Secretary’s Advisory Committee on
National Health Promotion and Disease Prevention Objectives for 2020
Social and Physical Environmental Determinants, Committee Work in the Coming Year
Via WebEx
Eighteenth Meeting: July 26, 2010
Committee Recommendations (Approved by Vote)
- All members who were present voted unanimously to approve the two documents produced by the Subcommittee on Action Steps and Evidence. These included:
- Evidence-based Clinical and Public Health Initiatives: Generating and Applying the Evidence
- Recommendations of the Subcommittee on Action Steps and Evidence
- All members who were present voted unanimously to approve the Recommendations for Implementing Healthy People 2020, with the following revisions:
- Explain the connections between the CHDI and Healthy People;
- Include statements about data quality and coverage;
- Include statements on the need for the CHDI to include data on social determinants.
- All members who were present voted unanimously to approve the Supplementary Report on Societal Determinants of Health.
Next Steps
- The Committee will work to identify effective strategies for publishing and packaging the products of the Committee’s work and ensure their dissemination in either hard copy or electronic formats.
- The Committee will continue to provide support and guidance to ODPHP and the Secretary on the issues related to the implementation and launch of Healthy People 2020.
- The Committee members will be contacted to determine scheduling for their next meeting.
I. Welcome and Desired Outcomes of the Meeting
Dr. Jonathan Fielding, Chair of the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020 (the Committee), welcomed participants. He explained that the meeting’s primary focus would be on finalizing outstanding products of the Committee’s work. The members would also hear updates from the U.S. Department of Health and Human Services (HHS) on plans for the launch of Healthy People 2020 objectives, proposed HP2020 implementation activities, and the Community Health Data Initiative. Lastly, the Committee would discuss its future role in implementing Healthy People 2020.
II. HHS Update
RADM Penelope Slade-Sawyer, Deputy Assistant Secretary for Health for Disease Prevention and Health Promotion, provided an update on the current HHS timeline for finalizing and preparing to launch the Healthy People 2020 objectives, leading health indicators, and implementation guidance. She explained that the final set of Healthy People 2020 objectives would be submitted for HHS clearance by the end of the week. The Department would review and comment on the objectives, baselines, target-setting methodologies, and targets within the 39 topic areas with objectives. Once the clearance process is completed, comments would be reviewed, and the final objectives would be submitted to the Secretary for approval. RADM Slade-Sawyer went on to explain that HHS has entered into a contract with the Institute of Medicine (IOM) to identify a set of leading health indicators for the nation. In coming months, the IOM would develop its recommendations and submit a report of its findings to HHS in late February, 2011. Plans for the December launch of Healthy People 2020, as well as a public call to action for stakeholders to implement Healthy People objectives, are underway and on schedule. RADM Slade-Sawyer expressed hope that the Committee members, who have given so much to the Healthy People process, would be present with HHS at the launch.
RADM Slade-Sawyer noted that HHS has undertaken various activities and platforms that will be used for implementation of Healthy People 2020. These include the Community Health Data Initiative, an annual meeting for Healthy People State and Territorial Coordinators, two new Healthy People State and Community Evaluation Projects, and the National Healthy People Prevention Summit.
- The Community Health Data Initiative would serve as a data warehouse for HHS health indicators.
- The Fifth Annual Meeting of Healthy People State and Territorial Coordinators (September 27th and 28th, Washington, D.C.) would serve as the “pre-kickoff” for Healthy People 2020. The goals of this meeting would be to explain the differences between Healthy People 2020 and Healthy People 2010; promote awareness among health officials of how Healthy People is being utilized; and receive feedback about tools and strategies that would encourage use of Healthy People 2020 in the future.
- HHS plans to conduct two new Healthy People 2020 State and Community Evaluation Projects. The first project would provide an opportunity for states to develop Healthy People 2020 implementation plans that respond to the new set of objectives. The initial phase of this evaluation has focused on the Healthy People 2020 framework. Fourteen states were funded; their work will be presented at the State Coordinators' workshop. In the project’s next phase, HHS will award additional states with funds to help translate the Healthy People 2020 objectives into action.
- The second evaluation project would be modeled after the Take Action Healthy People, Places, and Practices in Communities Project, which administered 112 awards of two to five thousand dollars across the country. RADM Slade-Sawyer said that the recipients of this next round of community awards would be community-based organizations. An announcement and description of application procedures would be made available in the spring of 2011 on the Healthy People Web site, through the Healthy People Consortium, and via the Healthy People Listserv.
