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Genesis of Healthy People:

Small Pox.

Interesting Coincidence
World health Organization October 1979 Virtual Eradication of Small Pox from general population

The Surgeon Generals Report On Health Promotion And Disease Prevention, 1979
Dr. Julius Richmond
A home grown, made-in-America product of a prior decade of federal and collaborating national organizations work on study documents.

Success Begets Confidence

William Foege & J. Michael McGinnis

Major Contributions to 1979 Surgeon General Report

Prominent WHO roles regarding Small Pox Championed Management by Objectives Paradigm

Signaled the intent to pursue a quantitatively objectives-guided approach. It presented a bold ten-year goal for reduction of mortality in each of four broad age groups and morbidity reductions in the elderly.

4 Defined Age Groups:

Healthy Infants Healthy Children, Adolescents, and Young Adults Healthy Adults Healthy Older Adults

The report indicated the arrival to a preventative train of thought, instead of the predominantly reactive practices used in earlier decades.

It seemed natural to me that one of the potentially unique and distinguishing characteristics ought to be the expression of specific goals. The 10-year time frame was simply logical for the sake of convenience, practicality, and politics.
- J. Michael McGinnis

10 Year Programs
After the original 1979 report programs were instituted each decade
o 1990, 2000, 2010, 2020

Tracking mechanisms to measure various health statistics

Healthy People 2010

Most recently completed initiative
Has the most up-to-date and readily available statistics Two primary goals
o Increase quality and years of life o Eliminate health disparities between social groups

Healthy People 2010

Objectives: A breakdown of all the elements of American health
Statistical information gathered about each one Steadily increasing number of measures
o 312 in Healthy People 2000 o 969 in 2010 o 1200 in 2020

Primary categories into which the objectives are sorted
Access to Quality Health Services Arthritis, Osteoporosis and Chronic Back Conditions Disability and Secondary Conditions Food Safety Immunizations and Infectious Diseases Mental Health and Mental Disorders Physical Activity and Fitness Substance Abuse Cancer Chronic Kidney Disease


Family Planning HIV Medical Product Safety Oral Health Sexually Transmitted Diseases

Educational and Community-Based Programs Health Communication Injury and Violence Prevention Nutrition and Overweight Public Health Infrastructure Tobacco Use

Environmental Health Heart Disease and Stroke Maternal, Infant, and Child Health Occupational Safety and Health Respiratory Diseases Vision and Hearing

Leading Health Indicators (LHIs)

A further step to reduce complexity Meant to make the initiative accessible to everyone Health concerns known to everyone:
o o o o o o o o o o Increase physical activity Reduce obesity Reduce tobacco use Reduce substance abuse Promote healthy sexual behavior Promote mental health Reduce injuries and violence Improve living environments Increase immunizations Increase access to healthcare

Increasing Bureaucracy
The sheer number of objectives to track
Questions of whether the program is trying to do too much at once

Lack of Direction
The past versions of Healthy People were mainly guidelines Placed the responsibility for change with state and local agencies

Lack of actual action from the federal level

o Allows focusing on one or two small areas for change o Mountains of useful statistics

Healthy People 2010 Overall Results

Master statistical report weighing in at over 550 pages Progress towards two main goals was made, but at a slow pace

Of the 733 objectives that were trackable:

o o o o 48% made some progress 23% met or exceeded goals 5% no change 24% got worse

Overall Results cont.

Most improvements made in occupational safety, immunizations, and environmental health
Most negative results in obesity and nutrition No real changes made in healthcare disparities across socioeconomic divides

Current State of the Healthy People Initiative

American health is improving but there are still serious problems in some areas
New initiative seeks to increase actions as well as measurable goals

Healthy People 2020

National Health Agenda
Scientific based 10 year initiative 600 Objectives 1200 measures covering 42 topic areas

History of Healthy People 2020

Based on the accomplishments of 4 previous Healthy People initiatives: 1. 1979 Surgeon Generals Report, Healthy People: The Surgeon Generals Report on Health Promotion and Disease Prevention 2. Healthy People 1990: Promoting Health/Preventing Disease: Objectives for the Nation 3. Healthy People 2000: National Health Promotion and Disease Prevention Objectives 4. Healthy people 2010: objectives for improving health

Lead federal agencies
Federal interagency workgroup General public The Secretarys Advisory Committee on National Health Promotion and Disease Prevention Objectives


Experts in respective field
o o o o o o o Administration on Aging, Agency for Healthcare Research and Quality Centers for Disease Control and Prevention Indian Health Services National Institutes of Health Office of Minority Health Office of Population Affairs

18 Total Agencies Topic areas

Federal interagency workgroup

Reviewed proposed topic areas Lead development effort
o o o o o o o o U.S. Department of Health and Human Service 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

General public
Phase 1
o Comment regarding the vision, mission, and implementation.

Phase 2
o Objectives

Phase 3
o New Objectives

The Secretarys Advisory Committee on National

Health Promotion and Disease Prevention Objectives

Development and implementation

Format Framework Guidelines for implementation

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

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.


Access to Health Services Clinical Preventive Services Environmental Quality Injury and Violence Maternal, Infant, and Child Health Mental Health Nutrition, Physical Activity, and Obesity Oral Health Reproductive and Sexual Health Social Determinants Substance Abuse Tobacco

216 data sources
o Behavioral risk factor surveillance system o Epidemiology capacity assessment o Drug abuse warning network

National censuses of events, Nationally representative sample surveys Search current data

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.


Shift toward health promotion
Patient Protection and Affordable Care Act National Health Agenda Promising future