Healthy People 2020 Comment System

The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020 has proposed a set of four draft overarching goals for Healthy People 2020:

Achieve health equity, eliminate disparities and improve health for all groups.
Eliminate preventable disease, disability, injury and premature death.
Create social and physical environments that promote good health for all.
Promote healthy development and healthy behaviors across every stage of life.

This section is closed for comments.

Anonymous on 3/7/2009 4:02:16 PM
As far as I am concerned, obesity is the major factor affecting our nations' health, now and in the future.   The rates of obesity continue to climb at alarming rates and given the substantial role obesity plays in many other diseases such as Type 2 Diabetes, which in turn can cause many other devastating diseases such as blindness, amputations and kidney disease, we need to tackle obesity head on.  Obesity should be this committee's number one focus: preventing and reversing obesity.   And the way to accomplish this goal is to educate our public.
As the previous commenter noted, if good eating does not start at home, good nutritional status is unlikely to happen.   And the only way for it to start at home is if parents are educated about food and nutrition.  We need a bold public awareness campaign of the importance of good nutrition and the health consequences of obesity and lack of good nutrition.  What if an ad campaign (possibly funded from an extra tax on fast food like we do with cigarettes?) explained that the World Health Organization estimates that 30% of all cancers are related to poor nutrition and lack of exercise?  Would this influence people to eat more fruits and vegetables?  It just might.  Just saying you need 5 a day clearly does not work--it gives no incentive or rationale for the number.  A motivating factor and education I believe could go a long way.  What if an ad campaign explained that if you are obese and have Type 2 Diabetes and are able to get back to a healthy weight, you may be able to stop taking your diabetes medication and maintain the disease with diet and exercise alone.  Would this make more Type 2 Diabetics interested and motivated to lose weight?  I think it might.   Most Type 2 Diabetics I educate have no idea their diabetes is related to their weight.  Why not initiate a broad public awareness campaign to educate our public.  I am doing it one patient at a time, but that's not enough considering the state of our nations' health.
This should be the priority and the focus--public awareness of the health consequences of obesity and poor eating.  We would have a healthier, more productive population and dramatically reduce costs.

Anonymous on 2/22/2009 5:44:47 PM
I agree that the goals sound very passionate, but somewhat broad.  I feel we should go further and break down each of the overarching goals with some simple points that make these broad goals seem more achievable.  This gives the average person a better understanding of how to go about making these goals reality.

Anonymous on 2/17/2009 7:51:58 PM
I believe that the goals sound really passionate but let's be honest a bit far-fetched when your talking about the word "eliminate".  Let's see in this decade obesity is one of our major problems and it's hard to eliminate such a thing when you promote good healthy habits at school and it's not followed thru at home.  Let's say we are making steps towards that but I wouldn't say eliminate.  Also with the high cost of health insurance which is leaving alot of people with the only option of not carrying it, I believe that there should be some rethinking in the aspect that there should be other options to making health insurance more affordable and available for everyone.

Ana Costa on 2/11/2009 6:38:26 PM
I really appreciate the fact that Healthy People 2020 has come up with the target goal to promote healthy development and healthy behaviors across every stage of life. According to the Obesity Society, in the past 30 years, the occurrence of overweight in children has doubled and it is now estimated that one in five children in the US is overweight. Both the short term and long term effects of overweight on health are of concern because of the negative psychological and health consequences in childhood. Obese children are developing obesity related diseases only seen in adults, such as type 2 diabetes, cardiovascular diseases, cholesterol and more. This epidemic has become very expensive with estimated $117 billion expenditure in health care in 2000 and the increase in medical costs. I would like to see more emphasis on creating a more specific goal to help minimize childhood obesity. Healthier behavior programs, aiming parents, guardian, teacher, and children could be developed and applied to society by the Health People 2020. It is important to see that and child can create healthy behaviors across every stage of their lives. The child obesity solution depends on home and community involvement and again I would like to see more emphasis on minimizing and perhaps eliminating this epidemic.

Anonymous on 2/11/2009 3:05:17 PM
I have always been told that if you shoot for to moon and miss you will still land upon the stars. I believe that with the objectives listed are exactly that. Achieve, eliminate, create, and promote are great openning words for each. I really like the promote healthy development and healthy behaviors across every stage of life. I don't believe that is strongly pressed upon most teenagers in todays society. Something they need.

Anonymous on 2/11/2009 10:25:08 AM
"Eliminate" is a strong word, but since we are talking about goals, elimination of the PREVENTABLE diseases is a great goal. These are goals, and if you don't set your stakes high, what is there to work for? If you don't eliminate them you do not fail, reduction is still an accomplishment, but even after reduction there is more work to do and that is why I think that eliminate is still a very powerful goal statement. In regards to the social and physical environment creation, I also think that would be a great goal to add because there are so many programs that individuals create themselves that become more successful when they have support from others opposed to when they tried on their own.

Anonymous on 2/10/2009 10:11:15 AM
Did anyone involved with defining these goals take a strategic planning course anytime in their past? Goals should be reasonably attainable, and use of language that is "all" is not reasonable.  "Eliminate" and "achieve" are absolutes, and will assure us of failure in relation to these objectives.  Please consider the many comments in this section that suggest alternative ways to develop measurable and achievable goals.

csull on 2/4/2009 9:14:49 AM
I agree that "eliminate" is too strong of a word in regards to preventable disease as individual freedoms will make this impossible. Achievable goals should be set instead, such as a drastic reduction (maybe including a reasonable percentage) in preventable disease, disability, injury and premature death.

Anonymous on 2/3/2009 11:40:08 PM
I feel that a couple of the overarching goals for Healthy People 2020 seem more as dreamy ideations than achievable goals...being only 10 years away. To eliminate preventable disease would require supervision by a higher power (such as the government) to eliminate many of the behaviors that we as Americans have freedoms to enjoy (such as the use of tobacco/alcohol products and the issue of obesity as related to unhealthy eating behaviors). I am not saying that these goals are not achievable, but to totally eliminate preventable disease in 10 years would require that action is underway with many of the issues to which this goal is associated (and many issues are not or little progress is being made at this point in time). I do however understand the purpose of setting goals high, which is important in improving these areas to some degree.

