Healthy People 2020. Overview.

> Introducing Healthy People 2020

Healthy People 2020 continues in this tradition with the launch on December 2, 2010 of its ambitious, yet achievable, 10-year agenda for improving the Nation’s health. Healthy People 2020 is the result of a multiyear process that reflects input from a diverse group of individuals and organizations.

>> Healthy People 2020. Vision

A society in which all people live long, healthy lives.

>> Healthy People 2020. Mission

Healthy People 2020 strives to:

• Identify nationwide health improvement priorities.
• Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress.
• Provide measurable objectives and goals that are applicable at the national, State, and local levels.
• Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge.
• Identify critical research, evaluation, and data collection needs.

>> Healthy People 2020. Overarching Goals

• Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
• Achieve health equity, eliminate disparities, and improve the health of all groups.
• Create social and physical environments that promote good health for all.
• Promote quality of life, healthy development, and healthy behaviors across all life stages.

>> Healthy People 2020. Four foundation health measures will serve as an indicator of progress towards achieving these goals:

• General Health Status
• Health-Related Quality of Life and Well-Being
• Determinants of Health
• Disparities

> History & Development of Healthy People

>> Healthy People 2020. History of Healthy People

Healthy People 2020 is based on the accomplishments of 4 previous Healthy People initiatives:

• 1979 Surgeon General’s Report, Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention
• Healthy People 1990: Promoting Health/Preventing Disease: Objectives for the Nation
• Healthy People 2000: National Health Promotion and Disease Prevention Objectives
• Healthy People 2010: Objectives for Improving Health

>> Healthy People 2020. Development of Healthy People 2020

Healthy People 2020 is the result of a multiyear process that reflects input from a diverse group of individuals and organizations.

>> Healthy People 2020. Healthy People development process:

• Objective Development and Selection Process
• Federal Interagency Workgroup
• Lead Federal Agencies
• Public Comment
• Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives

>>> Healthy People 2020. Objective Development and Selection Process

There are nearly 600 objectives in Healthy People 2020 with more than 1,300 measures. Each Healthy People 2020 objective has a:

• Reliable data source
• Baseline measure
• Target for specific improvements to be achieved by the year 2020

Draft objectives were prepared by experts from multiple lead Federal Agencies (1). The proposed objectives were then made available for public comment and reviewed by the Federal Interagency Workgroup (2), which used a set of selection criteria to choose the final objectives.

Many objectives focus on interventions that are designed to reduce or eliminate illness, disability, and premature death among individuals and communities. Others focus on broader issues such as:

• Eliminating health disparities.
• Addressing social determinants of health.
• Improving access to quality health care.
• Strengthening public health services.
• Improving the availability and dissemination of health-related information.

Review the Healthy People 2020 objective selection criteria(3).

… (1) lead Federal Agencies – Following is a list of the Lead Federal Agencies:>>> Healthy People 2020.  Lead Federal Agencies

Administration on Aging

• Older Adults

Agency for Healthcare Research and Quality

• Access to Health Services (co-lead)
• Genomics (co-lead)

Centers for Disease Control and Prevention

• Adolescent Health (co-lead)
• Arthritis, Osteoporosis, and Chronic Back Conditions (co-lead)
• Blood Disorders and Blood Safety
• Chronic Kidney Disease (co-lead)
• Dementias, Including Alzheimer’s Disease (co-lead)
• Diabetes (co-lead)
• Disability and Health (co-lead)
• Early and Middle Childhood (co-lead)
• Educational and Community-Based Programs (co-lead)
• Environmental Health (co-lead)
• Genomics (co-lead)
• Global Health (co-lead)
• Health Communication and Health IT (co-lead)
• Health-Related Quality of Life and Well-Being
• Heart Disease and Stroke (co-lead)
• HIV (co-lead)
• Immunization and Infectious Diseases
• Injury and Violence Prevention
• Maternal, Infant, and Child Health (co-lead)
• Occupational Safety and Health
• Oral Health (co-lead)
• Physical Activity (co-lead)
• Public Health Infrastructure (co-lead)
• Respiratory Diseases (co-lead)
• Sexually Transmitted Diseases
• Social Determinants of Health (co-lead)
• Tobacco Use

