Anonymous on 2/27/2009 8:36:10 PM
I agree that there needs to be an increase in public awareness and understanding of the causes of disease. Even a lot of people who know about them still don’t know enough to know how it affects them. Kids are walking around becoming morbidly obese and all you see on TV are infomercials about how adults can lose weight. So of course the kids are now trying to do all of those diets when that’s not the issue, but they don’t know any better. I feel that healthy people 2020 needs to reach schools as well as the community. I didn’t know about healthy people until I got to this University, and that may be too late for someone else.

Anonymous on 2/11/2009 4:26:57 PM
I feel that there needs to be an increase in the educating and understanding of causes of disease and how to prevent and protect from them. In our society today there are too many diseases being spread and too many teen pregnancies. I feel it is lack of knowledge among our younger generation. Something needs to be done to promote awareness. These are things that can be prevented for our health.

FitnessOK on 2/10/2009 9:52:09 PM
I think think this is an exciting thing that will help many of us in the fitness world to have a focus for our facilities and programs.  I am always looking for ways to motivate, teach and encourage our community to get active while promoting our facility.

Anonymous on 2/3/2009 5:12:44 PM
I believe that there should be stronger action taken to be held accountable to these goals that have been set. The reinforcement of the implementation of these proposed policies will help to ensure that progress will be made torward the goals that we wish to achieve.

Anonymous on 11/4/2008 12:31:38 PM
I have read over many of the really important comments/feedback presented by individuals here.  This is very important information and gives ideas and other issues to consider.  I hope these will be raised in future meetings.  I also very firmly agree with others that nursing should have representation, if it still does not.  Nurses play an important role in health promotion and involvement.  If looking at issues from a multidisciplinary approach, nursing representation should be included.  Thanks.

Anonymous on 10/21/2008 10:19:08 AM
I think there needs to be a stronger statement on the implementation of policies that will support these efforts.  If there is no infrastructure to support these outcomes then they will not be sustainable.  An example are the Comprehensive Cancer Efforts of the CDC, the collaborative that got funding thrived while those that didn't continue to struggle.  This funding could have been secured by a commitment from the state.

Anonymous on 9/27/2008 11:32:50 AM
It would be helpful to include in your goals the approach of resilience otherwise, disease focus will be the only focus.

Consumer Federation of America on 9/15/2008 10:19:52 AM
(CFA Comments Continued...)
•	August 2008, Nebraska Beef recalled 1.36 million pounds of meat because of possible contamination of E. coli O157:H7, related to an outbreak that resulted in at least 26 illnesses in 10 states; 
•	May – August, 2008: In one of the largest foodborne illness outbreaks in recent years, 1442 persons in 43 states were infected with Salmonella Saintpaul. At least 286 persons were hospitalized and the infection may have contributed to two deaths. Jalapeño peppers, Serrano peppers and tomatoes were identified as sources of the outbreak.  

Outbreaks such as these will only continue unless we repair our broken food safety system. This requires increased vigilance and attention to food safety at the highest levels of government. It is crucial that the federal government maintain, if not increase, its emphasis on food safety in its National Health Objectives. 

Inclusion of key topic areas in the 2020 National Health Objectives is instrumental in helping the federal government focus on important public health problems. From these focus areas flow strategies and programs designed to reduce the impact of these problems on the population. It is critical that the advisory committee include food safety as one of its focus areas for the 2020 National Health Objectives.  Foodborne illness is an important public health problem and it is vitally important that the 2020 National Health Objectives maintain the focus on food safety that was in the 2010 Health Objectives. Without such a focus, the federal government and other stakeholders will be hindered in combating what is largely a preventative disease.   

Sincerely, 

Chris Waldrop
Director, Food Policy Institute

Consumer Federation of America on 9/15/2008 10:18:57 AM
Consumer Federation of America is pleased to provide comments on the Health Promotion and Disease Prevention Objectives for Healthy People 2020. 

CFA is a non-profit association of over 300 organizations, with a combined membership of over 50 million Americans. Member organizations include local, state, and national consumer advocacy groups, senior citizen associations, consumer cooperatives, trade unions and anti-hunger and food safety organizations. Since its founding in 1968, CFA has worked to advance the interest of American consumers through research, education and advocacy.  CFA’s policy positions are determined by vote of member representatives at board meetings and the annual meeting. CFA’s Food Policy Institute was created in 1999 and engages in research, education and advocacy on food and agricultural policy, agricultural biotechnology, food safety and nutrition.

Food Safety Should Be a Focus Area in the 2020 National Health Objectives 
CFA has serious concerns about the proposed list of focus areas that have been developed for the 2020 National Health Objectives. The focus areas have been limited to approximately ten to fifteen, down from twenty-eight focus areas in the 2010 Objectives. These topic areas are critically important because the federal government develops its disease prevention and health promotion objectives for the United States around these key areas. 