RDO-09

Richa Singh on 1/29/2009 1:29:07 PM
The Health People is a comprehensive attempt to address the primary health concerns and issues of the populace.  Its revision every decade helps include new problems and health concerns. This is evident from the goals and mission of the Healthy people 2020 which highlight the importance of disease prevention and focus on promoting healthy lifestyle and behavior patterns.
	However a need to address or at least mention the problem of rising health costs is felt. As access to health care services is becoming limited due to the rising costs of insurance premiums and rising prices of prescription drugs, it is imperative that the issue be addressed in the healthy people document as well. It is important  because it has implication on health status of the people by limiting access. 
	Another issue within the goal of creating social and physical environment that promote good health for all, is the need to emphasize on the environmental and ecological issues to promote sustainable healthy lifestyles. 
	Further it is critical that the document be more publicized to create greater awareness among the people and not be confined to the academicians and health sector workers. This is important particularly in the context of the desired changes in behavioral health pattern of the population.

Dr Mary Anne Murphy on 1/25/2009 1:30:47 PM
As there are attempts to restruct the number of objectives in HP2010, trying ro figure out which objectives are more important than other, lets not forget that one goal we all struggle to communicate to our patients is how important one's overall health is. Eyes are not more important than ears, or teeth, or your liver. But the eyes are not healthy if these other organ systems are not healthy. A consideration should me made to add goal to educate patients on the importance of holistic health rather than subdividing the body into 400 categories. As it has been a goal for multiple government agencies to work TOGETHER in the creation/ development of HP2010, it should also be the goal of the results to be measured in an interdisciplinary format and that health care providers work together to educate patients on not only the importance of good health in their particular specialty, but to also encourage patients to maintain excellent OVERALL health.

Anonymous on 1/23/2009 11:58:06 AM
Overall, the goals have expanded and have become more specific, which gives one the perception of more tangible and thus more attainable goals individually rather than the two broader goals of 2010. Each goal is unique and important, but goals 3 and 4 entertain the possibility of empowering the people. I believe that many, if not most, health ailments are directly and indirectly linked to human behavior and the choices people make. When it comes to the individual and collectively as a whole, the greatest power, impact, and influence that one can make is on him/herself. If each person chose and behaved in a healthy manner, free of unhealthy choices to smoke, abuse drugs, live a sedentary lifestyle, submit to perceived genetic limitations, and have poor diets, then the only health issues that people would face are the ones that are out of their control. Goal 3 comes into play by creating environments that promote good health that may sometimes be outside of an individual's control. I do understand that not everyone has the same socioeconomic status, access to quality healthcare, and opportunities in life: life is not fair; however, public health policy and better environmental living conditions could certainly help and account for some of the health problems people face that are out of their control. Imagine a world where people simply made better health decisions and acted on them along with policy and environments that promoted health. Simply put – human behavior equates to health human.

Anonymous on 12/8/2008 1:09:54 AM
The goals of HP2020 are headed in the right direction, but as we have saw in HP2000, these goals are hard to reach and a more realistic approach needs to be taken.  The elimination of preventable diease, disability, injury and premature death will unfortanetly never happen.  In recenty years, some preventable disease have not only not decreased in occurance but they have risen.  Diabetes and obesity are on the rise, and it is because of this that all generations are dying prematurely.  We need to focus on awareness, education, affordable healthcare, and insurance paying for nutrition counseling before we think we're going to elimate anything.

Anonymous on 12/7/2008 8:05:51 PM
These four goals seem to be achievable for most everyone, but I do believe they should be worded differently. The first goal I think should not only be for all groups but for all ages as well. It is important to achieve good health throughout ones entire life. We just can't quit on someone once they reach a certain age. Cancers and disease affect many elderly individuals and they account for a large percentage of most diseases in the United States. The second goal should include caring for the disabled as well, because one again we can't forget about certain groups or people. Some disabilities are going to be around regardless of what we do and those people need to know health care providers and the government are there to assist them. The third goal should also include promoting environments, because it doesn't do much good to create it, if it isn't going to be promoted. I completely agree with goal 4 and I think promotion and prevention are so very important for a healthy nation!

Anonymous on 12/7/2008 2:02:06 PM
I think that overarching goal #3 could be improved if it read "Create AND SUPPORT social and physical environments that promote good health for all." I consider this addition to be very important because if we want these new environments to have prolonged effects, they must continue to be funded or else they will crumble and then no longer be available to the public (for example, broken playground equipment is non-functional and potentially dangerous to users). Thus, creating new environments that are ALSO sustained by continued financial and community support should be our focus because it will bring more lasting and beneficial impacts for public health. I think this is essential to making the creation of these environments worthwhile. 

Additionally, giving more support to existing health-promoting social and physical environments (like children's after school programs, community parks, etc.) is important and may be one way to reduce the costs of promoting good health for all if people's needs can be met simply through improvements of their existing environments.

Anonymous on 12/5/2008 10:59:37 AM
As the previous poster mentioned, the idea of eliminating preventable disease, disability, injury and premature death is overly ambitious and unrealistic. It would be miraculous if we could reverse the trend of increasing preventable disease (obesity, etc.) in the time space of a decade.  Therefore, it would better to emphasize a reduction rather than a elimination of preventable disease, disability, injury and premature death.

CassieW on 12/5/2008 9:40:25 AM
My only issue with the goal of eliminating preventable disease, disability, injury, and premature death is that we will then be looking to reduce overpopulation in Healthy People 2030. I think that we should instead look to REDUCE preventable disease, disability, injury, and premature death. This may be a goal that we can better live with in the future.

PolicyLink on 9/18/2008 7:17:30 PM
Goals for these next 10 years, and especially objectives once they are defined, should be measureable and achievable. In addition to “creating social and physical environments that promote good health,” it is also important to address economic aspects of local neighborhoods that influence health.

American College of Obstetricians and Gynecologist on 9/4/2008 5:26:05 PM
•	Overarching goal #3 would be enhanced if it read: “Create physical and social environments including economic, commercial, corporate and governmental policies that promote good health for all”.   The perception of the meaning of “social and physical environments” within the context of health is too often limited to the immediate surroundings of an individual (e.g. the family unit, community environmental issues).  Some key factors in many health issues are more global in nature, like corporate activity (e.g. tobacco advertising; health insurance coverage/policies; sick leave policies, etc), government policies (e.g. national health care system; legislation/regulations not based on evidence/science), and commercial activity (e.g. drug prices; availability of healthy foods)
•	We suggest the addition of another overarching goal that focuses on the means to health (i.e. what do communities and individuals need to be healthy?  What needs to change to provide those means?)