Food and Drug Administration

• Blood Disorders and Blood Safety (co-lead)
• Food Safety (co-lead)
• Medical Product Safety
• Nutrition and Weight Status (co-lead)

Health Resources and Services Administration

• Access to Health Services (co-lead)
• Adolescent Health (co-lead)
• Blood Disorders and Blood Safety (co-lead)
• Early and Middle Childhood (co-lead)
• Educational and Community-Based Programs (co-lead)
• HIV (co-lead)
• Lesbian, Gay, Bisexual, and Transgender Health (co-lead)
• Maternal, Infant, and Child Health (co-lead)
• Oral Health (co-lead)
• Public Health Infrastructure (co-lead)
• Social Determinants of Health (co-lead)

Immediate Office of the Assistant Secretary for Health, Office of Public Health and Science, Office of the Secretary

• Healthcare-Associated Infections

Indian Health Services

• Oral Health (co-lead)

National Institutes of Health

• Arthritis, Osteoporosis, and Chronic Back Conditions (co-lead)
• Blood Disorders and Blood Safety (co-lead)
• Cancer
• Chronic Kidney Disease (co-lead)
• Dementias, Including Alzheimer’s Disease (co-lead)
• Diabetes (co-lead)
• Disability and Health (co-lead)
• Environmental Health (co-lead)
• Hearing and Other Sensory or Communication Disorders
• Heart Disease and Stroke (co-lead)
• Mental Health and Mental Disorders (co-lead)
• Nutrition and Weight Status (co-lead)
• Oral Health (co-lead)
• Respiratory Diseases (co-lead)
• Sleep Health
• Substance Abuse (co-lead)
• Vision

Office of Disease Prevention and Health Promotion, Office of Public Health and Science, Office of the Secretary

• Health Communication and Health IT (co-lead)

Office of Global Health Affairs, Office of the Secretary

• Global Health (co-lead)

Office of Minority Health

• Lesbian, Gay, Bisexual, and Transgender Health (co-lead)

Office of Population Affairs

• Family Planning

Office of the National Coordinator for Health IT, Office of the Secretary

• Health Communication and Health IT (co-lead)

Office of Policy, Strategic Planning, and Communications, Office of the Assistant Secretary for Preparedness and Response, Office of the Secretary

• Preparedness

President’s Council on Sports, Fitness and Nutrition

• Physical Activity (co-lead)

Substance Abuse and Mental Health Services Administration

• Mental Health and Mental Disorders (co-lead)
• Substance Abuse (co-lead)

U.S. Department of Agriculture

• Food Safety (co-lead)

U.S. Department of Education

• Disability and Health (co-lead)

Lead Federal Agencies

>>> Healthy People 2020. Federal Interagency Workgroup. 

– Within the Federal Government, a Federal Interagency Workgroup (FIW) led the Healthy People 2020 development effort. The FIW members include representatives from U.S. Department of Health and Human Service agencies and offices as well as:

• U.S. Department of Agriculture
• U.S. Department of Education
• U.S. Department of Housing and Urban Development
• U.S. Department of Justice
• U.S. Department of Interior
• U.S. Department of Veterans Affairs
• Environmental Protection Agency

The FIW drew on the diverse backgrounds and expertise of its member agencies, lessons learned from past Healthy People efforts, broad-based public comment, and the work of the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020.