- HHS is planning a National Healthy People Prevention Summit for the spring of 2012. The goal of the meeting will be to bring together stakeholders (e.g., CBOs, state and local government agencies) to share information on how they have been using Healthy People and share HHS recommendations for implementation.
Dr. Fielding emphasized the importance of focusing on implementation and expressed support for the effort that HHS is putting towards implementation. RADM Slade-Sawyer responded that implementation was one of the challenges in the past, which is why they have focused significant effort on the implementation activities for this decade. She added that ODPHP values the input they receive from the public and stakeholders on Healthy People related activities.
III. HHS Community Health Data Initiative
Dr. Fielding welcomed Todd Park, HHS Chief Technology Officer, and Linda Bilheimer, Associate Director of National Center for Health Statistics (NCHS). Dr. Fielding explained that Mr. Park would be discussing the HHS Community Health Data Initiative (CHDI) and the role it will play in the launch and implementation of Healthy People 2020.
Mr. Park explained that the CHDI is a flagship project under President Obama’s Open Government Initiative, which has directed all Federal agencies to increase transparency, participation, and collaboration with regard to government decision-making. The CHDI is meant to increase awareness about health performance in communities throughout the U.S. and spark action to improve that performance. HHS plans to accomplish this by creating an “ecosystem of community health data” in which free, easily-accessible, high-quality, health metadata is provided by HHS, and then used by technology innovators (e.g., application developers for Google and the iPhone), researchers, non-profits, and government agencies to create easily accessible resources to improve the health of the U.S. population.
The CHDI was modeled after the National Oceanic and Atmospheric Administration’s (NOAA) work with weather data. The NOAA, the primary supplier of weather data in the U.S., publishes on the Internet free, high quality weather data, which is then accessed by the Weather Channel, iPhone application developers, news networks, and other users, who convert the data into products and services that can be easily accessed and understood by the general public. HHS is striving to do the same with community health data. To this end, a meeting of public and private technology innovators was assembled by the IOM in March 2010 to generate ideas. Following the March 2010 meeting, HHS launched the CHDI Web page, where they made datasets available for use and developers’ applications. Innovators used the data to build more than 20 applications, which were showcased for Secretary Sebelius at a meeting on June 2, 2010. Mr. Park provided examples of the applications that had been created.
Mr. Park also informed the Committee members that a new HHS Health Indicators Warehouse would be launched in December, 2010. He said that the Warehouse would be a publicly-available Web site where users can download up to 2,000 different health indicators by interest area. In addition to Healthy People 2020 data, the Warehouse would provide access to county health rankings, the underlying data that power county health rankings, community health statistics indicator data, and other datasets. Aggregated indicators for a variety of diseases and health outcomes will be available. Also included would be a new dataset of Medicare data on indicators of patterns of disease in the Medicare population, utilization of services, cost, and quality of care received. More information on the Warehouse is available at www.hhs.gov/open.
Mr. Park explained that HHS is committed to generating innovation through the CHDI. A centerpiece of this effort is a developer challenge called, “2010 Health 2.0,” which is being coordinated by an organization called Health 2.0. Health 2.0 is working with both government and non-government agencies to sponsor developers in the U.S. to build applications that can advance particular health objectives utilizing data from the CHDI and other sources. Applications that result from this challenge will be showcased at the Health 2.0 Conference in San Francisco in early October, 2010. Mr. Park argued that, to generate interest and participation from the public, publishing the data is not sufficient. The public must be aware that the data exist, and they must be provided with an explanation of how it impacts their lives.
IV. Discussion with Todd Park and Linda Bilheimer
Dr. Fielding asked Mr. Park to discuss the relationship between the CHDI and Healthy People 2020. Mr. Park explained that he views the CHDI as a vehicle through which Healthy People 2020 can be made more accessible to the public. The Healthy People 2020 metrics and data are central to the CHDI and the HHS Indicators Warehouse. The Indicators Warehouse will also contain a database of successful, evidence-based interventions that correspond to each indicator.
A Committee member asked Mr. Park whether the Indicators Warehouse would have the capability to generate output from Federal datasets and accept and contain datasets from reliable non-Federal sources, such as Los Angeles County. These could be linked into the system to enable benchmarking against national data. Mr. Park said that in the early stages, the Warehouse would make available definitive Federal datasets on public health and health care costs and quality. The HHS Indicators Warehouse would be one component of a broader Federal data supply, which will to be transitioning to the Data.gov site. Data.gov catalogues all Federal datasets that are available for download. HHS is currently talking with the Data.gov team about creating a health section that will house the Health Indicators Warehouse on the data.gov Web site. Mr. Park is hoping to create a place, potentially on the health section of Data.gov, where non-Federal datasets can be posted for technical use.