Partnership for Food Safety Education on 9/2/2008 2:36:40 PM
As an effort focused entirely on empowering consumer to reduce their risk of illness, the Partnership supports the goal to "Eliminate preventable disease, disability, injury and premature death," and further urges inclusion in HP 2020 of information contained in HP 2010 on prevention of foodborne disease through safe handling practices:  CLEAN: wash hands and surfaces often;  SEPARATE:  Don't cross-contaminate;  COOK:  Cook to proper, safe internal temperature as measured with a food thermometer;  CHILL:  refrigerate promptly and properly.

VF Gurley on 8/29/2008 6:26:16 PM
This are good goals with the addition of the following:
expand the first goal to "and improve health in all aspect for all groups" and
expand the last goal to "healthy development, healthy behaviors and healthy social networks across every stage of life"

Anonymous on 8/28/2008 12:35:26 PM
Increasing public awareness and understanding of the underlying causes of health and disease is truly an important aspect to healthy people2020. The hard part is to have people truly understand the direct link of what you put in your mouth and your activity and how it makes your body work, how it feels and how it looks. Everything else will fall into place once people are demanding help to change their lives. We need to make sure as health care professionals that we are prepared and ready with programs to help these people. We need to cause such a stir that people will approach and seek out our knowledge and help rather than hounding people to change thier lives. A great example is quitting smoking, if that person does not want to quit than they wont. Same thing goes for eating healthy and exercising and making healthy lifestyle choices.In doing all of this the goals of elimination of health disparites and the increase of quality and number of years of life will happen naturally. There are to many problems to focus on but we can not merly treat them cosmetically. By finding the root of the problem and treating that root, several of these problems will cease to exist. So rather than trying to seem overly ambitious with so many goals, the main goal of 2020 should be to change the way people think and to truly educate.

Susan Freeman on 8/26/2008 4:42:38 PM
My comment is in reference to "Eliminate preventable disease, disability, injury and premature death." 
I would like to see our nation's health care system work better as a whole with targeting an injury prevention plan of care from the hospital to the community (home, skilled facility, rest home,. assisted living) that specifically focuses on Falls. Once a person is identified at falls risk, or to have had a fall, the communication breakdown about that event gets lost across the continuum. Falls in the elderly and neurologically impaired patients account for a large percent of disability throughout the United States. Healthy People 2020 initiatives has an opportunity to increase awareness and foster pro-active Prevention approaches that may reduce disability burden related to injury from Falls.  Representatives from every possible venue (hospital, acute care facilities, assisted living, skilled care facilities, rest homes, patients and family advocates from the home) should partake in development of this initiative. Please consider adding Falls prevention to the plan for objective "Eliminate preventable disease, disability, injury and premature death." 
Thanks for listening.

Anonymous on 8/26/2008 4:41:38 PM
My comment is in reference to "Eliminate preventable disease, disability, injury and premature death." 
I would like to see our nation's health care system work better as a whole with targeting an injury prevention plan of care from the hospital to the community (home, skilled facility, rest home,. assisted living) that specifically focuses on Falls. Once a person is identified at falls risk, or to have had a fall, the communication breakdown about that event gets lost across the continuum. Falls in the elderly and neurologically impaired patients account for a large percent of disability throughout the United States. Healthy People 2020 initiatives has an opportunity to increase awareness and foster pro-active Prevention approaches that may reduce disability burden related to injury from Falls.  Representatives from every possible venue (hospital, acute care facilities, assisted living, skilled care facilities, rest homes, patients and family advocates from the home) should partake in development of this initiative. Please consider adding Falls prevention to the plan for objective "Eliminate preventable disease, disability, injury and premature death." 
Thanks for listening.

Jeffrey Axelrad on 8/17/2008 5:07:11 PM
JEFFREY AXELRAD’S COMMENTS ON “DEVELOPMENT OF HEALTHY PEOPLE 2020”

I am commenting in response to the Solicitation for Written Comments on the Development of Healthy People 2020, published in the August 8, 2008 Federal Register.

According to the Notice, “Healthy People will organize and establish a framework to address risk factors and determinants of health and the diseases and disorders that are affecting our communities.”

Research into possibly pertinent risk factors and determinants of health is a sensible undertaking. I address not the evaluation of sensible research but, rather, write to oppose diverting attention from research into less worthy avenues for governmental activity. To be specific, the Department of Health and Human Services (HHS) should not use this initiative as a vehicle for a behavior modification campaign or seek to restrict the availability of information about food through restrictions on food marketing. The reasons impelling this perspective are provided in the two articles which follow.

Thank you for considering this comment. If you want any additional participation in this initiative on my part, please contact me at law729@comcast.net.

