Priority-setting. Dr. Fielding said Healthy People is so big that guidance is needed for what users should concentrate on. It is important not to disenfranchise anyone, but we also need to determine what the highest yield opportunities are, and to rank the preventable burden (e.g., from one to ten). Social factors might be ranked first, but it is important to look at this question. Even by disease, or by organ system, where are the greatest opportunities based on the preventable fraction, preventable years of life lost, preventable qualities? These priorities should relate to LHIs. The same thing could be done for greatest disparities, inequities and inequalities. Even if there is not a clear solution, issues should be highlighted to give a sense of priority.
Dr. David Meltzer, Chair of the Subcommittee on Priorities, agreed with Dr. Fielding. He added that his subcommittee had been discussing these types of issues, and may be able to provide materials within the next few weeks. Dr. Fielding said the Committee would look forward to receiving these materials, and then producing a derivative article from it so that people can use it as guidance. He said it is important to give concrete examples so that others can understand the Committee’s thinking. He emphasized the need to give levels of specificity that can help the FIW and others to at least understand the Committee’s thinking. Such examples could take the reader from objectives to implementation to how it might have a feedback loop from the evaluation information collected to show how out the Action Model is a actually a basis for action.
Dr. Meltzer shared that he has being doing work for the Institute of Medicine to prioritize quality of care indicators. He noted that some interesting issues were the order of magnitude differences between interventions that focus on small dimensions of health care versus a larger system. For example, controlling hypertension as a public health intervention is huge compared to other quality indicators. This gives him hope that the priority-setting approaches being proposed by the Committee could be used to develop LHIs.
Social Determinants of Health. A Committee member asked for clarification from HHS of the status of social determinants objectives, and when those would be put forth. RADM Slade-Sawyer first recognized that there are objectives in Healthy People 2010 that address social determinants of health. She then noted that the FIW is working to expand these objectives in Healthy People 2020 by creating a separate topic area for this issue. They would keep in-mind the cross cutting nature of these objectives. Another Committee member raised concerns that it seems the social determinants are being treated as simply another set of objectives and indicators without an organizational model to make the material understandable. He was impressed with Sir Marmot’s model, which is organized into policy goals, policy objectives, and policy mechanisms. He felt the model could be useful to the Committee in presenting an approach to working with other departments.
The same Committee member raised the issue of how Healthy People would map onto national health reform. He said it appeared likely that the Senate would pass a bill and there would not be a conference Committee. This would change the focus at HHS dramatically, and that the Committee should be sure its work remains relevant within this context. For instance, it would be important to ensure that the Committee’s work on prevention and promotion is aligned with where national health reform is going on prevention and promotion. Dr. Fielding acknowledged this good point, but noted that the group should wait to see what provisions the final bill has before spending too much time discussing this matter.
V. Discussion of Committee Work in the Coming Year
Dr. Fielding asked RADM Slade-Sawyer for guidance to the subcommittees on what input would be most helpful to ODPHP, the Assistant Secretary, and the Secretary. RADM Slade-Sawyer said it would be helpful if the Subcommittee on Communications could suggest how to educate the public about the importance of improving health, especially as pertains to inequalities in social determinants of health. From the Subcommittee on Implementation, she asked for help in thinking through how to operationalize the ecological approach to health improvement, especially by providing concrete examples.
The Subcommittee on Priorities should provide guidance on the selection of measures, particularly with for LHIs. From the Subcommittee on Data and IT, RADM Slade-Sawyer asked for advice on the relational database. The Ad Hoc Group on Social Determinants should provide examples that illustrate social determinants of health, and guidance on how to educate the public about this approach. RADM Slade-Sawyer requested guidance on selecting objectives related to social determinants of health that will be added to Healthy People 2020. Lastly, RADM Slade-Sawyer asked that the Subcommittee on Evidence offer suggestions for how to select evidence-based action steps to achieve objective targets. Dr. Fielding thanked RADM Slade-Sawyer for this useful list, noting that as things progress there may be a need for increased specificity in these requests. Due to scheduling challenges he then signed off, turning facilitation of the meeting over to Vice-Chair Shiriki Kumanyika.
VI. Discussion of Subcommittee Progress and Challenges
Dr. Kumanyika led the group in reviewing the subcommittees’ work since the last Committee meeting. She said the general question to be discussed was how the Subcommittees can be most helpful, as the Committee is not the FIW and will not be able to address the “nuts and bolts” of developing Healthy People 2020. She asked each of the subcommittee chairs to comment on their group’s recent progress.