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Secretary’s Advisory Committee on
National Health Promotion and Disease Prevention Objectives for 2020
Approval of Recommendations to HHS & Discussion of Topic Areas
Via WebEx
Ninth Meeting: February 23, 2009
Committee Recommendations (Approved by Vote)
- All Committee members who were present voted to approve the memo, “Recommendations for Immediate Actions in Support of the Health Objectives to Improve the Health of the American People.”
- All Committee members who were present voted to approve the Report of the Subcommittee on System Requirements, with modifications as noted below.
Next Steps
- The Committee reached consensus that the Topic Areas of Healthy People 2020 should not be organized under the four categories of the Mission Statement.
- The U.S. Department of Health and Human Services requested that the Committee finalize topic areas this month so that it can address target-setting methodologies at its March meeting.
- Ronald Manderscheid agreed to revise the System Specifications report to include the following additional elements:
- A third example of a potential system query that would address health determinants, and interventions to address them.
- The notion that funders need consider how to advance Healthy People by funding the kinds of programs that Healthy People supports.
- A recommendation that the platform for the database has to be flexible so that it does not quickly become outdated.
- An estimated range of costs to produce the system.
- The Committee decided that Subcommittee charges should be rephrased as a series of questions, and sent back to the full Committee for comment.
- Committee members agreed to notify NORC and/or subcommittee chairs of which subcommittees they would like to join, and to send their suggestions for potential external members.
- ODPHP and the Committee will keep informed of activities related to Healthy People 2020 that could align with the initiative (e.g. State of the USA’s health indicator set, or the activities of the Alliance to Make US Healthiest).
- Dr. Kumanyika offered to create an overview of the product of the Committee’s Phase II work.
- The Committee will hold a Web-based meeting in February. Monthly, Web-based meetings will be held throughout the spring. Members will determine at a later date whether they should meet in-person in the late spring or early summer.
I. Topic Areas: Presentation and Discussion
Dr. Jonathan Fielding, Chair of the Secretary’s Advisory Committee on Health Promotion and Disease Prevention Objectives for 2020, welcomed participants to the Committee’s ninth meeting. He explained that the agenda would begin with a presentation by Dr. Patrick Remington, Chair of the Subcommittee on Topic Areas, as Dr. Remington needed to leave the meeting early. The Office of Disease Prevention and Health Promotion (ODPHP) had asked for feedback by March on the Committee’s recommendations for “topic areas” to organize the Healthy People 2020 objectives, so there was a need for timely discussion on this issue. After the presentation, the meeting would follow the stated agenda.
Dr. Patrick Remington said that there had been strong participation in the discussions of the Subcommittee on Topic Areas. The Subcommittee had explored possible approaches to developing topic areas, which are organizing categories for objectives. He showed how the organizing categories for Healthy People had evolved over the decades. The 15 “priority areas” of the 1990 Health Objectives were clumped within the broad categories of health protection, health promotion, and preventive services; the 22 priority areas of Healthy People 2000 were organized within four categories (including the three from the previous decade, plus “data and surveillance.”) There were 28 “focus areas” for Healthy People 2010, and they were not organized within broader categories, but “enabling goals” were articulated.
The Subcommittee on Topic Areas proposed that Healthy People 2020 topic area categories might be organized under the four elements of the Mission Statement (see Appendix 1). The topic areas could build on earlier iterations of the initiative to offer some continuity, and add a new focus on health equity and determinants of health in the social and physical environment. Dr. Remington said the Subcommittee views topic areas as important “doors of entry” into the relational database. A remaining task would be to link the objectives together to show the logic for how a health outcome relates across the continuum of the framework—whether focused on diseases/health outcomes, or on determinants/programs and policies.
Dr. Fielding suggested that the Subcommittee develop a list of specific topic area categories for review by the Committee. Dr. Shiriki Kumanyika, Committee Vice-Chair, said it is important to link the topic areas to the framework to ensure that the areas in the framework are covered (especially the broad determinants and the life course issues). Dr. Remington concurred, and said the challenge would be to coordinate the overlap in areas where groups may be working on determinants as well as program and policy issues.
A Committee member asked whether topic areas would be assigned to a single Healthy People 2020 goal. She argued against doing this because, for example, not all disabilities are preventable. Another member responded that the Subcommittee on System Specifications had been using relational thinking to outline the mechanisms by which people will enter the Healthy People database. A dynamic approach to addressing topics from multiple entry points suggests that topics will be interrelated. The notion that a topic area would match up with a single goal is inconsistent with the trajectory of this thinking. Dr. Fielding summarized by saying that the table presented by the Subcommittee was helpful to ensure that no important issues are omitted, but that the Committee should not suggest that the topics would only fit into the four categories of the Mission Statement.