Dr. Fielding asked Mr. Park to discuss the methods HHS would employ to evaluate the effectiveness of this initiative. Mr. Park explained that in the initial phase of the CHDI, evaluation efforts would focus on gathering process metrics to answer questions such as: how many applications were created from the CHDI? How many participants (technology innovators) are involved? In reference to the 2010 Health 2.0 Developer Challenge, how many challenges are launched? How are these applications being used and by whom? HHS would also like to gather qualitative data on the usefulness of the applications and to document their impact on improving health performance and the health status of populations.
V. Other Web Related Activities
Dr. Manderscheid commented briefly on Sonoma County’s Network of Care for Healthy Communities “Community Dashboard,” (found online at: http://hcn.sonoma.networkofcare.org/).  He explained that this application was among those that were showcased during the June 2, 2010 meeting; it is already live. He suggested that the Committee members review this application as a “real-world example” of the potential for health data to be made accessible and understandable to the public. Mr. Park added that a Web cast of the June 2nd meeting was also available at www.hhs.gov/open.
VI. Recommendations of the Subcommittees
Dr. Fielding led the Committee in discussion of and voting on outstanding Committee products so that these documents could be transmitted to the Secretary. These items included: the Supplementary Report on Societal Determinants of Health; a report on Evidence-based Clinical and Public Health Initiatives: Generating and Applying the Evidence; Recommendations of the Subcommittee on Action Steps and Evidence; and the Recommendations for Implementing Healthy People 2020. Dr. Fielding asked Subcommittee Chairs who led these efforts to explain their work.
Subcommittee on Action Steps and Evidence. Dr. Steven Teutsch, co-chair of Subcommittee on Action Steps and Evidence along with Dr. Fielding, led discussion of the Report on Evidence-Based Clinical and Public Health Initiatives. Dr. Teutsch explained that the report was developed in response to an HHS request for guidance on what criteria should be used to select “evidence-based” or “knowledge-based” actions that could be taken to achieve the Healthy People 2020 objectives.
The report, Evidence-Based Clinical and Public Health Initiative: Generating and Applying the Evidence, summarizes the ideas of two separate groups of experts that convened over the course of a year to discuss evidence-based practice in public health, challenges in assessing evidence in support of public health interventions, and existing resources for evidence-based public health practice. The memo, Recommendations of the Subcommittee on Action Steps and Evidence, responds directly to questions posed by HHS about how to help Healthy People users bring evidence to bear in their decision-making. It provides a hierarchy of evidence, and presents concrete examples of how that hierarchy can be applied to inform decisions. Dr. Teutsch then explained the key principles that are outlined in the memo, including levels of evidence within the hierarchy. Dr. Fielding added that the central point made in the documents is that one should use evidence-based interventions when possible, but when the evidence is not available then the alternative hierarchy of evidence can be used.
A member noted that the literature on transitioning from evidence-based public health theory to practice is minimal. He said the report made a relatively complicated subject easy to understand. He inquired about plans to disseminate of this report, as well as other documents that have been produced by the Committee, to the practice community. Dr. Fielding explained that once the Committee votes to approve the documents, they are transmitted to the Secretary; they enter the public domain 30 days after they have been transmitted. He asked ODPHP about opportunities to disseminate the Committee’s reports. RADM Slade-Sawyer replied that ODPHP would be willing to work with the Committee to discuss dissemination of their work. Dr. Teutsch noted that many of the ideas presented in the report reflect the work of Subcommittee members, including Ross Brownson, Alice Ammerman, and others. Their work is posted on their Web sites.
A Committee member asked how the hierarchy of evidence could be used to evaluate issues related to addressing social determinants of health and eliminating health inequities (e.g., a Health in All Policies approach and Health Impact Assessments [HIA]). In the U.S. these are fairly new concepts, but they are getting a lot of support around the globe. Dr. Teutsch replied that as progress is made in reviewing complex intersectoral interventions, there will be more reliance on forms of evidence such as HIA. Dr. Fielding added that efforts that Robert Wood Johnson and Pew have undertaken will help to catalyze the growth of HIA.
- Dr. Fielding entertained a motion to approve the two documents produced by the Subcommittee on Action Steps and Evidence. Committee member Patrick Remington made a motion to approve the report, and member Ronald Manderscheid seconded the motion. All members who were present voted unanimously to approve the Subcommittee’s documents.
