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Subcommittee on Environment and Health Determinants
Subcommittee Chair: Abby King, PhD, Stanford Prevention Research Center

The subcommittee has focused on the domains of physical and "social environments" (the latter was considered broadly, e.g. cultural and economic environments). Key issues discussed included the importance of: 1) multi-level framing of interventions (from the individual through the environment and policy levels); 2) building multi-disciplinary, inter-sectoral partnerships across the U.S.; 3) promoting environmental justice to increase health equity and decrease inequalities. 4) Focusing on "higher-level" interventions (e.g., passive prevention strategies) when possible. The subcommittee felt these responsibilities should extend beyond the public health sector, and brainstormed about how to identify and get buy-in from other appropriate sectors.

Members discussed emerging environments, such as virtual environments that are being created by interactive communication technologies. They would like to create a separate, introductory section that talks about themes of social and physical environments and lays out the multi-level nature of health. These themes should also be woven throughout the Healthy People documents. They liked the model that Dr. Remington’s group developed, and could create a "mini-framework within a framework" to talk about behavioral, physical, and social environments. The subcommittee is currently: adding to the Healthy People 2010 definitions of social and physical environments, refining overarching principles, and recommending activities. Unresolved issues include: best ways to include this multi-level focus within each area of the document; finding ways to highlight opportunities for intervention; surveillance; and how to obtain buy-in from all sectors. Dr. Fielding agreed it is important to think about what the opportunities are, as well as the interventions.

Subcommittee on Priorities
Subcommittee Chair: David Owen Meltzer, MD, PhD, University of Chicago

The subcommittee sought to gain insight into how to prioritize the goals and objectives of Healthy People, since there have been an increasing number of objectives in each iteration. The group addressed three main questions: (1) what principles should be used to guide prioritization? 2) What logic model should be used? (3) How were these issues addressed in previous iterations of Healthy People? The subcommittee drafted a list of principles, some of which included: the need for framework, need for specified objectives, and need for measures across multiple domains (see Appendix 3). It will be important to provide a process and tools to inform prioritization efforts. The question of whether we are talking about prioritizing objectives or interventions has also been raised.

Dr. Meltzer reviewed a number of potential logic models to help frame this discussion. He highlighted the model proposed by Dr. Remington, as well as other possible models. He added that more discussion is needed about whether any of these models is adequate. The subcommittee has begun to review previous approaches used to develop priorities for Healthy People. He noted that earlier processes were categorization exercises. They were strong in generating long lists of possible objectives and interventions, but they were weaker in winnowing through them. Thus, guiding principles must be integrated into the process. Unresolved issues for this subcommittee include: mapping principles to an actual process, both in the short-run and the long-run; deciding what framework or logic model will be used; deciding how to build on previous iterations; and preparing recommendations. Some discussion of how costs will figure in is also needed.

Preparations for June Meeting

Dr. Fielding asked Ms. Blakey if there were specific expectations for what should be accomplished by the June Meeting. Ms. Blakey said that ODPHP would like to have a discussion by the full committee of issues that have been addressed by the subcommittees. They would like to have a clear direction or near-final draft that they could put forward for formal public comment. Ultimately, this would be submitted for clearance throughout the Department, although a final draft is not needed by June. For example, the Advisory Committee could produce definitions of health equity and a draft framework.