II. HHS Update
Dr. Fielding asked RADM Penelope Slade-Sawyer, Deputy Assistant Secretary for Health for Disease Prevention and Health Promotion, to provide an update on the progress of the U.S. Department of Health and Human Services (HHS) in developing Healthy People 2020. RADM Slade-Sawyer explained that the Federal Interagency Workgroup (FIW) was making final edits to the vision, mission, and overarching goals. She reviewed changes that the FIW has proposed for each of these elements of the framework, and then gave an overview of the timeline for developing a draft set of objectives by the summer. From March through June of 2009, HHS workgroups and the FIW would be convening to develop and review specific objectives for Healthy People 2020. From June through July, HHS staff would recommend specific knowledge-based interventions for achieving the proposed Healthy People 2020 objectives.
RADM Slade-Sawyer stressed that HHS will accept public comments through a variety of means throughout the objective development process, including the Internet and public meetings. In coming weeks, the Healthy People 2020 public comment Web site (www.healthypeople.gov) will be updated to allow submission of comments on the current Healthy People 2010 objectives. In the summer, a draft set of objectives for Healthy People 2020 will be posted for public comment. ODPHP is also planning to solicit comments through regional meetings that will be open to the public. (Dates and locations for those meetings have not yet been announced.) RADM Slade-Sawyer explained that, to meet the goal of launching Healthy People 2020 in early 2010, HHS would like to receive feedback from the Advisory Committee on the following issues:
- Healthy People 2020 topic areas (by March, 2009)
- Target-setting methodologies (by April, 2009)
- Criteria for selecting knowledge-based strategies (by May, 2009)
- Recommendations for implementation strategies (by June, 2009).
III. Desired Outcomes of the Meeting
Dr. Fielding noted that during the remainder of the meeting, the Committee would finalize its recommendations to HHS for immediate actions to be taken over next year; seek agreement on systems specification for the online Healthy People 2020 relational database; and finalize the charges of Phase II subcommittees. He said it would be important to get additional guidance on what HHS needs when seeking “recommendations for implementation.” He said that recommendations for implementation might not be complete by June, but perhaps the Committee could finish the first phase of this work by then.
IV. Immediate Committee Recommendations to HHS for Action Over the Next 12 Months
Dr. Fielding thanked Subcommittee Chair Lisa Iezzoni for drafting a memo of recommendations with the input of other Advisory Committee members, and then opened the floor for comments. A Committee member emphasized that the recommendations were especially important in light of upcoming decisions about how HHS would respond to the stimulus package. Another member asked how the Committee would be able to track HHS’ response to the memo. RADM Slade-Sawyer said the document would be submitted through the usual channels, and a response will come back through the system. A minor edit was proposed for item 3 of the memo, under the last bullet point, to remove the “e.g.” before the NIH. This would keep the recommendations broad. A motion was made to approve the recommendations, and the motion was seconded.
- All members who were present voted to approve the memo, “Recommendations for Immediate Actions in Support of the Health Objectives to Improve the Health of the American People.”
V. Online Relational Database: Systems Specifications and User Interface
Dr. Ronald Manderscheid, Chair of the Subcommittee on System Specifications, explained the background for a report that his subcommittee had prepared. The report describes specifications for an information technology project that would allow the creation of an online version of Healthy People. Such a tool would allow users to submit queries for specific data. While it does not include a true user interface, it does describe the process by which one could develop a user-friendly user interface.
The Subcommittee had discussed the need to make this tool relevant to users with different knowledge levels, and to create an underlying relational database would allow linkages among variables. In general, the approach of the Subcommittee was to give structure to the project and at the same time focus on the user throughout this work. Dr. Manderscheid noted that this last point would be relevant to the work of the Subcommittee on implementation, because users should be engaged in the various stages of designing the Healthy People 2020 system. Dr. Manderscheid stated that the Subcommittee on System Specifications had completed this piece of work, and recommended that it be approved by the Committee.
Dr. Fielding thanked the Subcommittee for their excellent work, and invited comments and discussion from the Committee. One member commented that she would like to see the addition of a third example of a potential system query that would address health determinants and interventions to address them. She added that some of the primary audiences that are described in the report have their hands on the reins of funding. She felt that the report should reflect the notion that funders need consider how to advance Healthy People by funding the kinds of programs that Healthy People supports. Third, she commented that the platform for the database has to be flexible so that it does not become outdated. Dr. Manderscheid agreed with these suggestions, and offered to work with the member to address them.
Lastly, Dr. Fielding inquired how much it would cost to design and start building the system that is described in the report. Dr. Manderscheid responded that he has not estimated the cost, but would produce a range so that HHS could use that information for decision-making purposes. Dr. Fielding requested a motion to approve the report with the modifications that had been discussed, and to entrust Dr. Kumanyika and him to approve the final version once those changes have been made. A member moved to approve the report, and the motion was seconded.
- All Committee members who were present voted to approve the System Specifications report with suggested modifications.
VI. Phase II Subcommittee Charges
Dr. Fielding reviewed the list of subcommittees and charges that the Committee developed at their January meeting. The preliminary charges are shown in the list below, along with suggested revisions or additions.