_____________________________

How Consumer Marketing Impacts Food Safety Legal Issues

Jeffrey Axelrad

Introduction
My topic is consumer marketing’s effect on food safety legal issues. At the outset, let’s be clear that “marketing” is a broad and expanding concept. Advertising through television, radio, newspapers, magazines and similar media is a traditional slice of the entire marketing pie, but only a slice. Vending machines and product displays in stores, along with shelf location, packaging and price are an integral part of product marketing. Product visibility, in television shows, movies and video games, is certainly an additional slice, as is any kind of concerted effort to create “buzz” for a product. Advocates of marketing restrictions want to constrain all marketing efforts. Some advocates focus on individuals under a certain age while other efforts are not age-limited.
The attacks on marketing are broad-based. The courts are one forum for the attacks, but other forums are being exploited as well. School boards are a vehicle for vending machine controversies; State governments are an avenue for focusing on “disclosure” and other issues; federal agencies, including the Departments of Agriculture, Health and Human Services, along with its autonomous component, the Food & Drug Administration (FDA), and the Federal Trade Commission (FTC), are places where restriction advocates focus attention. For instance, restrictions on what can be covered under the school lunch program involve local decisions, but must be made within the limits of requirements set by federal law. Senator Harkin has introduced legislation that requires nutritional information on menus of chain restaurants, establishes rulemaking authority within the Federal Trade Commission to issue restrictions on advertising with respect to children and authorizes the Secretary of Agriculture to prohibit the marketing and advertising of food in schools participating in the School Lunch or Breakfast programs. See., e.g., S. 2592, 109th Cong., Child Nutrition Promotion and School Lunch Protection Act of 2006; S. 3484, 109th Cong., to amend the Federal Food, Drug, and Cosmetic Act to extend the food labeling requirements of the Nutrition Labeling and Education Act of 1990; S.2558, 108th Cong., the HeLP America Act.
Keeping in mind that the legal controversy explicitly extends to how the law should evolve, whether through litigation or changes in the regulatory framework, bedrock legal concepts are a basic anchor for analysis.
Anchor Legal Concepts and Their Misuse
Commercial sellers can be liable for injuries caused by defective products. RESTATEMENT (THIRD) OF TORTS, Product Liability, § 1. Not directly relevant factors aside, a product is defective if it (a) “contains a manufacturing defect,” (b) “is defective in design,” or (c) “is defective because of inadequate instructions or warnings when the foreseeable risks of harm posed by the product could have been reduced or avoided by the provision of reasonable instructions or warnings by the seller or other distributor . . . and the omission of the instructions or warnings renders the product not reasonably safe.” RESTATEMENT (THIRD) OF TORTS, Product Liability, § 2. Under liability theory (a), manufacturing defects, “a harm-causing ingredient of the food product constitutes a defect if a reasonable consumer would not expect the food product to contain that ingredient.” In addition, a commercial product seller, including a distributor, can be held liable if it “makes a fraudulent, negligent, or innocent misrepresentation of material fact concerning the product.” RESTATEMENT (THIRD) OF TORTS, Product Liability, § 9. State Consumer Protection Acts, enacted mostly during the 1960s and 1970s in many states, for the most part cover deceptive acts and practices, in accordance with provisions that vary from jurisdiction to jurisdiction. These kinds of state legislation initially did not appear to add any additional substantive issue to the preceding principles even as they expanded remedies for violations of their terms. Victor E. Schwartz & Cary Silverman, Common-Sense Construction of Consumer Protection Acts, 54 KAN. L. REV. 1 (October, 2005)
Traditionally, tort law concepts impose liability for food sales only if the food is processed and sold in a manner that a responsible seller will not countenance. For instance, under the traditional view of controlling legal principles, “[g]ood butter is not unreasonably dangerous merely because, if such be the case, it deposits cholesterol in the arteries and leads to heart attack, but bad butter, contaminated with poisonous fish oil, is unreasonably dangerous.” RESTATEMENT (SECOND) OF TORTS, § 402A, comment i.
Activists seek to expand these traditional concepts to encompass theories unmoored by the any sensible principle except inflated tort liability. A restaurant’s failure to provide calorie counts for portions of its daily specials becomes the predicate for a product defect theory arguing inadequate warnings, which, according to the proponents, turns the case into at least a jury question for the finder of fact as to whether the portions are “unreasonably dangerous.” The trans-fat controversy as the basis for a defective product theory is already the stuff of attention in the popular press: Alluring food, attractively presented, becomes the basis for a “misrepresentation” theory of liability. Additionally, state Consumer Protection Acts are utilized to sue restaurants, even if customers do not rely on the acts or omissions that form the theory of liability. This result is far removed from the original intent of the Acts’ supporters. Compare, Pelman ex rel. Pelman v. McDonald's Corp. 396 F.3d 508 (2nd Cir. 2005) (New York’s Consumer Protection Act, prohibiting “deceptive” acts or practices “does not require proof of actual reliance”) with Schwartz & Silverman, Common-Sense Construction of Consumer Protection Acts, supra.
These theories are to be distinguished sharply from claims predicated upon actual representations of prepared foods’ content. If an individual relies upon a statement that a food product does not contain beef or peanuts, the product contains beef/peanuts and the individual is injured as a consequence, traditional concepts provide a remedy. The difference is really one of consumer expectations.
If a consumer can see or observe a food product, the consumer can make decisions for herself. Requiring warnings and overly detailed laundry lists of information do not serve to assist consumers; rather, overuse renders them little more than “background noise.” See generally, Jennifer Steinhauer, Eating Well;

JacquieO on 8/12/2008 8:00:47 PM
There appears to be an unhealthy, agenda-driven focus on removal of firearms to prevent unintentional childhood death; however, firearms are not a major cause of death for children.  In the 1-4 age group, firearms do not warrant a ranking as a cause of death.  In the 5-9 age group, firearms rank as an unintentional injury well down the list behind motor vehicle accidents, drowning, fires and burns, suffocation, other land transportation, pedestrian, "other," struck by or against, "unspecified," falls, "other" specific classifiable, and poisoning.

We need a return to traditional values regarding respect for firearms and their role in sports history and in national heritage.  As such, they should be presented as a viable option for school and community education programs.  In this way, children learn the historical value of sporting arms, appropriate uses, and safe handling.

Candace Eden on 7/18/2008 4:01:00 PM
the goals that are drafted above appear to provide an end goal with a specific measurable outcome. Although that is admirable, it may not be realistic. I wonder if the wording would be better served if it were more aspirational in nature such as the third goal is stated. Aspiring to health equity with specific steps in that direction and attempting to eliminate disparity in all healthcare environments...rings truer unless the document provides measurable elements that attest to the fact that we have achieved health equity and eliminated disparities for all health groups.

Anonymous on 7/11/2008 1:43:11 PM
As the number 1 environmental health threat to this nation, radon should receive significant attention.  It is also one of the most fixable problems with a reasonable goal of virtually eliminating its contribution to lung cancer in the very near future.  With proper attention, we could add it to the list of problems that USED to be.

Samuel L Church MD MPH on 7/4/2008 3:21:36 PM
As suggested elsewhere on the forum, I feel that emphasis should be placed on staying healthy versus focus on disease.  Specifically on "creating social and physical environments.....," things like explicit delelopment of strong parenting skills before there is a major family crisis, or better yet, before families have children.  This can be beneficial to every SES group.

JJ Strouse on 6/7/2008 11:34:10 AM
I would suggest that sickle cell disease be used as a  model disease for the elimination of health disparities and lack of access to care.  As a genetic illness that mostly occurs in minorities with poorer access to health care and less financial resources, this population is at greater risk than other genetic illnesses of similar severity and more diverse distributions in the population of the United States.

Rebecca on 6/2/2008 9:27:02 AM
For bullet number 1.  There is no way to eliminate disparities as long as human beings have the freedom of choice.  Making this a goal is a sure way of sabatoging the success of HP2020.  I would suggest a more realistic term such as "reducing".  

Also, the same goes for bullet #2.  We can never eliminate preventable diseases as long as we have the freedom to choose.  Think about this before you make this a goal.  "Reducing" is more realistic.