• The result to be achieved should be important and understandable to a broad audience and support the Healthy People 2020 goals.
• Objectives should be prevention oriented and/or should address health improvements that can be achieved through population-based as well as individual actions, systems-based, environmental, health-service, or policy interventions.
• Objectives should drive actions that will work toward the achievement of the proposed targets (defined as quantitative values to be achieved by the year 2020).
• Objectives should be useful and reflect issues of national importance. Federal agencies, states, localities, non-governmental organizations, and the public and private sectors should be able to use objectives to target efforts in schools, communities, work sites, health practices, and other environments.
• Objectives should be measurable and should address a range of issues, such as: behavior and health outcomes; availability of, access to, and content of behavioral and health service interventions; socio-environmental conditions; and community capacity – directed toward improving health outcomes and quality of life across the life span. (Community capacity is defined as the ability of a community to plan, implement, and evaluate health strategies.)
• Continuity and comparability of measured phenomena from year to year are important, thus, when appropriate, retention of objectives from previous Healthy People iterations is encouraged. However, in instances where objectives and/or measures have proven illsuited to the purpose or are inadequate, new improved objectives and/or new measures should be developed. Whether or not an objective has met its target in a previous Healthy People iteration should not be the sole basis for retaining or deleting an objective.
• The objectives should be supported by the best available scientific evidence. The objective selection and review processes should be flexible enough to allow revisions to objectives in order to reflect major updates or new knowledge.
• Objectives should address population disparities. These include populations categorized by race/ethnicity, socioeconomic status, gender, disability status, sexual orientation, and geographic location. For particular health issues, additional special populations should be addressed, based on an examination of the available evidence on vulnerability, health status, and disparate care. Data sources are not necessarily a prerequisite for inclusion of a special population in an objective.
• Healthy People 2020, like past versions, will be heavily data driven. Valid, reliable, nationally representative data and data systems should be used for Healthy People 2020 objectives. Each objective will have 1) a data source, or potential data source, identified, 2) baseline data and 3) assurance of at least one additional data point throughout the decade.

Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives

The U.S. Department of Health and Human Services (HHS) convenes the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020 (Advisory Committee) to produce recommendations regarding the development and implementation of Healthy People 2020. Its 12 members are nationally known experts in public health. The Advisory Committee and its subcommittees produce recommendations for the Healthy People format, framework, and guidelines for implementation.

> What’s New for 2020

>>> Healthy People 2020. Focus on the Determinants of Health

A renewed focus on identifying, measuring, tracking, and reducing health disparities through a determinants of health approach.

>>> Healthy People 2020. New Topic Areas

Be sure to check out the new topic areas for 2020:

• Adolescent Health
• Blood Disorders and Blood Safety
• Dementias, Including Alzheimer’s Disease
• Early and Middle Childhood
• Genomics
• Global Health
• Healthcare-Associated Infections
• Health-Related Quality of Life and Well-Being
• Lesbian, Gay, Bisexual, and Transgender Health
• Older Adults
• Preparedness
• Sleep Health
• Social Determinants of Health

>>> Healthy People 2020. Putting Healthy People 2020 to Work

Get started implementing Healthy People 2020 in your community with these tools and resources for planning a successful public health intervention. Whether you are new to the field or just brushing up on your knowledge, this section walks you through the basics of planning, implementing, and tracking your public health program.

>>> Healthy People 2020. Evidence-Based Resources

Each of the Healthy People 2020 topic areas includes related evidence-based interventions and resources from:

• U.S. Preventive Services Task Force (USPSTF) Clinical Preventive Services
• Guide to Community Preventive Services
• healthfinder.gov’s Quick Guide to Healthy Living Information for Consumers

>>> Healthy People 2020. Online Community

Get connected using Twitter, LinkedIn, or one of the Healthy People 2020 webinars.

>>> Healthy People 2020. Leading Health Indicators

The Healthy People 2020 Leading Health Indicators reflect high-priority health issues and communicate actions that can be taken to address them. They will be used to assess the health of the Nation over the decade, facilitate collaboration across sectors, and motivate action at the national, State, and community levels to improve the health of the U.S. population.

