’re happy we can say these about the initiative.
But we also know that with anything of this size, and the fact that there are so many contributors to the process, there are going to be some challenges that need attention so that they are no longer challenges. A few for HP include –
-- How do we get data for objectives that are important enough to be in Healthy People but don’t have a source to provide that data?
-- And the need to provide better resources, like implementation strategies. In the past, we have been criticized for supplying a laundry list of objectives, without any advice on how to go about getting started or achieving them and this is something we are addressing in Healthy People 2020.
Final 6 6

7. Workgroup (28 federal agencies)
Healthy People: Federally Led, Stakeholder Driven
HHS
ODPHP
Federal Interagency
Workgroup (28 federal agencies)
HHS Secretary’s Advisory Committee
State & Local
Governments (50 state coordinators)
National-level Stakeholders, including members of the Healthy People Consortium (2,200+ organizations)
In terms of the structure – while Healthy People is Federally led, it is driven by many stakeholders from the national, state and community levels.
Federal Input
--The Federal Interagency Workgroup oversees and coordinates the process within the Federal government.
Public Input:
13-member Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020, convened in January 2008 by the HHS Secretary to help ensure transparency and public input. They’ve held many meetings, several of which have been open to the public to provide feedback.
There have been online public comment periods, regional and public meetings
And for those of you who remember the Consortium from Healthy People 2010, this group, made up of agencies and organizations, has been reinvigorated for 2020 and have provided input as well.
Community-Based Organizations, Community Health Clinics, Social Service Organizations, etc.
Individuals, Families, & Neighborhoods across America

8. …and these overarching goals.
This graphic also shows an issue that’s a major focus for Healthy People 2020: the determinants of health and the important roles they play in improving health. Our director is known for saying that ‘health is too important to leave to the health sector alone.’ We know that factors in the physical and social environment, issues with health services (access and quality), individual behavior and biology and genetics can affect health and so they must be included in the equation.

9. Healthy People 2020: Mission
Healthy People 2020 strives to:
Identify nationwide health improvement priorities;
Increase public awareness and understanding of determinants of health, disease, disability and opportunities for progress;
Provide measurable objectives and goals applicable at national, state, and local levels;
Engage multiple sectors to take actions to strengthen policies and improve practices driven by best available evidence and knowledge;
Identify critical research, evaluation, and data collection needs.

10. Healthy People 2020: New Topic Areas
Life stages
Adolescent Health, Early and Middle Childhood, Older Adults
Blood disorders and Blood Safety
Dementia, including Alzheimer's Disease
Genomics
Global Health
Healthcare-Associated Infections
LGBT Health
Preparedness
Health-Related Quality of Life and Well-being
Sleep Health
Social Determinants of Health
As I mentioned, Phase II focused on developing the topic areas and objectives. Many of the areas in Healthy People 2010 have been carried over into Healthy People 2020 with some new areas added and here is a short list of some of them. In all, there are 42 topic areas, representing almost 600 objectives that have been developed by agency-level working groups – who are the subject-area experts.

11. Overview of Health Disparities
Achieve health equity, eliminate disparities, and improve the health of all groups.
Definition: a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage
Healthy People 2020 defines health equity as the “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”[i]
 Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”[i]

12. For all Americans, other influences on health include the availability of and access to:
A high-quality education
Nutritious food
Decent and safe housing
Affordable, reliable public transportation
Culturally sensitive health care providers
Health insurance
Clean water and nonpolluted air
Powerful, complex relationships exist between health and biology, genetics, and individual behavior, and between health and health services, socioeconomic status, the physical environment, discrimination, racism, literacy levels, and legislative policies. These factors, which influence an individual’s or population’s health, are known as determinants of health.

13. Disparities by race and ethnicity
African Americans and American Indians/Alaska Natives have higher rates of infant mortality and diabetes.
A higher percentage of Asian Americans live in poverty than do non-Hispanic whites.
Native Hawaiians/Other Pacific Islanders have much higher rates of cancer and hepatitis.
Hispanics have higher rates of obesity, HIV/AIDS, and smoking.

14. Disparities by gender
Women have higher rates of obesity, arthritis, osteoporosis, some mental disorders, and autoimmune diseases, such as lupus and multiple sclerosis than men.
Women, especially those in their childbearing years, continue to be the fastest growing segment of the population to be infected with HIV or diagnosed with AIDS. An estimated 25 percent of people living with HIV in the United States are women.
Because women can experience the symptoms of a heart attack differently than men, they may be misdiagnosed, or women may not realize they are having a heart attack until it is too late.
More women than men live in poverty.