W.P. Stewart MPH on 5/29/2008 2:51:51 PM
Healthy People 2020: The Road Ahead
U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion
Office of Public Health and Science, Office of the Secretary
1101 Wootton Parkway, Suite LL100
Rockville, MD 20852

Public Comment for Healthy People 2020,
Vision, Mission and Overarching Goals

As you consider goals for 2020, I urge you to keep in mind that although school aged children and youth tend to be healthy, they are establishing habits that have implications for their future health status. Prevention efforts targeting young people will pay off over time. In that context, I also urge you to consider schools as sites for intervening with young people.

Specifically, we recommend an overarching goal for this population that states: Students are Healthy: Physically, Socially, Emotionally, and Academically.

As indicators, we have suggestions in each realm. Each of the recommended indicators has strong evidence of a relationship to positive health outcomes. The physical health indicators include
1. Immunization rates
2. Blood-lead levels
3. Obesity rates
4. Food security
5. Adoption of health enhancing behaviors such as being physically active; refraining from use of tobacco, alcohol, and illicit drugs; getting adequate sleep; using protective devices and equipment; and consuming nutritionally balanced diets

Indicators in the social health realm include rates of victimization and of adolescent pregnancy and STDs. Young people who are victims of bullying, harassment, violence, or personal violation through theft are more likely to exhibit anti-social behaviors themselves and to suffer intentional and unintentional injuries. Adolescent females who become pregnant are at greater risk than other women of complications during pregnancy and of low birth weight babies. Their parenting skills tend to be undeveloped, so their children are at increased risk of neglect and abuse. They and their children are less likely than other adolescents to complete high school. STDs place young people at risk for infertility and myriad health problems.

Some of the strongest evidence related to emotional health is that young people who are connected to a significant adult engage in fewer health risk behaviors and perform better academically than those who are not so connected. Disruptive classroom behaviors not only often signal an emotional or mental health problem, but they interfere with the ability of classmates to learn. Classroom and school-wide interventions exist that have decreased disruptive behaviors. Thus recommended indicators include Relationship with a caring adult and disruptive behaviors at school

While recognizing that the Department of Health and Human Services focuses on improving the nation’s health, we recommend including academic indicators. There is a strong correlation between high school graduation rates and health status. Graduation rates have a strong connection to school attendance. Success in school and family involvement in a child’s education are both predictive of improved graduation rates and of health outcomes. By including the indicators of high school graduation, school attendance, family involvement in education, academic performance measures, and the ability to read on level by third grade, in a health document, you will encourage researchers to look at both academic and health indicators when conducting research with young people. Having even stronger evidence of the interrelationship between health and academic outcomes will support school administrators in their efforts to include health promotion strategies in schools.

W. Pete Stewart, Jr., MPH

Annie Beigel on 5/27/2008 3:57:01 PM
Healthy People 2020:  The Road Ahead
U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion
Office of Public Health and Science, Office of the Secretary
1101 Wootton Parkway, Suite LL100
Rockville, MD 20852
	
Public Comment for Healthy People 2020, 
Vision, Mission and Overarching Goals 

On behalf the New York State Department of Health’s Tobacco Control Program and the Tobacco Cessation Centers of New York State, we would like to support the national effort to establish Healthy People 2020 goals and objectives. The proposed vision and mission are comprehensive and should encourage all relevant stakeholders and partners to participate in Healthy People 2020. The proposed overarching goals, however, do not include strengthening organizational structures within the health system that promote primary and secondary prevention, improve quality of life, and reduce health disparities and health care costs.

We recommend that you add a new overarching goal:
“Support health systems that promote good health for all.”  e.g. health systems that screen for tobacco use and prompt clinicians to assist patients who use tobacco to quit.    
Alternatively, we recommend that you revise overarching goal number three to state;
“Strengthen and change social environments, physical environments and health systems to promote good health for all.” 

Thank you for considering this recommendation as you form the Vision, Mission and Overarching Goals for Healthy People 2020. 
Sincerely,

Annie Beigel, 
Manager of Cessation Programs
New York State Department of Health
Tobacco Control Program
ESP Corning Tower, room 710
Albany, New York 12237-0675
amb12@health.state.ny.us

Sara Delafield on 5/22/2008 11:55:50 AM
The proposed overarching goals seem to exclude the health systems changes necessary to deliver health promotion, preventive and other services that are critical for improving longevity and reducing health disparities. Adding a new overarching goal, such as, “Support health system changes that promote good health for all.” would increase awareness and the need for change at a systems level as well as engage policy makers in health related discussions.

Dessa BergenCico on 5/12/2008 7:22:50 PM
Addictions affect not only the individual who is addicted but society as whole. Addictions encompass more than alcohol and other drugs; behavioral addictions such as gambling, sex addiction and food addiction also affect millions of Americans. The biological, psychological and social dynamics of addiction devastate individuals, their families and communities. Alcohol, other drugs and behavioral (AODB) addictions equally impact urban, rural and suburban communities and are prevalent at all socio-economic levels. A focus on AODB addictions will support the achievement of violence prevention, mental health and life stage disease objectives for  Healthy People 2020.

Pam Hoffman MD on 5/5/2008 12:19:08 PM
These are laudable, albeit very broad goals.  There will need to be measurable objectives for each.  For example, preventable diseases, disability develop over decades:  it is not realistic to postulate that they can be eliminated by the year 2020, but we should be able to reduce the incidence.
Part of this goal should be improving ways of caring for existing disabilities.

Arizona Department of Health Services on 5/1/2008 8:17:34 PM
We certainly have the ability to reduce health disparities over 10 years.  However, the absolute elimination of disparities in a 10 year timeframe has the potential to be unrealistic.  This is supported by the fact that ‘eliminate health disparities’ was a focus in HP 2010 – if it had been achieved, it would not be necessary to repeat it.  It is certainly realistic to ‘work towards’ the goal of achieving health equity and eliminating disparities in 10 years.  Similarly, we may ‘work towards’ reducing preventable disease, disability, injury, and premature death.  Though our long-term goal may be to eliminate health disparities, we need to be realistic about the time we have to reach this goal, and the impact we can make in 10 years. 

"Create social and physical environments that promote good health for all." 
This is right on target!  Especially important in Arizona.  For example, type II diabetes is on the rise and for the most part the built environment is underdeveloped; there are a lack of walkable communities, safe parks, and bicycle paths.  In addition, our population is projected to double in the coming 20 years, for which this type of goal would provide an opportunity to correct this lack of infrastructure that would promote healthy lifestyles.