The 2010 list of focus areas included the area of Food Safety. This was appropriate because foodborne illness has a serious impact on the people of this country. The inclusion of food safety helped focus federal government activities in developing important measurable objectives for reducing the impact of foodborne illness on the population. These objectives provide an important marker against which federal agencies measure progress in their efforts to improve the safety of the food supply for consumers. 

Unfortunately, the 2020 National Health Objectives do not include Food Safety among its list of focus areas. There is no substantive justification for the Department of Health and Human Services to drop food safety as a focus area. In fact, it is particularly inappropriate to do so at this time for three reasons. First, foodborne illness is a serious public health problem in the United States. Second, progress in reducing the rate of illness associated with major foodborne pathogens has stalled. Third, the recent spate of nationwide foodborne illness outbreaks has demonstrated the need for increased vigilance in reducing the impact of foodborne illness. 

Given this, both the media and the American people might interpret dropping food safety as a focus area for Healthy People 2020 as an effort to direct attention away from a record of failure. CFA strongly urges the advisory committee to include food safety as one of its focus areas for the 2020 National Health Objectives and to set goals to be met by 2020. 

Food Safety is an Important Public Health Issue
Foodborne illness is a considerable public health problem. Each year in the United States, 76 million people are sickened by a foodborne disease, 325,000 are hospitalized and 5,000 die . Although foodborne disease can afflict anyone, those most at risk include children, pregnant women, the elderly and persons with compromised immune systems. The economic toll on society is large as well. The U.S. Department of Agriculture’s Economic Research Service estimates that the annual economic cost of medical care, productivity losses and premature death for just five foodborne pathogens is $6.9 billion .

Foodborne illness is primarily a preventable problem. But an adequate prevention system requires comprehensive and measurable goals and objectives set out by the federal government. Comprehensive strategies can then be developed to meet those goals and objectives. Setting measurable goals and objectives is essential to developing the necessary strategies that will reduce the risk to consumers of pathogenic contamination of the food supply. 

Progress on Reducing Foodborne Illness is Far From Complete
Another reason to include Food Safety in the 2020 National Health Objectives is because efforts to improve food safety are far from complete. Data from the CDC in 2007 shows that much of the progress in reducing the impact of foodborne illness on the U.S. population has now stalled, particularly for E. coli O157:H7 and Salmonella. The rates of illnesses from these pathogens remain close to the original baseline data of 1996-98. (MMWR, 2008) While there were major reductions in foodborne illnesses in the late 1990s, there has been little progress since 2001. Salmonella infections are more than double the National Health Objective of 6.8 cases per 100,000 population. The U.S. actually reached its National Health Objective for E. coli O157:H7 in 2004, but was unable to sustain that success and illness rates have increased in subsequent years. Progress in reducing Campylobacter infections has stagnated. Most concerning, the U.S. government has failed to meet its National Health Objective for Listeria for three years in a row. The illnesses from this pathogen are so serious that, in 2000, President Clinton moved forward the goal of reducing Listeria related foodborne illness to 2.5 cases per million to 2005 and the U.S. has not been able to meet that goal. 

These statistics demonstrate that substantial progress is not being made in efforts to control foodborne illness. Although various government and food industry resources and efforts are focused on reducing the potential for contamination, exposure to foodborne pathogens continues to result in a high foodborne illness burden among the U.S. population. In January 2007, the Government Accountability Office, Congress’ investigational arm, designated the U.S. food safety system as a “high risk” area of the federal government and recommended a fundamental reevaluation of the federal food safety system . This only underscores the importance of maintaining Food Safety as a key topic area in the 2020 National Health Objectives. Without such emphasis, we will continue to lose ground in the fight against foodborne illness. 

Recent Foodborne Illness Outbreaks Demonstrate Need for Increased Vigilance
Additional evidence of the need to maintain a strong focus on food safety has been seen in the recent spate of nationwide foodborne illness outbreaks linked to a wide variety of foods. The extent and frequency of these outbreaks over the past two years indicate a broken food safety system that needs greater attention and focus. A brief highlight of major foodborne illness outbreaks demonstrates the importance of maintaining a strong emphasis on food safety. 

