RADM Slade-Sawyer said current departmental leadership had authorized ODPHP to move forward with developing specific Healthy People 2020 objectives. HHS and other Federal staff members were convening in workgroups to recommend which Healthy People 2010 objectives should be eliminated, retained, or revised as a starting point for developing the Healthy People 2020 objectives. The Federal Interagency Workgroup (FIW) would be reviewing these recommendations, along with suggestions for new topic areas, in the coming months. A draft set of objectives would be ready by the fall of 2009, at which time a more extensive public comment process would take place. HHS plans to convene three public meetings across the country in the fall; details of locations would be announced on the healthypeople.gov Web site. RADM Slade-Sawyer explained that ODPHP had shifted the timeline of the launch for 2020 from January 2010 to the last quarter of 2010. This would allow the time necessary to vet objectives and evidence-based resources and develop the online, relational database. RADM Slade-Sawyer expressed the Department’s gratitude to the Committee. Dr. Fielding thanked RADM Slade-Sawyer and ODPHP for their support.
II. Desired Outcomes of the Meeting
Dr. Fielding explained that the Committee would vote on recommendations for topic areas and finalize provide feedback to the subcommittee that is working on target-setting. During the Committee’s May meeting, the focus would be on criteria for selecting evidence-based resources. Issues and questions related to implementation strategies would be discussed at the Committee’s upcoming meetings in May, June, July, and possibly even extending into August. Dr. Fielding then introduced Patrick Remington, Chair of the Subcommittee on Topic Areas.
III. Healthy People 2020 Topic Area Recommendations
Dr. Remington reminded the Committee that they had begun discussing topic areas during the January, 2009 meeting. A Subcommittee on Topic Areas was formed and has met twice since then. The Subcommittee addressed four general issues: 1) clear definitions of terminology; 2) clarification of the function of topic areas; 3) the need to build on the 2020 framework; and 4) the need for logic models that would facilitate the shift from a paper-based format to an online, relational database.
The Subcommittee viewed topic areas as serving several functions: they organize groups of related objectives; they assist in Federal management of objectives in that a Federal lead agency is tasked with tracking each topic area; and they help users to locate the content that is of interest to them within Healthy People. In Healthy People 2010, focus areas tended to be mutually exclusive. For Healthy People 2020, this Subcommittee views topic areas as interrelated. In the past, a group could work exclusively on one focus area, but in Healthy People 2020 there would be an expectation that objectives overlap. Thus, topic areas would continue to have lead agencies, but communications within groups would be needed. Objectives would be located in multiple topic areas—some “upstream,” and others “downstream” in disease outcomes.
The Subcommittee used a broad framework of interventions, determinants, and outcomes to organize the topics, but did not view this as a fixed classification. Many objectives may be an outcomes in addition to being important determinants and interventions. A Healthy People 2020 user would enter a topic area to explore Healthy People 2020. Therefore, it is important to have a strong understanding of how interventions relate to determinants and how determinants relate to outcomes, which would require a significant amount of work. The map of these interrelationships could be straightforward for some areas; for others, more complex modeling of independent effects and relationships between different determinants could be needed.
Dr. Remington discussed the Healthy People 2020 Action Model, including interventions (e.g., policies, programs, and information), determinants of health, and then more traditional health outcomes, all working across the life course. He explained that this is the model upon which logic models should be based, and there would generally be topic areas that fall into the three areas of interventions, determinants, and outcomes. He provided an example based on selection of the topic area, “cancer,” to show how the user would enter “interventions” and then “cancer” to pull up relevant objectives. He noted that there could be controversies about the causal relationships between risk factors and diseases (e.g., diet and breast cancer). The real test of this approach would come when people try to develop the logic models, because solid evidence is not available in all areas. Dr. Remington posed the issue of how to determine what should be done in areas where evidence is accumulating for an association between risk factors and outcomes, but is not yet proven.
Dr. Remington explained that Federal staff would be working in each topic area and could show where objectives should be positioned on a logic model. These tags would be relevant along a spectrum from interventions to determinants to outcomes. This would be an iterative process in that coordination would be needed, for example, to ensure that objectives relating to nutrition would be aligned across cardiovascular disease and cancer prevention. It is important that the objectives converge on a single common objective that crosses topic areas.