TracyT on 4/30/2008 11:04:13 PM
This is a copy of the 3 minute presentation I gave at the Chicago Regional Mtg.
Breastfeeding is primary about disease prevention.
• Breastfeeding affects all life stages. While it begins at birth, the residual effects are observed during childhood and adolescence. In childbearing years, lactation affects women’s nutritional and reproductive health with lasting effects. At older ages, people who were breastfed as infants show fewer metabolic and cardiovascular insults.
• Breastfeeding is regarded by the World Health Organization as baby’s first immunization. It has been shown to reduce ear infections, atopic dermatitis, gastrointestinal infections, lower respiratory tract diseases, asthma, diabetes, childhood leukemia, SIDS, NEC, and many other diseases.
• For each month a child is breastfed, their obesity risk is reduced by 4%.
What other action can produce such long lasting health benefits? They continue…
• Breastfeeding helps mother’s health by lowering her risk of Type 2 Diabetes, osteoporosis, pre menopausal breast cancer, ovarian cancer. Breastfeeding also benefits mothers by providing natural child spacing.
• Breastfeeding is an important measure for health and disease prevention.
Society benefits when resources are invested in supporting breastfeeding.
• It is environmentally friendly. It avoids factory energy use and waste. Every year over 87,000 tons of waste from formula containers fill US landfills.
• It conserves resources. This is especially important in time of food and fuel shortages.
• In emergency situations, breastfeeding enables a mother to care for her child herself, with less dependence on the emergency care system.
Businesses Benefit from Supporting Breastfeeding:
• In the US, 55%of women with children under 3 are employeed.
o One day absences to care for sick children occur twice as often for mothers of formula feeding infants
• Lower health care costs associated with breastfeeding. Once study found that for every 1,000 babies not breastfeed, there were 2,033 extra physician visits, 212 extra hospitalization days, and 609 extra prescriptions for the top three illnesses alone (ear, respiratory, and gastrointestinal infection.)
• The insurance company CIGNA conducted a 2 year study of 343 employees who participated in a lactation support program. Results? Annual savings of $240,000-health care expenses, 62% fewer prescriptions, and $60,000 in reduced absenteeism rates.

Societal Support Necessary To Promote Breastfeeding: Successful breastfeeding does not occur in a vaccum.
• Currently, 75% of women in the US initiate breastfeeding We need to eliminate barriers such as lack of maternity leave, lack of access to skilled help or workplace accommodations.
• What about the mothers who get off to a rocky start? Referring to breastfeeding support is vital. Help is available through professionals such as International Board Certified Lactation Consultants (or IBCLCs) who work through WIC programs, hospitals, physician’s offices and in private practice. Help is also available through lay counselors such as La Leche League and Peer counselors.
• While the majority of women do want to breastfeed (75%), approximately 25% of women currently do not. Does that mean that as health care providers we do not actively promote breastfeeding to all women? Of course not! As health care providers, we promote many healthy behaviors such as immunizations, care seat use, safe sex, and smoking cessation, to name a few. More visibility of breastfeeding will help people get accustomed to it. Health care workers need to send a consistent message. That message is, “Breastfeeding is how we feed infants.”
• What about disparities in breastfeeding performance? Currently, low income, less educated, younger women, and minority groups breastfeed at lower rates. Breastfeeding levels the playing field for lower income infants. An exclusively breastfed baby in a poor family is getting food that’s just as good as anything a rich family can provide. The breastfeeding community welcomes collaboration with minority health advocates, women’s movement, anti-poverty movements and other community organizations currently working with families.
• What can we, as health advocates, do? Above all, stop allowing corporations to use our health care system to market products that compete with breastfeeding. Advertising of formula and distribution of gift bags by health care professionals should be discontinued. The World Health Organization Code of Marketing Breastmilk Substitutes should be followed. Our current practice of handing out formula marketing bags to new mothers is as ridiculous as handing out cigarettes in a cardiac ward. Both practices would be counterproductive to the short term and long term health of patients.
• Many mothers complain that everyone tells them something different about breast feeding.We all should have basic training in breastfeeding support and promotion. Health care workers need to send a consistent message. That message is, “Breastfeeding is how we feed infants.”

National Latina Institute for Reproductive Health on 4/30/2008 9:49:01 AM
The four draft overarching goals for Healthy People 2020 are vague and do not provide a method to set measures in assessing whether the goals have or have not been achieved.  Thus, grand and lofty statements such as “eliminate health disparities,” are impossible to achieve in 10 years and do not foster action to bring us closer to those goals. 

Lastly, the fourth overarching goal has a process as a goal, not a state of individual or environmental health. It can be argued that in fact, we have achieved this goal in that the government and private sector are actively engaged in this type of promotion. What is needed is a commitment to eliminate harmful environment, products, and messages that compete with health behavior and development promotion. This goal should be to eliminate the promotion of unhealthy food and drugs, especially in low-income communities where they are disproportionately targeted and provide evidence-based health education that respects and engaged all communities


The following is an edited version of what the Healthy People 2020 goals can look like:

o	Achieve health equity, eliminate disparities and improve health for all groups through strategic planning and collaboration amongst an interdisciplinary and diverse group of agencies, professionals, advocates, activists, scientists, and community members.
o	Reduce inequities in 10 main health outcomes between people of color and white people by 90% without reducing absolute measures of health for either group.
o	Eliminate preventable disease, disability, injury and premature death. 
o	Establish health commissions that monitor environmental, social and linguistic determinants and barriers to access to health.

Anonymous on 4/17/2008 10:34:23 PM
I had the opportunity to attend the Region 6 & 7 meeting in Ft. Worth. I was honored to have this opportunity to be part of the intial development stages of Healthy People 2020. There were many great topics that arose at this meeting. I support the addition of health equity, but I do feel it needs to be defined properly. The sample definitions that we were given in our breakout sessions really did not define equity. The definitions better defined inequity. I also don't want the public to read the word equity and think you are implementing a national healthcare plan.

I completely support the development of "social and physical environments that promote good health for all". We really do need more parks and safe places for children and adults to have the opportunity to get outside and exercise together. I have seen parks in different areas that promote physical exercise (walking, running, hiking, etc.). These are great place and we need more of them, and they need to be free or very low cost so everyone has access to them.

I don't know how much input you have one tax breaks, but now the goverment offers tax breaks on home improvement to make the home more energy effiecent, why not give tax breaks for exercise equipment or gym memberships. These are things that if used will save tax dollars in the future because the population will be healthier and require less medical expenses.