- Subcommittee on Priorities: (Co-Chairs, David Meltzer, Abby King)
Preliminary Charge: How do we think about priorities at the national, state, and local level?
Dr. Fielding indicated that a general charge was appropriate for the Subcommittee on Priorities at this time, although members could further refine the charge once they have met.
- Topic Areas & Objectives: (Chair, Patrick Remington)
Preliminary Charge: Organize the list of Healthy People 2010 objectives into homogenous categories. Add any that are missing.
Dr. Fielding emphasized that topics should not be “pigeon-holed” into categories. Others stated that topic areas should not all be concentrated in the health sector, but should incorporate other impacts on health dealing with the social and physical determinants of health outcomes.
- Evidence & Target-Setting: (Chair, Patrick Remington)
Preliminary Charge: Create a transparent process for target-setting that communities can use to set their own objectives. Create evidence-based public health practices.
Targets could be used at the local, state, regional, or national levels. Evidence-based practices to improve health at the population level should also be incorporated. A member emphasized transparency for 2020 and the need to be clear about how targets were set and achieved. This charge should be revised to state that, “transparent processes (plural) can be used to set objectives for multiple users, at multiple levels.”
Dr. Kumanyika asked whether this subcommittee would deal with targets that change along the way (e.g., if new evidence becomes available). Dr. Fielding felt that this was a broad issue that the Committee as a whole should discuss later in the year to suggest how often targets should be revisited, what the process for reviewing them should be, and how targets should be changed.
- Implementation: (Co-Chairs, Eva Moya, Adewale Troutman)
Preliminary Charge: Reflect on the range of potential users at the national, state, and community levels. What are their needs for tools, aids, and guidance for communities?
Dr. Fielding asked about the issues of performance monitoring and incentives for achieving goals and objectives. Also, another bullet is needed to identify the mechanisms needed to assure accountability and high performance among those who are charged with improving the public’s health. He noted that, for the sake of a realistic timeline, it may be necessary to phase this work.
- Data & IT Issues (Chair, Ron Manderscheid)
Preliminary Charge: Interface with NCHS to determine their needs and capabilities. Determine issues related to working with partners for data and the role of Health IT.
It is important to ask whether HHS has the capacity to support Healthy People 2020 around key populations (e.g., Native Americans, LGTB). This data is necessary to improve health determinants over time. A member stated that there would be a need for continuing work on IT issues, beyond systems specifications (e.g., the creation of an interactive online community). The charge should include recommendations on: Key needs and capabilities; the importance of incorporating data from other sectors, and suggesting what tools can be used to mine those for health implications, and how the broad national approach to IT can be integrated with and support achievement of the Healthy People 2020 goals and objectives.
Dr. Kumanyika recommended that all of the subcommittee charges be rephrased as a list of specific questions that are going to be answered. She clarified that this work could be done offline. Dr. Fielding agreed and said that the charges would be rephrased as a series of questions, and would be sent back out to the full Committee for comment. (See Appendix 2 for a list of revised charges based on this meeting’s discussion.) Dr. Fielding added that he would like to get a sense of who will be participating in the subcommittees. He asked Committee members to send their preferences to NORC and/or the subcommittee chairs, along with suggestions for potential external members.
Dr. Kumanyika shared her thoughts on the importance of having overlap among different subcommittees, and understanding the “big picture” of how the various pieces will fit together. She presented a series of slides to show how the subcommittee categories mapped back to the mission statement and the framework. While the subcommittees would work separately, they should also keep in mind an idea of how their work would come together into a single product. She noted that the framework should be used as a template to make sure that key issues aren’t omitted. Dr. Kumanyika volunteered to create an overview of the intended product for the second phase of the Committee's work.
VII. Wrap-up and Next Steps
A member asked about a brief that had been included in the Committee members’ briefing materials, describing the efforts of the State of the USA (SUSA) and its CEO, Christopher Hoenig to develop a Web-based, interactive tool. She felt it was important to avoid duplicating efforts. Carter Blakey, ODPHP, explained that Mr. Hoenig had presented to the Federal Interagency Work Group the previous week to inform them of SUSA’s work and ensure that it is aligned with Healthy People 2020. Dr. Kumanyika added that some discussion should occur around the potential for confusion if multiple indicator sets are used to report on the nation’s health. Some harmonization of reporting systems would be beneficial.
RADM Slade-Sawyer noted that she met with SUSA recently to express the hope that they can come together and mutually support each other with complementary and not competing sets of indicators. She also noted that the Alliance to Make US Healthiest is becoming a non-profit corporation, which offers a potential opportunity to have a group outside of government that would be aligned with Healthy People. The Advisory Committee discussed the possibility of having an in-person meeting in June, but did not reach any final conclusion. Dr. Fielding once again thanked all participants for their and concluded the meeting. |