•	September 2006: 204 people were sickened and three died as a result of an E. coli O157:H7 outbreak linked to bagged spinach that was produced in California and distributed across 26 states and parts of Canada;
•	November and December 2006: 152 persons were sickened and 79 persons hospitalized as a result of two E. coli O157:H7 outbreaks linked to leafy greens at Mexican fast food restaurants;
•	March 2007: the CDC reported that 425 persons in 44 states were sickened after eating a national brand of peanut butter contaminated with Salmonella; 
•	September 2007: Topps Meat Company recalled 21.7 million pounds of frozen ground beef products because of E. coli contamination linked to 40 illnesses in 8 states; 
•	October 2007: 272 persons in 35 states were sickened in an outbreak of Salmonella I 4,[5],12:i: linked to Banquet brand pot pies; 
•	February 2008: USDA announced the recall of 143 million pounds of raw and frozen beef products from Hallmark/Westland Meat Packing Company as a result of violations of human handling requirements. A large portion of this meat had been sent to the National School Lunch Program; 
•	August 2008, Nebraska Beef recalled 1.36 million pounds of meat because of possible contaminat

Anonymous on 9/14/2008 5:31:38 PM
On behalf of S.T.O.P.--Safe Tables Our Priority, I appreciate the opportunity to comment on the Healthy People 2020 program and to specifically express our organization's deep concern with the exclusion of food safety in its goal setting and objectives process.  We find this particularly upsetting after our country's having experienced another record year of contaminated food recalls and foodborne illness outbreaks.

S.T.O.P. is a national, non-profit public health organization dedicated to preventing illness and death due to pathogens in our nation's food supply.  S.T.O.P.'s work involves advocating sound public policy, building awareness of foodborne risks and its management, and providing victim assistance.  S.T.O.P. was founded in 1993 in the aftermath of the Jack-In-The-Box E. coli O157:H7 epidemic from contaminated ground beef that occurred in California and throughout the Pacific Northwest, the watershed event that catapulted food safety to public attention.  S.T.O.P. has worked with thousands of foodborne illness victims and their families over the years and has been active in participating in the food safety debate.

The Centers for Disease Control and Prevention estimates that every year 76 million Americans suffer a foodborne illness; 325,000 require hospitalization; and 5,000 people die.  Most vulnerable populations to the most severe forms of food poisoning include children, the elderly and those with compromised immune systems, which include pregnant women, people undergoing cancer treatment, diabetics and people with HIV.

The economic burden to society is equally daunting.  In 2000, the USDA's Economic Research Service estimated the financial burden at $6.9 billion for just the six most common pathogens known at that time.  This estimate does not take into account any tangential costs such as travel, child care, mental therapy or cost of pain and suffering.  Nor does this estimate account for costs associated with chronic illnesses that can result in shortened life expectancy.  S.T.O.P. is so concerned with the underestimation of the financial burden to society that we are in the process of developing a foodborne illness victims data base along with a research project on the long-term effects of foodborne illness on survivors.  This is in order to get a more accurate measurement of the true economic burden of foodborne illness, a determining factor in allocating government resources to the various food safety agencies.

Goals and standards build accountability and promote continuous improvement on the part of  government and industries.  Holding government agencies accountable with specific goals essentially puts an onus on them to be vigilant in promoting and enforcing stonger programs on behalf of the public's health and safety.  The food safety agencies participation in such a program is crucial.

We strongly urge the architects of the Healthy People 2020 Objectives to recognize food safety as a critical public health concern and include it in its program.

Respectfully submitted,

Nancy Donley
President and mother of Alex (1987-1993)
S.T.O.P.--Safe Tables Our Priority

The Center for Science in the Public Interest on 9/12/2008 10:37:16 AM
Re: Comments on the Development of Healthy People 2020 Objectives (FR Doc. E8-18299 Filed 8-7-08).
	
On behalf of the Center for Science in the Public Interest (CSPI), we appreciate the opportunity to comment on the development of the Healthy People 2020 Objectives.  CSPI is a nonprofit health advocacy and education organization focused on food safety, nutrition and alcohol issues. CSPI is supported principally by the 900,000 subscribers to its Nutrition Action Healthletter and by foundation grants.  We accept no government or industry funding. 

CSPI is very concerned by the exclusion of food safety from the list of potential topic area categories to organize the 2020 Healthy People Objectives.  Food safety was identified as one of 28 Focus Areas in the Healthy People 2010 Objectives, and these objectives have been widely used to analyze and measure the effectiveness of federal food safety programs.  Recent food safety problems indicate that now is not the time to turn attention away from this critical issue.

The current proposal lists 12 potential topics, ranging from physical activity to preventive services by life stages, but fails to recognize food safety as a discrete issue.  We see this as a critical oversight.  While we appreciate the desire to streamline the document—as evidenced by the Draft Model objective to reduce topic areas and objectives—food safety cannot be ignored.

Each year 76 million Americans get sick, 325,000 are hospitalized, and 5,000 die from foodborne hazards in the United States, according to the Centers for Disease Control and Prevention (CDC).  Cost provides another measure for recognizing the critical state of food safety and foodborne illnesses.  The Department of Agriculture Economic Research Service estimated the economic costs of hospitalizations, lost productivity and death from the five most common pathogens as $6.9 billion in 2000.  The greatest percentage of this cost is from premature death, which occurs primarily in people over age 65 for Salmonella and children under age five for E. coli O157:H7.  The elderly, people with compromised immune systems, pregnant women, children and infants are most at risk of serious illness from foodborne illnesses.  Many pathogens, including Salmonella, Campylobacter and pathogenic E. coli can lead to chronic illness and reduced life expectancy.