> Foundation Health Measures

Over the course of the decade, the 4 foundation health measures will be used to monitor progress toward promoting health, preventing disease and disability, eliminating disparities, and improving quality of life. These broad, cross-cutting measures include:

1. General Health StatusMeasures of General Health Status include:
• Life expectancy
• Healthy life expectancy
• Years of potential life lost
• Physically and mentally unhealthy days
• Self-assessed health status
• Limitation of activity
• Chronic disease prevalence

2. Health-Related Quality of Life and Well-BeingMeasures of Health-Related Quality of Life and Well-Being include:
• Physical, mental, and social health-related quality of life
• Well-being/satisfaction
• Participation in common activities

3. Determinants of HealthA range of personal, social, economic, and environmental factors that influence health status are known as determinants of health. Determinants of health include such things as biology, genetics, individual behavior, access to health services, and the environment in which people are born, live, learn, play, work, and age.

4. DisparitiesMeasures of Disparities and inequity include differences in health status based on:
• Race/ethnicity
• Gender
• Physical and mental ability
• Geography

— 1. More about measuring General Health Status – Measures of general health status provide information on the health of a population. Throughout the decade, Healthy People 2020 will assess the general health status of the U.S. population by monitoring:

• Life expectancy (with international comparison)
• Healthy life expectancy
• Years of potential life lost (YPLL) (with international comparison)
• Physically and mentally unhealthy days
• Self-assessed health status
• Limitation of activity
• Chronic disease prevalence

Life Expectancy (With International Comparison)

Life expectancy is a summary mortality measure often used to describe the overall health status of a population. Life expectancy is defined as the average number of years a population of a certain age would be expected to live, given a set of age-specific death rates in a given year.Healthy People 2020 monitors 2 life expectancy measures:

• Life expectancy at birth
• Life expectancy at age 65

International Comparison of Life Expectancy

Life expectancies are 1 of the most commonly used measures for international health comparison. In 2007, the United States ranked 27th and 26th out of 33 countries within its peer group of Organization for Economic Co-operation and Development (OECD) countries, for life expectancy at birth for females and males, respectively.

Healthy Life Expectancy

Healthy life expectancy is the average number of healthy years a person can expect to live if age-specific death rates and age-specific morbidity rates remain the same throughout his or her lifetime. Thus, healthy life expectancy is a snapshot of current death and illness patterns and can illustrate the long-range implications of the prevailing age-specific death and illness rates. The measure allows for easy comparisons across populations and over long periods of time.Healthy People 2020 tracks healthy life expectancy using 3 measures:

• Expected years of life in good or better health
• Expected years of life free of limitation of activity
• Expected years of life free of selected chronic diseases

— 2. More about Health-Related Quality of Life and Well-Being

Health-related quality of life (HRQoL) is a multi-dimensional concept that includes domains related to physical, mental, emotional and social functioning. It goes beyond direct measures of population health, life expectancy and causes of death, and focuses on the impact health status has on quality of life. A related concept of HRQoL is well-being, which assesses the positive aspects of a person’s life, such as positive emotions and life satisfaction.

Clinicians and public health officials have used HRQoL and well-being to measure the effects of chronic illness, treatments, and short- and long-term disabilities. While there are several existing measures of HRQoL and well-being, methodological development in this area is still ongoing. Over the decade, Healthy People 2020 will evaluate the following measures for monitoring HRQoL and well-being in the United States:

• Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Measure – assesses global physical, mental and social HRQoL through questions on self-rated health, physical HRQoL, mental HRQoL, fatigue, pain, emotional distress, social activities, and roles.
• Well-Being Measures – assess the positive evaluations of people’s daily lives – when they feel very healthy and satisfied or content with life, the quality of their relationships, their positive emotions, resilience, and realization of their potential.
• Participation Measures – reflect individuals’ assessments of the impact of their health on their social participation within their current environment. Participation includes education, employment, civic, social and leisure activities. The principle behind participation measures is that a person with a functional limitation – for example, vision loss, mobility difficulty, or intellectual disability – can live a long and productive life and enjoy a good quality of life.

• What makes some people healthy and others unhealthy?
• How can we create a society in which everyone has a chance to live long healthy lives?

Healthy People 2020 is exploring these questions by:

1. Developing objectives that address the relationship between health status and biology, individual behavior, health services, social factors, and policies.
2. Emphasizing an ecological approach to disease prevention and health promotion. An ecological approach focuses on both individual-level and population-level determinants of health and interventions.