Subcommittee on Implementation. Ms. Eva Moya and Dr. Adewale Troutman, co-chairs of the Subcommittee on Implementation, led discussion on the Subcommittee’s work on Recommendations for Implementing Healthy People 2020. This work was carried out nearly a year ago, but no formal vote to approve the document was ever held. Dr Troutman said the recommendations were developed in answer to an HHS request for guidance on how to move from the framework to action, and how to provide Healthy People users with the tools and guidance they need. He provided an overview of the subcommittee’s work to develop the recommendations. Eva Moya briefly walked the members through the specific recommendations listed in the document. It consists of a set of five immediate recommendations to be implemented within the first year of launching Healthy People, as well as a set of longer-term recommendations, which the subcommittee suggests should be initiated within the first five years of the launch.
A Committee member suggested adding a sentence or two to link the work of the CHDI to the proposed Healthy People interactive Web site (one of the five recommendations for immediate action). Dr Fielding said that, based on Mr. Park’s presentation, he was under the impression that the Healthy People Web site would be a part of the CHDI and would therefore not need to link to it. Carter Blakey of ODPHP confirmed that Healthy People would be one of the “apps” on the CHDI, while the Healthy People data would be stored in the Indicators Warehouse that is part of the CHDI.
Dr. Shiriki Kumanyika, vice-chair of the Committee, emphasized that it was critical to explain the connections between the CHDI and Healthy People, and to include statements about data quality and coverage. She expressed uncertainty about whether the CHDI would generate data on social determinants of health because during his presentation, Mr. Park spoke about healthcare data. She suggested that the implementation recommendations include statements on the need for data on social determinants to be integrated into the CHDI. Dr. Fielding agreed and asked that these changes be incorporated. He proposed that, with approval from the Committee, he and Dr. Kumanyika would review the revised, final version of the document before it is submitted to the Secretary.
- Dr. Fielding requested motion to approve the recommendations of the Subcommittee on Implementation. Dr. Manderscheid moved to approve the report, and Dr. Remington seconded the motion. All members who were present voted unanimously to approve the recommendations.
The Committee proceeded to discuss strategies to ensure wide dissemination of the Committee reports and products. Dr. Fielding recommended that the Committee work closely with NORC and ODPHP to identify effective strategies for publishing and packaging these reports to generate interest among the public and ensure their wide distribution in either hard copy or electronic formats. The consensus of the group was that the materials should be packaged and either printed as a supplement to a Journal, or made available in some other citable format, apart from simply being the proceedings of a Committee. The documents should be available on Pub-Med so that they can be easily found and cited. A Committee member suggested looking into one of the online journals, such as Preventing Chronic Disease or MMWR. Other options might include Public Health Reports or other peer-reviewed journals. The Committee acknowledged that due the resources required, online or government publications may be a most feasible option. Dr. Fielding hoped that ODPHP, together with other agencies within HHS, would find enough value in these reports to identify funding to produce a printed version.
Supplementary Report on Societal Determinants of Health. Dr. Shiriki Kumanyika explained the process that went into the production of the Supplementary Report. The report has been underway for about a year, and has undergone numerous revisions. Input has been incorporated from both external and internal reviewers. External feedback was received from Paula Braveman at UCSF and Wilhelmine Miller at George Washington University. The report seeks to explain the importance of “societal” determinants of health. (Dr. Kumanyika explained that the Committee has adopted the term “societal determinants” instead of social determinants because the term “social” does not include the physical environment, whereas “societal” incorporates both social and physical environments. She also said that the supplementary report overlaps with other Committee documents, but is intended to stand on its own, to be a resource for the practice community and students.
- Dr. Fielding requested motion to approve the Supplementary Report on Societal Determinants of Health. Dr. Troutman moved to approve the report, and Dr. Remington seconded the motion. All members who were present voted unanimously to approve the Supplementary report.
VII. Next Steps
Dr. Fielding said that the final item on the agenda was the future work of this Committee. ODPHP has requested that Committee be “at the ready” to help with the launch and implementation of Healthy People 2020, and the members have agreed. Going forward, Dr. Fielding said that dissemination of the Committee’s products and implementation of Healthy People 2020 would be high on their list of priorities.
Dr. Fielding thanked the Committee members for the many hours of volunteer work that they had devoted to this effort. RADM Slade-Sawyer expressed her gratitude for the Committee’s efforts and indicated that ODPHP would seek input from the Committee as the launch draws closer. Dr. Fielding noted that the Committee may meet again in December, 2010, if not before then. The meeting was adjourned. |
