Another member asked whether there was an underlying assumption that different methods could be brought to bear on different topic areas, depending on their content, or whether a standard set of methods should be applied. Dr. Fielding responded that this would be a good question for the Subcommittee on Target-setting to address. Dr. Kumanyika referred to a series of questions that had been posed to the Committee in the presentation slides for the meeting. She suggested that the Subcommittee on Target-setting prioritize and group these questions to make their discussions more efficient. These questions were:
- What target-setting methods have been used in the past?
- What are the pros and cons associated with each method?
- If multiple methods are used, how should one determine which method is appropriate?
- What would an ideal method of target-setting look like?
- What tools are available now that were not for 2010?
- How should past performance on targets be factored in?
- If trends are improving, how should the bar be raised?
- What compromises are acceptable…
- When there is essentially no evidence base?
- When the available evidence is weak?
- When the available evidence is strong but relevance is limited?
- To account for the influence of secular trends?
V. Healthy People 2020 Topic Areas
Dr. Remington, Chair of the Subcommittee on Topic Areas, reviewed the Subcommittee’s proposed definitions for the terms, “vision,” “goal,” and “focus area/topic area.” For Healthy People 2020, the term “topic area” would be used instead of the term “focus area” that was used for Healthy People 2010. He explained that, in trying to map the topic areas to the broad categories of the framework, his subcommittee found that some topics mapped well, but others didn’t because they are addressed across the continuum from interventions to determinants to outcomes. Another potential approach to organizing topic areas is a matrix that shows how topic areas flow across the different elements of the framework. The rationale for this approach was to help the FIW work across topic areas. Topic areas would be developed independently of objectives, and there would be many similar objectives.
He suggested that Healthy People 2020 would be likely to have more topic areas than the 28 that were in 2010, perhaps 30 or more. If a grid was used to organize topic areas in relation to the framework, users could enter the grid through an interest (e.g., social and economic determinants) or through a specific topic area. (e.g., specific diseases) or vice-versa. He warned that “the devil is in the details” in selecting topic areas, but based on written feedback from Committee members, there seemed to be consensus that the Healthy People 2010 topics would continue with some modifications, and six to eight new topic areas would also be added.
Dr. Fielding asked the Committee for feedback on the function of topic areas, and, secondly, what specific topic areas should be proposed. He noted the key functions of Healthy People 2010 focus areas, were: organizational, managerial, and communications-related. Dr. Fielding asked if an expanded number of topic areas would change their overall function, especially considering that each topic area is assigned to a Federal agency that is responsible for those objectives. Would that system need to change with an increased number of topic areas? Dr. Fielding then said the Committee does not necessarily need to answer all of these questions, since they are up to the FIW. Yet he said that the Committee should ensure that the topic areas are more than a point of entry.
Dr. Fielding reviewed proposed selection criteria for topic areas, and asked the Committee members for comments. The proposed criteria were:
- A logic model to clarify pathways of intervention
- Coherence of content; clarity of boundaries between Topic Areas:
- Reflects a body of available literature that can be accessed to promote health and prevent disease and injury;
- Reflects our understanding of the pathophysiology and multiple underlying determinants of health;
- Relates to a schema or logic model that links back to the HP2020 framework;
- Can be “owned” by a group of individuals with complementary expertise to adequately address the issue;
- Allows sufficient focus (e.g., a manageable number of objectives).
A couple of members commented that these selection criteria for Healthy People 2020 topic areas seemed fine, before moving on to comment directly on the topic area categories themselves. Dr. Fielding later said that there seemed to be general agreement on the selection criteria for topic areas.
In written feedback, Committee members had voted to retain all of the 28 Healthy People 2010 focus areas, to add 8 new topic areas that were proposed by the Subcommittee, and to create additional new topic areas or split Healthy People 2010 focus areas. That would lead a total of 52 topic areas for Healthy People 2020. One Committee member said the traditional Healthy People focus area categories map well to the organization of state and Federal agencies, but new areas dealing with issues like social and economic disparities and child development might not map as well to the organization of agency divisions and bureaus. He felt it was even more important to make sure that cross-cutting issues would be addressed since there would not be specific divisions to take ownership of them. Another member commented that the proposed topic areas are fine for content, but the Committee should also address infrastructure issues such as data, IT, staff and other issues.