…

Determinants of Health: A Framework for Reaching Healthy People 2020 Goals
This video demonstrates some of the factors that make some people healthy and others unhealthy. Two examples in this video serve to illustrate determinants of health, as well as interventions which can change determinants of health and lead to a specific health outcome or outcomes. The video then explains the four phases of the intervention life cycle.

This video was created by The Office of Disease Prevention and Health Promotion (ODPHP), U.S. Department of Health and Human Services. It explores ODPHP’s Healthy People 2020 initiative, and explains a concept known as determinants of health.
…

Determinants of Health

• What makes some people healthy and others unhealthy?
• How can we create a society in which everyone has a chance to live long healthy lives?

Healthy People 2020 is exploring these questions by:

1. Developing objectives that address the relationship between health status and biology, individual behavior, health services, social factors, and policies.
2. Emphasizing an ecological approach to disease prevention and health promotion. An ecological approach focuses on both individual-level and population-level determinants of health and interventions.

Policymaking

Policies at the local, State, and Federal level affect individual and population health. Increasing taxes on tobacco sales, for example, can improve population health by reducing the number of people using tobacco products.

Some policies affect entire populations over extended periods of time while simultaneously helping to change individual behavior. For example, the 1966 Highway Safety Act and the National Traffic and Motor Vehicle Safety Act authorized the Federal Government to set and regulate standards for motor vehicles and highways. This led to an increase in safety standards for cars, including seat belts, which in turn, reduced rates of injuries and deaths from motor vehicle accidents.

Social

Social determinants of health reflect social factors and the physical conditions in the environment in which people are born, live, learn, play, work and age. Also known as social and physical determinants of health, they impact a wide range of health, functioning and quality of life outcomes.

Examples of social determinants include:

• Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods
• Social norms and attitudes, such as discrimination
• Exposure to crime, violence, and social disorder, such as the presence of trash
• Social support and social interactions
• Exposure to mass media and emerging technologies, such as the Internet or cell phones
• Socioeconomic conditions, such as concentrated poverty
• Quality schools
• Transportation options
• Public safety
• Residential segregation

Examples of physical determinants include:

• Natural environment, such as plants, weather, or climate change
• Built environment, such as buildings or transportation
• Worksites, schools, and recreational settings
• Housing, homes, and neighborhoods
• Exposure to toxic substances and other physical hazards
• Physical barriers, especially for people with disabilities
• Aesthetic elements, such as good lighting, trees, or benches

Poor health outcomes are often made worse by the interaction between individuals and their social and physical environment.

For example, millions of people in the United States live in places that have unhealthy levels of ozone or other air pollutants. In counties where ozone pollution is high, there is often a higher prevalence of asthma in both adults and children compared with State and national averages. Poor air quality can worsen asthma symptoms, especially in children.

Health Services

Both access to health services and the quality of health services can impact health. Healthy People 2020 directly addresses access to health services as a topic area and incorporates quality of health services throughout a number of topic areas.

Lack of access, or limited access, to health services greatly impacts an individual’s health status. For example, when individuals do not have health insurance, they are less likely to participate in preventive care and are more likely to delay medical treatment.

Barriers to accessing health services include:

• Lack of availability
• High cost
• Lack of insurance coverage
• Limited language access

These barriers to accessing health services lead to:

• Unmet health needs
• Delays in receiving appropriate care
• Inability to get preventive services
• Hospitalizations that could have been prevented

Individual Behavior

Individual behavior also plays a role in health outcomes. For example, if an individual quits smoking, his or her risk of developing heart disease is greatly reduced.

Many public health and health care interventions focus on changing individual behaviors such as substance abuse, diet, and physical activity. Positive changes in individual behavior can reduce the rates of chronic disease in this country.

