Dr. Kumanyika was opposed to separate disparities targets, both in past iterations of Healthy People and for Healthy People 2020. She supported the notion of using disparities to measure progress towards narrowing the gap in health status. She did not support the idea of, for example, indicating that a certain level of obesity was acceptable for African American women and a different percentage was acceptable in White women. That approach was ineffective and controversial. Another Committee member agreed with this point. He said the challenge is to ensure that the best possible health is achieved for everyone, with health equity being the target. The introduction to Healthy People 2020 could address this issue, acknowledging that populations are starting from different levels of health status, but that strategies are needed to document progress toward the overall target for the population. Other members agreed and emphasized the need to inform communities about which subgroups need support to reach the target.
- Dr. Fielding asked for a vote to approve the recommendation that there should not be separate disparities targets. Nonetheless, disparities are important and progress on eliminating disparities should be tracked. Specific interventions to reduce disparities should also be noted. All members who were present voted in favor of the recommendation; none were opposed.
Dr. Remington asked for discussion of what guidance and tools should be provided for target-setting. He reviewed the Subcommittee's recommendations, including the use of a variety of methods, with a rationale for each. A decision-chart could present options in a hierarchal format. A set of clear principles for local-level target-setting should be provided; there should be an understanding that there will be one national target, but that target need not be the one that they will use for local-level planning and tracking. Methods used at the national level should be clear and transparent, so that they can be applied at the local-level. There was no additional discussion of this issue.
- Dr. Fielding asked the Committee for a vote to approve the above recommendations. All members who were present voted in favor; none were opposed.
As a final question, Dr. Remington asked whether the subset of objectives that have targets should relate in some way to topic area categories or priority objectives. For example, should target-setting methods be limited to areas that have specific and measurable targets? Or should targets be set using less complete information? (This would result in targets such as "a 20% improvement" in a certain level.) He expressed the view that it is OK to have a hierarchy of methods. The preferred method would yield very specific targets based on scientific projections, but other targets could be set using less complete information and expert judgment. Even with imperfect information, he felt that it is better to have a target than not.
Dr. Fielding asked how objectives that are set using incomplete information should relate to the evidence (for example, from the Clinical and Community Guides). Dr. Remington said that when evidence exists, it should be used to set specific, projected targets based on the evidence. A Committee member pointed out that the Committee is using many different terms (e.g., priority objectives, indicators, targets, etc.). She felt that it should be possible to have "priority objectives" that are important for the country, that do not necessarily relate to the subset of objectives that have evidence-based targets. They are not necessarily mutually exclusive, but these sets of objectives need not relate directly to each other. Others agreed with this point.
Dr. Remington reiterated the question of whether there should be a "middle category" of objectives that do not have enough evidence available to develop science-based, S.M.A.R.T. targets, but where incomplete information is available. He felt that an objective should not be eliminated because it does not have a S.M.A.R.T. target (e.g., evidence is not available to make a specific projection). After some discussion the members agreed that, whenever possible, objectives shoul d have S.M.A.R.T targets. For some conditions, this information will not be available. Targets can be set using other methods as long as they are clearly described. (Dr. Fielding was called away momentarily and asked Vice-Chair Kumanyika to take over.)
- Dr. Kumanyika asked the Committee for a vote to approve the recommendation that, whenever possible, Healthy People objectives should have S.M.A.R.T. targets. In cases where complete information is not available, targets can be set using other methods so long as those are clearly described. All members who were present voted in favor; none were opposed.