The Government Accountability Office (GAO) designates food safety as a high risk federal government program.  Agriculture, including all food production, is about 13 percent of the gross domestic product, and is the largest industry and employer in the country.

Further, the inclusion of food safety as a Healthy People 2010 objective has provided important benchmarks for measuring food safety improvements and failures.  The public health agencies tasked with ensuring food safety—including FDA, CDC, and USDA—routinely cite Healthy People 2010 and compare the progress made in relation to the objectives in support of their work.

For example, the CDC’s FoodNet Data reports track diseases caused by common pathogens and compare rates of occurrence to previous years.  The success of various preventive programs is measured by progress toward the Healthy People 2010 goals.  Similarly, PulseNet is a national network of public health laboratories that performs DNA "fingerprinting" on bacteria that may be foodborne, and measures rates of infection against Healthy People 2010 objectives.  USDA’s Food Safety and Inspection Service Salmonella standards and agency budget requests also regularly reflect the food safety emphasis evidenced by Healthy People 2010.

Food safety is an issue of critical importance to American consumers, one that is frequently highlighted in the media with press reporting on outbreaks and recalls.  Examples of this over the last two years include outbreaks from pathogenic E. coli in spinach and ground beef, Salmonella in peanut butter, tomatoes and Serrano peppers, botulism in canned foods, among others.  Public health officials, consumers, and food safety advocates need the Healthy People 2020 metric to measure the effectiveness of regulatory controls and it has been regularly used by CDC, FDA and USDA in evaluating and reporting to the public on their programs.  Important data and attention can be gained from the inclusion of food safety among the objectives highlighted by Healthy People 2020.

The absence of food safety in the Healthy People 2020 objectives represents a failure to adequately acknowledge this critical public health need.  We therefore urge the drafters to include food safety among the other important issues to be addressed in the forthcoming document.

Sincerely,
					
Caroline Smith DeWaal
Director, Food Safety
Center for Science in the Public Interest

American College of Obstetricians and Gynecologist on 9/4/2008 5:23:59 PM
•Statement #1 would be enhanced if it read: “ Increasing public awareness and understanding of the underlying causes and contributing factors for health, disease, and disability;  
•Statement #2 would be enhanced if it read:  Providing nationwide priorities that are responsive to emerging health issues as well as measurable objectives and goals.

Partnership for Food Safety Education on 9/2/2008 2:17:14 PM
The Partnership for Food Safety Education urges that food safety not be removed as a topic area in development of Healthy People 2020 and points to the four draft mission statements of HP 2020  as consistent with the inclusion of food safety as a key topic:

* "to increase public awareness and understanding of the underlying causes of health, disease and disabilty."  We support the emphasis on public awareness and understanding.  Education is a critical aspect of reducing risk of foodborne illness through people's safe food handling practices.  

* the goal to "provide nationwide priorities & measureable objectives and goals" is critical.  Specfic goals for reduction of infections caused by specific foodborne pathogens should be retained in HP 2020.  By setting specific targets for reduction of infection linked to different pathogens there is a common set of benchmarks briding the multiple government agnecies that have responsibility for the food safety system in this country.  This approach has been working since HP 2010 - and it has been critical to developing regulatory and educational approaches to reducing illness from specific pathogens.  Such specific benchmarks allow for the multiple Federal agencies with jurisdiction, and the food industry, to work from the same page on national illness prevention strategies.  

* as well, the Partnership supports improving research and data collection related to the impact on public health of foodborne illness and a strengthened system of data collection on the types and causes of foodborne illness outbreaks.

Partnership for Food Safety Education

Anonymous on 8/30/2008 1:57:03 AM
For a focus on the needs of women, US birth practices rise to the top of my list.  I would love to see more health promotion in the following topic areas:
  
* the benefits of normal birth (and the risks of interventive birth practices)

* breastfeeding promotion (and not acquiescing under pressure to de-emphasize its benefits, driven by an entire industry that thrives on breastfeeding failure)

* the importance of cardiovascular health (across the lifespan) 

* awareness and prevention of domestic violence (homicide being one of the leading causes of death in pregnant women - totally preventable, in theory at least)

* the cesaerean birth epidemic and the unacceptability of "vaginal birth bans" in any US birth facility

* transparency in data management - this would enable citizens to be better consumers, and evaluate options in health care resources themselves

* the health insurance industry, being a driving force in health care economics, needs serious attention - as in any other market economy, competition should drive the market, with reward for excellence, and where low-quality providers are unable to stay in business (this also impacts the malpractice insurance industry and I am concerned about potential conflicts of interests that might emerge from these industries being so intertwined)

* more resources devoted to public health systems

* an emphasis on the Midwives Model of Care and how its use (by all categories of professionals, including physicians) could be expanded - with greater application of this model, marked improvements on nearly all indices of maternal and child health could be accomplished, practically overnight

Thank you for this good work!