Examples of individual behavior determinants of health include:

• Diet
• Physical activity
• Alcohol, cigarette, and other drug use
• Hand washing

Biology and Genetics

Some biological and genetic factors affect specific populations more than others. For example, older adults are biologically prone to being in poorer health than adolescents due to the physical and cognitive effects of aging.

Sickle cell disease is a common example of a genetic determinant of health. Sickle cell is a condition that people inherit when both parents carry the gene for sickle cell. The gene is most common in people with ancestors from West African countries, Mediterranean countries, South or Central American countries, Caribbean islands, India, and Saudi Arabia.

Examples of biological and genetic social determinants of health include:

• Age
• Sex
• HIV status
• Inherited conditions, such as sickle-cell anemia, hemophilia, and cystic fibrosis
• Carrying the BRCA1 or BRCA2 gene, which increases risk for breast and ovarian cancer
• Family history of heart disease

— 4. More about Disparities.

Although the term “disparities” often is interpreted to mean racial or ethnic disparities, many dimensions of disparity exist in the United States, particularly in health. If a health outcome is seen in a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health. It is important to recognize the impact that social determinants have on health outcomes of specific populations. Healthy People 2020 strives to improve the health of all groups.

To better understand the context of disparities, it is important to understand more about the U.S. population. In 2008, the U.S. population was estimated at 304 million.

• In 2008, approximately 33 percent, or more than 100 million persons, identified themselves as belonging to a racial or ethnic minority population.
• In 2008, 51 percent, or 154 million, were women.
• In 2008, approximately 12 percent, or 36 million people not living in nursing homes or other residential care facilities, had a disability.
• In 2008, an estimated 70.5 million persons lived in rural areas (23 percent of the population), while roughly 233.5 million lived in urban areas (77 percent).
• In 2002, an estimated 4 percent of the U.S. population aged 18 to 44 years identified themselves as lesbian, gay, bisexual, or transgender.

During the past 2 decades, 1 of Healthy People’s overarching goals has focused on disparities. In Healthy People 2000, it was to reduce health disparities among Americans. In Healthy People 2010, it was to eliminate, not just reduce, health disparities. In Healthy People 2020, that goal was expanded even further: to achieve health equity, eliminate disparities, and improve the health of all groups.

Healthy People 2020 defines health equity as the “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”

Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”

Over the years, efforts to eliminate disparities and achieve health equity have focused primarily on diseases or illnesses and on health care services. However, the absence of disease does not automatically equate to good health.

Powerful, complex relationships exist between health and biology, genetics, and individual behavior, and between health and health services, socioeconomic status, the physical environment, discrimination, racism, literacy levels, and legislative policies. These factors, which influence an individual’s or population’s health, are known as determinants of health.

For all Americans, other influences on health include the availability of and access to:

• A high-quality education
• Nutritious food
• Decent and safe housing
• Affordable, reliable public transportation
• Culturally sensitive health care providers
• Health insurance
• Clean water and nonpolluted air

Throughout the next decade, Healthy People 2020 will assess health disparities in the U.S. population by tracking rates of illness, death, chronic conditions, behaviors, and other types of outcomes in relation to demographic factors including:

• Race and ethnicity
• Gender
• Sexual identity and orientation
• Disability status or special health care needs
• Geographic location (rural and urban)

> HHS Prevention Strategies

Healthy People serves as the foundation for prevention efforts across the U.S. Department of Health and Human Services (HHS). Healthy People supports HHS efforts to create a healthier Nation, including:

• Tobacco Control Strategic Action Plan
• HHS Initiative on Multiple Chronic Conditions
• Action Plan for the Prevention, Care and Treatment of Viral Hepatitis
• Healthcare-Associated Infection (HAI)
• Public Health System, Finance, and Quality Program
• HHS Action Plan to Reduce Racial and Ethnic Health Disparities
• National Prevention Strategy
• National HIV/AIDS Strategy
• National Drug Control Strategy
• Let’s Move Campaign
• President’s Food Safety Working Group
• Global Health Initiative

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* The above information is adapted from materials provided by USA Department of Health and Human Services (HHS)
** More information at USA Department of Health and Human Services (HHS)