There was one gentlemen that brought up men's health at the Ft. Worth meeting. I was touched. He's right there does need to be more promotion for men's health. Most men don't go to the doctor as much as women do. The really need a lot of education and promotion for prevention. I do think the government should get on board for men's health.

Finally, I realize for Healthy People 2020 you are tring to have more broad goals and objectives so the numbers aren't so overwhelming. Perhaps you may consider using the word holistic, this would include mind, body and spirit. This way it covers everything from mental health, oral health, vision, and the spirituality of every person at every life stage.

Gioia Rizzo and Leslie Elder on 4/15/2008 4:52:09 PM
As medicine continues to progress, the advancements in life-saving interventions, although generally positive, have vast social implications.  A concrete example is the pediatric tracheostomy and ventilator dependent population.  There are several hundred tracheostomy and ventilator dependent children in our state who feel the effects of income and insurance disparity at their time of discharge, and throughout the time they are technology dependent to breathe.  These medically and socially complex children are eligible to receive from Medicaid 16 hours/day of in-home nursing care to provide safe and healthy environments.  However, with a national nursing shortage, they often go home with inadequate staffing, have extended hospitalizations that cost considerably more than outpatient care, or have frequent readmissions due to omissions in care or fatigued parents.  

When these children have Medicaid to fund their home nursing, they in particular spend more time waiting in the hospital for nurses than children who have private insurance.  This is due to the poor reimbursement from Medicaid for nursing and equipment in comparison to the reimbursement from insurance policies.  Even when children have private insurance, they can exhaust their lifetime maximums during their lengthy hospitalization.  Some of these children are eligible for Medicaid when this happens, and some are not.  The vast majority of insurance policies exclude private duty nursing for these children from their policies with the hope that Medicaid or State funding programs will pick up the cost.  The ability for insurance companies to exclude this medically necessary care ends up becoming a huge financial burden to the Medicaid system.

Medicaid reimbursement to nursing agencies and equipment companies is substandard and consequently, because these agencies lose money taking Medicaid cases, many are outright refusing to provide staffing to these families. They work much harder to staff the children who have private insurance, in part to offset the loss of caring for the Medicaid child.  These compounding and complicated issues are a result of not negotiating American social infrastructure when advancing medicine.  When speaking to and attempting to develop healthy populations, it is essential that home life and home care needs be considered.  Children deserve to be raised with their families in their communities where they thrive, not in the hospital.  It is appropriate to address the justice issues that we see when a family’s insurance, or lack of, is determining how quickly they can get their children home and attempt to establish some normalcy, and the disparity in the care they receive when the payer is Medicaid versus private insurance.

Scott W. George MLIR on 4/1/2008 9:52:22 AM
Atlanta Regional Meeting- March 17, 2008

I’d like to thank the Department of Health & Human Services for conducting these regional public meetings, and for allowing me the opportunity to speak on behalf of men’s health as a critical priority in the design of a health plan that will address serious healthcare disparities and impact significantly on the future of our Nation’s overall public health.

Men's health in the United States is in a state of crisis revealing a breadth of health inequities that warrant national attention. This crisis has led to the need for effective strategies and interventions designed to improve the health determinants as well as reduce and eliminate the widespread chronic diseases and health conditions that negatively affect the health of American men, and indirectly the lives of women.

I am alarmed as both a man, and a father of two sons, that in the year 2008, men continue to live a lifespan on average that is nearly six years less than women. I am alarmed that men have higher death rates for all of the top ten causes of death in the U.S. I am alarmed that prostate cancer will strike 1 in 6 men, yet we have nothing that would even comes close to the technology of a mammogram available for early detection. I am alarmed by statistics that show that men are 50 percent less likely than women to visit a doctor for preventive health care and screenings for serious acute and chronic diseases. And finally, I am alarmed by the impact on women and children who are left behind following the early passing of their husbands and fathers. In fact, the U.S. Administration on Aging has found that more than one-half the elderly widows now living in poverty were not poor before the death of their husbands.

It is my strong belief that men are not predestined to die before women, that it is neither biology nor simply God’s will. I believe that this inequity is created and sustained by a combination of cultural causes---“men don’t cry”, and systemic causes borne of a healthcare system that has largely avoided addressing men’s unique health requirements.

Let me offer an example of what I mean from my own personal experience. As a clinical skills educator with Clinical Skills USA, I train medical and nursing students in the communication and exam skills required in preventive healthcare, and the promotion of healthy lifestyle habits for both men and women. The methods and skills employed in physical health assessment are considerably different for men than they are for women---after all, we have important body parts that are different. The methods and skills employed in communicating with the patient are considerably different for men, than women---after all, “women are from Venus and men are from Mars”. And of course, the appeals we make to men in promoting healthy lifestyle habits are more difficult to convey---because, after all men are not encouraged to enter a doctors office unless the pain is excruciating, or he is so old that he is wetting his pants. And after all, when the patient is in intense pain, or is urinating on himself, who is it that would ask that patient to take a few minutes to listen to your speech on safe sex or proper exercise.

Through my association with medical and nursing schools in the U.S., I have become keenly aware of the disparity in the amount of attention devoted to men’s unique health issues in our clinical education programs. Women’s health courses are generally “non-elective”, while health courses devoted to men’s unique health issues are generally “non-existent”. This disparity in the preparedness of our future doctors and nurses to serve men is further exacerbated by the reality that new female clinicians are significantly better prepared to treat women, than either female OR male clinicians are prepared to treat men. This is true because many of our male clinicians, under the ages of 40 or 50, have not personally experienced a comprehensive male physical exam, including their reproductive organs. This is in contrast to women, including female clinicians, who will generally experience their first pelvic and breast exam by the time they reach the age of 23, and thereafter begin a lifetime of routine visits to the clinic for preventive care. During these visits they will be exposed to health promotion addressing regular physical exams, breast self-exams, safe sex, proper diet and exercise, and the ills of tobacco, alcohol and drugs. All of which is delivered by the most credible authority available, a medical professional. Men, if they’re lucky, may hear about healthy lifestyle habits from their parents or teachers---but then, who listens to them anyway? “What do they know?” And even then, how many parents and teachers are promoting testicular self-exams to their male children or students? This is the unfortunate truth, even though testicular cancer is the most common cancer among men between the ages of 17 and 35, and is more common in men between those ages, than breast cancer is for women in that same age group. Sadly, most male victims of testicular cancer were unaware of these facts before recognizing that they had the disease. After a number of years of visiting their physician for regular check-ups, women benefit greatly by developing a familiarity with the clinical environment. And although no male or female in their right mind enjoys a visit to the doctor’s office, men will often endure 40 or 50 years of anxious anticipation before they’ll be asked to drop their pants for the first time, for the dreaded “digital rectal exam”! In the meantime, the anxiety caused by a lack of familiarity with our clinicians, and the clinics they work in, gives men plenty of good reason to avoid the exam room all together. “I think I can live with the pain.”