15. Disparities by gender
More men die from heart disease, cancer, influenza and pneumonia, chronic liver disease, diabetes, and AIDS than women.
More men die prematurely from violence (homicide and suicide) and accidents than women.
Men abuse alcohol and drugs at higher rates than women.
More men than women smoke tobacco.
Men are more likely to delay routine checkups and ignore symptoms of a health problem than women.

16. Lesbian, Gay, Bisexual, and Transgender Populations
LGBT youth are 2 to 3 times more likely to attempt suicide.
LGBT youth are more likely to be homeless.
Lesbians are less likely to get preventive services for cancer.
Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.
LGBT populations have some of the highest rates of tobacco use
The LGBT data is primarily from smaller, non-national sources.

17. Persons With Disabilities or Special Health Care Needs
Adults with disabilities are more likely to be obese or overweight and have high blood pressure and high cholesterol than other adults.
The rates of substance abuse among people with disabilities are about 2 to 4 times greater than that of the general population.
Research has shown that women with disabilities have a higher risk for emotional, physical, and sexual abuse than do women without disabilities.

18. Geographic Location: Rural Residents
Rural residents face a number of barriers in
accessing quality health services, and they experience significant health disparities. Compared with their urban counterparts, rural residents were more likely to:
Report being in fair to poor health
Live with a chronic disease such as diabetes
Die from heart disease
Be admitted to a hospital for uncontrolled diabetes
Disparities between the health of rural and urban residents are complex and not always clearly defined. Environmental factors, social structures, and transportation interact with the race, ethnicity, and age of rural populations in different ways than among urban populations. Residents can be located in rich or poor counties and in States with large or small populations.
In general, rural residents are more likely to be older and poorer, and have more chronic health conditions than their urban counterparts.[i] Rural residents are frequently more at risk than urban residents for many health-related outcomes. Both men and women living in rural areas had higher rates of death from cancer than urban residents.[ii]

19. Geographic Location: Urban Residents
Concentrated poverty
Higher levels of indoor and outdoor pollution, such as noise and air pollution from motor vehicle traffic and industry, and indoor exposure to allergens, carcinogens, and lead
Overcrowding, leading to higher rates of infectious diseases
Environmental pollutants

20. Healthy People 2020 Online
Vision: Create an engaging, user-centered Web site that gives new and existing users of Healthy People a platform to learn, collaborate, plan, and implement strategies to reach the objectives.
And a new feature we are excited about is that HP2020 will be web-based, interactive and easily accessible! If you remember, the Healthy People 2010 objectives were launched as two thick books. Not so for HP2020. The online version will make it easier for users to do a variety of things – such as connect with one another to share ideas and plans or find resources – that may have been a bit more difficult with the previous static version.
So as a special treat for our State and Territorial Coordinators, we would like to share with you, the look and feel of Healthy People 2020.
These still frames have only been seen at ODPHP and the Implementation Subgroup of the FIW.
Other HHS offices have NOT seen them.
The reason we are showing them to you, is because consortium members, of which state coordinators are a part of, helped to develop the wire frames for the site. 20

21. Healthy People 2020 Online
This site is still under development, so there may be some changes when you see it at launch.
But what I want to show you is, how simple it is to get to what you want to see. Essentially, how that large document can be easily navigated through on the web.
So concerns of Healthy People being too big, well the web makes it easy for you to find what you are looking for.
Simply click on topics and objectives. 21

22. Healthy People 2020 Online
You will find the overview and additional tabs that direct you to “list of objectives” and “evidence based resources”.
If you click on “list of objectives” you will find. . . 22

23. Healthy People 2020 Online
The objectives, printable in PDF, the target and baseline, in addition to the data source.
If you click on evidence based resources. . . 23

24. Healthy People 2020 Online
You will find links to the clinical guide and the community guide at the launch. We will be further developing resources throughout the decade drawing upon successful strategies in the field. 24

25. Healthy People 2020 link to Data Warehouse
Health Indicators Warehouse (HIW):
contains national, state and community health data plus data on successful interventions by indicator. Will include data never previously released, and will be delivered in a structured, standardized, machine-readable, easily accessible way, free of charge and intellectual property constraint

26. Health Indicators Warehouse Available 1/21/11 www.healthindicators.gov
Will include:
HP 2020 data
CMS data
MATCH data
CHSI
HP 2020 is developing an interface with the warehouse that will result in detailed HP data becoming available in Spring 2011

27. Healthy People 2020: Looking Ahead
Release of LEADING HEALTH INDICATORS
Spring 2011
Healthy People 2010 Final Report - Fall 2011
Healthy People Users Conference - Spring 2012
Continued development of implementation plan and resources
Health in all Policies – recognition that HUD, Dept of ED, Trans, Veterans Affairs etc. all need to work together to improve health.

28. Healthy People 2020 FOR MORE INFORMATION:
Office of Disease Prevention and Health Promotion
US Department of Health and Human Services
Draft 28 28