Sincerely, Angelita Nixon

VF Gurley on 8/29/2008 6:21:27 PM
As with the vision statement, the first mission statement "Increasing public awareness and understanding of the underlying causes of health, disease, and disability;" implies a scope that is limited to physical health.  If the statement was modified to state "..underlying causes of health, well-being, disease and disability" the mission would more clearly encompass the non-physical factors that contribute to health in the physical, emotional, social and environmental senses of the word.

Kate Palliative Care on 8/29/2008 10:59:01 AM
I do not see any reference to "quality of life" or "wellness" in the Vision and Mission or in these four draft statements. As an organization that works with people who are trying to live the fullest life possible for as long as possible, whether they be  patients trying to maintain mental health or caretaking family members trying to maintain physical and mental health in the midst of enormous stress, it is important to address "quality of life" or "wellness" issues in this growing constituency. By including "quality of life" in your vission and mission, you make it cler that you will not abandon them.

JacquieO on 8/12/2008 9:17:16 PM
VITAMINS & SUPPLEMENTS

Through research, the medical community now recognizes the value of vitamin and herbal supplements in some cases.  For example, niacin (B3) is an excellent way to raise HDL (good cholesterol) and is routinely prescribed by cardiologists.  Calcium and vitamin D supplements are prescribed for osteoporosis.  Supplements can be expensive and recommending that they be an allowed FSA expense would make them more affordable and thereby encourage a healthier lifestyle.  

Regulating supplements through the FDA would have a negative impact on health promotion since it would require medical visits to get prescriptions and increase costs because of mandatory FDA research for a prescription-drug designation.  Something similar happened recently with quinine, a prescription malarial drug routinely prescribed for leg cramps.  Quinine is an old drug known for it's safety, but an American drug company conducted new research and qualified to use their new patent with the FDA.  It was remarketed as Qualaquin.  The only ingredient?  Quinine.  People now pay nearly $200 for something that costs $4 for 30 days.

Recommendations as to keeping vitamins and other supplements freely available helps people to maintain a healthy lifestyle without increasing costs for the supplements themselves or adding unnecessary medical visits.

JacquieO on 8/12/2008 9:10:14 PM
The high cost of healthy foods including vegetables, fruits, and dairy impacts the development of obesity, type II diabetes, gout, heart disease, and more in adults.  The least expensive and filling foods form the basis of meals for the poor and elderly on fixed incomes.  Suggested or existing programs that increase awareness are not effective for the poor and elderly because these populations cannot afford to purchase those healthy choices even when they know what they are.  Perhaps we need a program that provides a debit card to be used only for the purchase of vegetables and fruits for most people except for those with the highest incomes.  The rising costs of healthy food choices are now making them unaffordable to the middle class as well.  Instead of spending millions more dollars on additional, unnecessary research that concludes with the same findings or "educating" people on healthy food choices, give the millions consumers to purchase the appropriate foods they need to be healthy.  

Here is something novel:  How about a law mandating that for every single, unhealthy food product a manufacturer sells with addictive ingredients such as corn syrup and sucrose or unhealthy and unwanted GMO ingredients the manufacturers would be required to put out another single product with no unnecessary additives to enhance flavor (sugars) or increase their profit (GMO).  Then, average Americans could make healthy choices without paying the price of "organic."

JacquieO on 8/12/2008 8:58:31 PM
Weight loss is key to reducing obesity and increasing health and longevity.  Doctors are able to make patient recommendations, but periodic medical visits are not enough to provide the support necessary to help people make difficult lifestyle changes.  Addressing a multiplicity of psychological aspects can be accomplished by making group exercise programs readily available.  For numerous reasons, this enhances continued motivation and helps ensure successful weight loss.  Yet, gym memberships and physical therapy present an expensive barrier.  How about a requirement that non-profit hospitals assign space at their hospital-owned physical therapy centers at no-cost to existing patients of participating doctors?  This would be best since exercise equipment is readily available.  Another possibility is that each municipality provide free space in their community buildings for the purpose of group exercise programs and the provision of federal grants to purchase exercise equipment.