I’m reminded of a conversation I had with a local physician, who had previously been the Chief Medical Officer for a large oil company with a predominantly male workforce. At one point he and his medical staff surmised that they could provide their employees with a wonderful benefit, by offering everyone a complete physical exam without cost to them. After several weeks of promoting this benefit and seeking recipients via flyers distributed throughout the workplace, they had only a handful of takers. The CMO approached the Human Resources Department and asked, “Why the poor show of interest”? The HR Department was unable to provide an explanation, but did offer him the opportunity to appeal to the entire employee group at their next monthly safety meeting. During that meeting the CMO addressed the importance of regular comprehensive check-ups, and emphasized the cost-savings to the employee when comparing the cost of a similar physical exam at an outside clinic. After an exhaustive appeal, the physician asked for a show of hands of all those who had finally been convinced to accept the offer of a free physical exam. Much to his dismay, only a few of the employees raised their hands, and all of them were female. After gazing upon the many uninterested male faces with blank stares, the likely obstacle suddenly crossed his mind. He looked at the men and said, as he raised a single index finger in the air, “how many of you are reluctant to have a physical exam because of this?” Suddenly expressions appeared on the faces of the men, and slowly heads starting nodding. His next question was, “how many of you would participate in the physical exam if I promised you that I would not use this or any other finger?’ Hesitantly, hands started to rise, until nearly 80 percent of the men agreed to take advantage of this important benefit. Fortunately, this story has a happy ending. After coaxing the men into the clinic for their physicals in a one-on-one, doctor-to-patient situation, the adept medical staff was successful in convincing nearly all of the men over the age of 40 to participate in the prostate exam.

Anonymous on 3/31/2008 8:49:25 AM
I would like to see more emphasis on non traditional sports for school age children.  When we target team sports we are only reaching a small percentage of our students.  I would like to see individual sports such as archery -( National Archery in the Schools Program, ) rifle sports ( NRA/4H) ,  cross country running,  become institutionalized in the schools.  These are life long sports and do not target gender.  They are individual sports where students can set individual goals, develop self esteem, and life long interest in other outdoor activities.

Nechama Wildanah CPM on 3/29/2008 2:55:23 PM
I'm glad to see that health equity and an end to health disparities has been identified as a goal.  I hope that Healthy People 2020 will address the health disparities between men and women, and our awful track record of maternity care in the U.S as a women's health issue.  Birth is an important life cycle event for women, and I think our practices during the childbearing year need to be evaluated.  Many of our current maternity care practices (ie a 30% cesarean rate, high rates of episiotomy and epidural use etc.) harm mothers and babies.  Most interventions used in maternity care are not evidence-based, and I veiw their common use as a barrier to many women's overall health.  I feel that not taking the time to study interventions that affect the health of so many women before putting them into practice represents an inequity in research and in policy. I feel that studying interventions should also invovle talking with women, and should look at their overall childbearing experience, and their sense of ownership of their experience. We need to also look at normal childbirth, free of intervention, and at midwives as care providers.  I hope that Healthy People 2020 will make women's health and maternal child health a priority.

Anonymous on 3/24/2008 10:01:02 PM
The Women, Infants, and Children supplemental food program does not support the breastfeeding objectives in Healthy People 2000 and 2010.  The first food package for the infants who are on this program should be breast milk and breastfeeding support for the mothers.  More infants would be breastfed and overall better health for the infants and the mothers would result in the families who are served by the WIC program.  This must be seriously considered in order to achieve optimal health for women, infants, and children and to support the purpose of the national health promotion and disease prevention objectives in the Healthy People document.

Anonymous on 3/19/2008 10:17:59 AM
Every year about 30,000 people are killed by guns in America. Two to three times that number are injured. The cost of the injuries is estimated at 100 billion dollars each year. This is a public health epidemic and we still are not getting information to the public on a wide spread basis about prevention. And these deaths and injuries are all preventable.

75% of the children killed by firearms are killed in their own homes or the homes of a friend or relative. These are all preventable accidental shootings.

A study by the University of Pennsylvania and Emory University showed that over 3/4 of the children studied as they were left in a playroom with a gun, found the gun and picked it up. All of their parents had been convinced that their child would not touch the gun at all because they had previously had a conversation with their child and felt they understood the danger and would leave the gun alone and tell an adult.

An attempted suicide is more often fatal if a gun is used in the attempt. Most guns used in suicides were from their own home.

A UNC- Chapel Hill study showed that only 50% of parents who are gun owners, lock their guns. 56% of people who don't have kids but have children who visit their homes, lock them.

Locally we are addressing this by working with several Duke Pediatric Clinics in Durham, NC to make it standard practice to inquire about firearms in the home during 6 month well-baby checkups. A questionnaire that asks about other safety concerns- use of car seats, etc. is given to parents before they see the doctor. Parents who indicate a need are given a free gun lock at the clinic. All parents are given an ASK (Asking Saves Kids) brochure and urged to asked about the presence of firearms in the homes their children visit and how they are stored.

In North Carolina we recognize that this is a Public Health crisis that needs to be addressed. That is why we are here today, to raise awareness that prevention works and can greatly reduce needless gun deaths and injuries.

Anonymous on 3/19/2008 10:17:56 AM
Every year about 30,000 people are killed by guns in America. Two to three times that number are injured. The cost of the injuries is estimated at 100 billion dollars each year. This is a public health epidemic and we still are not getting information to the public on a wide spread basis about prevention. And these deaths and injuries are all preventable.

75% of the children killed by firearms are killed in their own homes or the homes of a friend or relative. These are all preventable accidental shootings.

An attempted suicide is more often fatal if a gun is used in the attempt. Most guns used in suicides were from their own home.

A UNC- Chapel Hill study showed that only 50% of parents who are gun owners, lock their guns. 56% of people who don't have kids but have children who visit their homes, lock them.