Anonymous on 7/5/2008 2:23:07 PM
As a registered nurse of 40 years in leadership positions, I was shocked that a nurse was not a member of the 13-member advisory committee.  Nurses are pehaps one of the largest groups that will be involved in the grass-roots implementation of policies arising from this committee, yet their voice is muted in any decision-making as a committee member.  The USA begs for more nurses, yet overlooking them in this instance sends a terrible message.

Anonymous on 6/4/2008 3:23:04 PM
Public Comment on Healthy People 2020
Development Process and Draft Framework
May 2008


The American Psychological Association (APA) is pleased to provide comments as part of the collaborative process of building the framework for Healthy People 2020.  APA is the largest scientific and professional organization representing psychology in the United States and the world’s largest association of psychologists, with 148,000 members and affiliates. APA works to advance psychology as a science, as a profession, and as a means of promoting health, education, and human welfare. 

Since 1979, Healthy People has set and monitored national health objectives to meet a broad range of health needs, encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of our prevention activity.  Currently, Healthy People 2010 is leading the way to achieve increased quality and years of healthy life and the elimination of health disparities.

In anticipation of the upcoming regional meeting, which will take place on May 28, 2008, in Bethesda, Maryland, APA is grateful to submit comments and questions to help guide the discussions and presentations for Developing the Framework for Healthy People 2020 at this important event.   

Behavioral Research
Psychological scientists are eager to be partners in the development of Healthy People 2020 goals and objectives. Behavioral and social science is needed to inform the conceptualization and planning of the goals, and to measure progress toward achieving them. The National Institutes of Health (NIH) have funded important behavioral studies, such as the Diabetes Prevention Program, a modest lifestyle intervention shown to prevent development of diabetes in people at risk. NIH is now seeking to fund field studies to establish this intervention in communities around the country to measure its effectiveness with different groups and in different settings. In this instance and many others, NIH has clearly worked to fund research that can undergird recommendations for public health.  Are there mechanisms for NIH and its investigators to be informed about specific needs and gaps in knowledge observed by public health practitioners? Ideally translation will work from bench to trench, back to bench again. 

NIH has just added as part of its trans-institute Roadmap a pilot initiative called "The Science of Behavior Change." The purpose of the initiative is to establish the groundwork for a unified science of behavior change that capitalizes on both the emerging basic science and the progress already made in the design of behavioral interventions in specific disease areas. 
By focusing basic research on the initiation, personalization, and maintenance of behavior change, and by integrating work across disciplines, this Roadmap effort and subsequent trans-NIH activity could lead to an improved understanding of the underlying principles of behavior change. This should drive a transformative increase in the efficacy, effectiveness, and (cost) efficiency of many behavioral interventions. A timely question is, can this initiative, which is still in the planning stage, help advance the development of goals of Healthy People 2020? 

Children, Youth, and Families 

The following critical priorities affecting children, youth, and families have been identified to provide guidance to the Department of Health and Human Services (HHS) in its development of the Healthy People 2020 objectives involving this population.  As such, we recommend that in the development of the framework for Healthy People 2020, HHS should pay particular attention to the following areas:

1.	Quality of Life for Children and Families

a.	Quality of life is used an indicator of the effectiveness of health promotion efforts. Quality of life includes not only freedom of movement and access to care but also the ability to fully participate in daily activities without worry or concern about chronic health conditions. When children and family members are unduly concerned about their health, they are less able to fully participate in daily activities (e.g., work, school, leisure) and this concern can affect the well being of other members of the family.
b.	The ways in which we go about measuring quality of life in children, in particular, are underdeveloped. Too often child quality of life is determined by parent report which can be affected by parent mental and physical health status. 
c.	Quality of life is rarely the result of a single factor. Rather, multiple risks such as socioeconomic factors, co-morbidity of mental and physical health conditions, and access to care combine to predict quality of life. Thus, efforts to improve quality of life for children and families must take into consideration the economic, cultural, and social context in which children and families live.