JacquieO on 8/12/2008 8:45:22 PM
The goals of increasing public awareness and identifying critical research and data collection needs converge with the issue of the leading cause of blindness in the US.  According to the World Health Organization, leading causes of blindness vary by global geographic location.  Where eye examinations are rare in third world locales, the leading causes of blindness are glaucoma and cataracts.  In developing nations where refined foods have recently become available and obesity rates rise, the leading cause of blindness is diabetes.  In developed countries, macular degeneration leads all causes of blindness.  Researchers are frantically seeking a genetic cause or something treatable by medical technology or pharmaceuticals.  

No one wants to discuss the dirty, little secret available on the FDA website.  Slit lamp examinations and hand-held ophthalmoscopes used on dilated pupils shines the equivalent of the sun's rays directly on the retina.  Exposure to sunlight is a known factor in the development of the not-yet-treatable, dry form of macular degeneration.  The genetic association is less plausible since everyone in the US is genetically related to people in less-developed nations where macular degeneration is not a health issue.  All of the eye examinations conducted in developed countries to detect and prevent blindness from cataracts, glaucoma, and diabetes may well be the cause of the macular degeneration epidemic, especially if you consider the universal (albeit anecdotal) claim of seniors who report losing their vision immediately following an eye exam.  

The FDA notation on slit lamp and ophthalmoscope safety is that a UV filter lens should be added to the equipment.  Try finding a private practice or major university that uses one.  There should be a recommendation to mandate the use of UV filters on all lighted equipment used during eye examinations.  To do less is to participate in unnecessary eye damage.

craig lefebvre on 8/6/2008 10:04:08 AM
Incorporating the following principles into the framework and purpose of Healthy People 2020:

1. Adoption of a consumer-focused (or agent-based, customer-centric, end user driven) approach to the development and achievement of each objective.

2. Focus on citizen engagement throughout the development, implementation and evaluation of Healthy People 2020.

3. Design of objectives and processes that strive for ubiquity, or pervasiveness, and are relevant to people’s lives – i.e., helps them achieve their personal aspirations and be productive members of society.

4. Recognition that health information, in all its forms and manifestations, is only as useful as it is relevant and accessible when people need and want it.

Angela on 7/23/2008 1:01:28 AM
I am very discouraged that a nurse is not on the advisory commitee for healthy people 2020. I believe the nursing voice is vital to this comittee and should be represented.

Denturist on 7/15/2008 12:27:45 AM
"Regulating the denturist profession across the Nation in providing affordable denture care for Americans is the little thing we can do to help with the current healthcare crisis Americans are dealing with. People are healthier and more productive when they have a denture that functions properly."  Gary W. Vollan L.D.

pandora on 7/9/2008 6:10:14 PM
I am very disappointed.  How can you not have any nurses on your advisory committee?  Nurses have more contact and more influence on the community then anybody and what your implying is that all of our input is not of value to your committee?  I have long used the available information on your web site and though highly of the work that you are doing, but I wonder if you are missing an important resource.

Tracy on 7/1/2008 8:00:14 PM
Please, please, please add at least one nursing position to the Advisory Committee!  Nurses are the largest body of professional healthcare providers!  Nurses are holistic and focused on the human response to illness or potential illness!  Nurses consider disease prevention to be at the very core of what we do.  Who is better to consider these issues and set goals for the health of our nation?

I believe that the credibility of this initiative is in jeopardy without nursing representation.

The American Academy of Ophthalmology on 6/16/2008 10:49:38 AM
The Federal government spends more than $4 billion annually in benefits and lost taxable income due to blindness and vision impairment. The American Academy of Ophthalmology believes that eye and vision health is critical for healthy people to live independent lives; therefore, it is essential that vision objectives be included in the Healthy People 2020 framework that is currently being developed.   

Eye disease is a major public health problem in the United States that causes significant suffering, disability, loss of productivity, and diminished quality of life for millions of people.  Blindness and vision loss affects more than one million Americans age 40 and older. Public opinion polls have consistently identified fear of vision loss as second only to fear of cancer.  It is widely believed that half of all vision loss can be prevented by early detection and treatment. 

More than half of all Americans will suffer some form of eye disease in their lifetime– one out of three people by age 65, and one of two by age 80. And yet, a recent survey found that the majority of Americans do not think they are at risk for developing eye disease and do not know the risk factors associated with the diseases. As the 78 million baby-boomers become age 65, the number of Americans that will develop age-related macular degeneration, cataract, diabetic retinopathy and glaucoma is expected to grow dramatically and the resultant financial burden on the nation’s economy and public health system will be significant. According to the US census projections, the number of people turning 60 each day in 2006 was 7,918.

Blindness and visual impairment from most eye diseases and disorders can be reduced with early detection followed by appropriate treatment.  The importance of early detection and intervention to public eye health through screening and regular vision exams must be central to any responsible public health strategy.  Health education programs directed at those who are at greater risk for eye diseases and disorders are important tools in preventing blindness and visual impairments.  

The American Academy of Ophthalmology urges the Department of Health and Human Services to include vision in the HP 2020 framework and we look forward to working with you to develop appropriate vision objectives within the framework.

TW Marcy on 5/25/2008 6:31:17 AM
As a physician, I support the national effort to establish Healthy People 2020.  However, I would like the proposed overarching goals to more explicitly include health systems changes in hospitals and physician offices that would improve the delivery of health promotion and behavior change interventions from these sites. One possible approach is to include a new overarching goal: “Support health system changes that promote good health for all.”  Or, overarching goal number three could be changed to state “Strengthen and change social environments, physical environments and health systems so that they promote good health for all.”

Sara Delafield on 5/22/2008 11:45:19 AM
On behalf of Team Act, the Tobacco Cessation Center I would like to support the national effort to establish Healthy People 2020. As a health care administrator, previous guidelines have provided a comprehensive framework for developing measurable goals and objectives.   The proposed vision and mission include areas of participation for a diverse and comprehensive group of stakeholders to foster awareness of the underlying causes of disease and disability, and develop improved health outcomes by implementing evidenced based programming which can then be evaluated.

Anonymous on 5/4/2008 11:25:42 PM
As a Family Nurse Practitioner I believe a nurse should serve on the committee developing the objectives for Healthy People 2020 and should have a nurse member permanently.  Nursing is the largest work group in the health care system and are responsbile for the delivery and education of health care to our population.  Having a permanent nurse member will ensure a well rounding committee that is in the best interest of the public.

Community United Against Violence on 5/1/2008 9:55:12 PM
I recommend that when the research team begins to collect and analyze data related to causes and co-factors that might lead to “health, disease, or disability”, there should be as much importance placed on psychological, social, and economical factors as on biological ones. When factors that are more “environmental” in nature are ignored, issues such as intimate partner violence and different forms of hate violence are disregarded and in consequence their physical and psychological effects on survivors are unnoticed     .

The team should also use or develop research tools that are specific to the Gay, Lesbian, Bisexual, and Transgender Communities, given that violence within and against these communities is very prevalent. In addition, using tools that work as “blankets” will make physical and psychological trauma INVISIBLE in these groups.

I therefore recommend that Violence is seen as a health issue, and that the most affected communities are looked at with the most appropriate tools so that public awareness is truly improved and the evidence collected for evaluation will in fact be accurate.

Arizona Department of Health Services on 5/1/2008 7:48:10 PM
Regarding the first draft statement, we recommend the following modification:
 ‘Increase public awareness and understanding of the underlying causes of health, disease, and disability -- that lie both within and outside the health sector’. 
Because many of the social determinants of health lie outside the health sector, i.e.: built environment, employment, place of residence, etc, we would suggest making this explicit.

National Latina Institute for Reproductive Health on 4/30/2008 9:43:32 AM
The four draft statements should be edited as follows:
o	Increase public awareness and understanding of factors that contribute to health, health inequities, chronic illness, and disability.
o	Improve results in eliminating health inequities and improving health by providing nationwide priorities and measurable objectives and goals to guide effective strategies and tactics. 
o	Catalyze action using the best available evidence to improve policy and practice. 
o	Identify research and measurement priorities for improving the evidence base for action and evaluation.

kwildes on 4/28/2008 3:53:19 PM
I also agree we should be looking at our food supply and production. High fructose corn syrup is one example that comes to mind-more awareness of the general public about this common ingredient and it's unhealthy effect on the human body would be a step in the right direction.

Dor Mullen on 4/15/2008 4:06:24 PM
More research and measurement are not what is needed.  We need to implement what we already know and don't apply.  The under-considered variable is the addictive nature of the national food supply.  The most expensive national addiction is not alcohol or cigarettes.  It's food.  When you add up the true cost to the nation of the overly refined food supply which consists of foods that act more like drugs than foods, food is in first position.  We lose.

Anonymous on 4/10/2008 11:25:56 AM
The first bullet point is curious..."underlying causes of health"?  It seems to me that health is the norm and does not have underlying causes - it is absence of health that has underlying causes...
There is also a need to address factors other than disease and disability that may undermine the quality of life (allowing for consideration of such things as stress, post traumatic stress disorder, child abuse, poor maternal-infant attachment, etc.)
I would suggest the following wording:
"Increase public awareness and understanding of factors that promote health, decrease productivity, and /or increase the risk or severity of disease and disability.

Anonymous on 3/31/2008 12:39:49 PM
I would encourage you to examine the impact of stress and sleep difficulties. I work on a college campus and these issues are huge for our population, yet they don't appear in Healthy Campus 2010, because there weren't objectives in HP 2010 related to stress management or improving sleep.