2.	Health Disparities

It is not clear that we have made great strides in reducing health disparities for children, youth, and families.  For children, the higher prevalence rates of chronic health conditions, such as asthma, obesity, and early onset diabetes are just a few of the examples where disparities are not only present but also have been increasing over the past decade. Greater attention to the multiple risks associated with these increases is critical and urgently warranted.  Some prime areas to target include:

a.	Examining the influences of discrimination or oppression on the physical and mental health status of ethnic minority children, adolescents, and families;
b.	Researching the prevalence of disproportionate rates of stress-related illnesses in African Americans and other ethnic minorities; 
c.	Building on the culturally-based strengths and resilience of ethnic minority children and families in the promotion of mental and physical health;
d.	Exploring ways in which the healthy practices and lifestyles of ethnic minority families can be drawn upon to reduce health disparities;
e.	Investigating the influence of the disparate health practices of ethnic minority children, adolescents, and families on persistent health disparities; 
f.	Promoting safe communities and reducing the risk of violence exposure and trauma for children and adolescents; and 
g.	Encouraging healthy eating, active lifestyles, exercise, and movement in ethnic minority children, adolescents, and families. 

3.	Childhood Obesity and Healthy Family Lifestyles

We strongly urge the inclusion of obesity and healthy family lifestyles in Healthy People 2020. This must include coordinated efforts among policy makers, public health officials, and leaders in the private sector. A one size fits all approach has not, will not, and cannot work. Some main areas to target include:

a.	Food advertising to children;
b.	Promotion of physical activity in safe communities;
c.	Promotion of healthy nutrition and accessibility of healthy foods for all families regardless of income;
d.	Supporting home environments and providing families with the skills to create culturally rich home environments that promote healthy interactions; 
e.	Linking home, school, and community in healthy lifestyles;
f.	Promoting understanding of the stigma associated with weight;
g.	Promoting food policies that allow families to make healthy choices; and
h.	Identifying and exploring the complex cultural factors involved in the growing epidemic of childhood obesity.

4. Advertising to Children: Report of the APA Task Force on Advertising and Children

Task Force Report Findings

Commercial practices targeting children have experienced profound changes over recent years, resulting in unprecedented levels of advertising reaching young audiences.  The average child is exposed to more than 40,000 television commercials a year.  Approximately 80 percent of all advertising targeted to children falls within four product categories: toys, cereals, candies,

Divorce Minister on 4/30/2008 4:11:41 PM
The opportunity for those of us in the community to talk to you about goals and objectives is greatly appreciated. This morning I had the privilege of attending the Chicago Regional meeting and was amazed at the passion and insight of the attendees at the meeting. 

As a coordinator of divorce ministry, I have had too many years of experience watching families disintegrate when a marriage fails. Research abounds that shows the negative health and economic impact of divorce on the entire family. Marriage is the basis for our social and economic framework. In America, we now have two generations of young people who have not seen long-term marriages, and they doubt they are capable of ever achieving such a goal. Rampant cohabitation and serial divorce is all too common. Our families are in a health crisis and much of it stems from the high divorce rate. 

HHS, with the Healthy Marriage Initiative, has made a huge difference in providing funding for programs to help build healthy relationships for couples and singles. I have learned that people want to do the right thing. When people make faulty choices in relationships they suffer and often become ill as a result. When divorce happens, the health of everyone in the family is often compromised. Risky behaviors ensue and complications arise. 

Providing educational programs for singles to learn better mate selection is a requisite to improving health in America. Providing workshops for couples to learn to communicate with each other and to learn how to care for the marriage they are in is crucial to improving health in America. How much of a reduction of domestic violence might we achieve if we helped couples get and maintain the relationships they yearn for?

Children today are drifting on uncertain waters when they shuttle from mom’s house to dad’s house. The children that do not even have a relationship with dad or mom are suffering identity crisis. These situations are health concerns – both physical and emotional health are effected. 

The crisis of marriage and the family caused by divorce and domestic violence is affecting all aspects of public and private life in America. Your organization has tremendous power to get us back on track and build a healthier family network that then will be better able to demonstrate the standards of HP2020. The best of all health standards will not be applied if the families in which they need to be practiced are not structured and strong. 

Build Healthy Marriages and Healthy Families and the work of HP 2020 will flow much easier and more successfully.