Anonymous on 3/29/2008 9:51:48 AM
The World Health Organization (WHO) and the CDC rank the US maternal mortality rate as 41st in the world. This is totally unacceptable.( African American women have a maternal mortality rate 3-4 times as high as white woman.)  As the most technological country in the world we should rank rank 1st, having the LEAST maternal deaths/ 100,000 births. The CDC goes on to state that this rate is UNDER reported, due to the fact that many states do not have a box on their death certificate that specifies whether or not the woman was pregnant at the time of death. Thus, no investigation into the CAUSE of death is done, and the death goes uncounted.
The high rate of interventions used in childbirth is one of the primary reason for this extremely  unnecessary high maternal morality rate.   Birth is the most natural, normal  process in life and it should be allowed to occur naturally. Birth should not be induced, forced, or operated ( C- Section) on, unless a PROVEN ( not assumed) emergency exists. The cascading of events that occur once a woman is induced ( or "augmented")  many times become life threatening. ACOG, after decades of subjecting women to an episiotomy, is now saying the procedure is not needed as a "standard of care" due to the evidence that the RISKS and adverse events following the procedure, outweighed the benefits. There are MANY studies showing that induction directly increases hyper-stimulation of the uterus, and of the fetus, putting both the mother and the baby at risk, and also is a direct cause of AFE ( amniotic fluid embolisms). The high ( close to 37%) rate of C-Sections done in the US, can be directly correlated to the induction rate. Studies go on to prove that the safer the mother feels during birth, in her surroundings and with her care, the more certain she is to have an unmedicated, natural birth. Studies also prove that babies and moms who do not have "pain medicine" and who are not "augmented" during the birth process, are healthier, have less post-partam  problems, are more alert immediately following birth, and generally do better faster and easier after the birth itself. 
One of the primary goals of Healthy People 2020, should be to 1) dramatically reduce the rate that labor is induced in the US. ( One San Francisco hospital reports and 85% induction rate), 2) reduce the C-Section rate in the US to 12% or below 3) educate woman and the public in general on "natural" interventions to reduce the intensity of contractions during labor, which will 4) dramatically reduce the medical intervention rate during labor, which in turn will 5) significantly reduce the maternal mortality rate in the US. All of these goals can be accomplished by public support and promotion of the Mother Friendly Childbirth Initiative, written by the Coalition to Improve Maternity Services (CIMS).  Promoting  natural birth  brings forth healthier moms, babies and ultimately Healthy People.

Anonymous on 3/26/2008 10:18:54 AM
Oral health has been a Focus Area in Healthy People in 1990, 2000, and 2010 and has played a significant role in enabling improvements in oral health.  This focus on oral health has encouraged collaboration among the public health, health care, education, voluntary, and private sectors and has resulted in programs and initiatives designed to both educate residents of the Commonwealth and treat those with limited access to dental care.  Despite these efforts there is still much to be done: 
        Dental caries (tooth decay) continues to be the most common childhood disease in Virginia.  It is five times more common than asthma and seven times more common than hay fever.

        Over 820,000 Virginians live in Dental Professional Shortage Areas.

        In Virginia, children from families living below the poverty level have almost 12 more restricted-activity days due to dental pain and disease than their counterparts from higher income families.

        About 50% of the Commonwealth’s citizens (3.8 million) have no dental insurance.  Most are adults.  (Children = 200% FPL have dental coverage via FAMIS.)

       The 2000 Surgeon General’s report, Oral Health in America: A Report of the Surgeon General stated unequivocally that good oral health is an important feature of overall health and wellness.

I live in a rural area where many people have problems with access to care.  Although I work in community health center where we provide care for the area, we have many problems with patients not coming to their appointments.  They don't have gas to get here or their car is broken down or they can't drive.  

Another problems I see is that the patients does not see the value in good oral health.  I believe this stems from several different issues.  1)  Their parents didn't have their teeth so they don't think they need teeth either until it's too late.  2)  I go into schools and do oral health education as part of outreach with my position at the health center, but there seems to be concern over how much time I will take away from the children and that may prevent them from learning the information they need to learn to perform well on the Standard of Learning tests.  3) Children do not get enough education about oral health to know how to take care of their teeth. 4)  If the parent or teacher does not see oral health as important, what chances does the child have to learn that it is unless we provide enough education in schools.  

I have volunteered to come to schools and teach children about oral health during children's dental health month in February.  There have been very few teachers that have called to take advantage of the opportunity.   I believe offering schools and those that deal with infants and young children is the place to start education.  Some how we need to help them to see the value in knowing how to care for themselves.

I have screened children's teeth in local elementary schools and indeed over 50% of the children in our area have dental caries.  Some of these children are in serious pain and have no one who can help them or don't know how to get help.  Caries  bacteria is contagious and it is preventable.  I believe education is the most important way we can help prevent dental disease.  Provding reliable transportation is another way we could help those who can not get to their dental appointments.

I would welcome comments.