Dr. Fielding stated his understanding that the Secretary’s Advisory Committee would need to fit together the work of the subcommittees to get close-to-final agreement on key definitions and terms, to the extent possible. They would provide an outline of what the final product might look like, and whether it would consist of a single product or a group of products. Ms. Blakey confirmed that this was in line with her thinking.
Suggestion #1: Schedule a conference call among subcommittee chairs
Dr. Fielding commented that it would be useful to have a conference call of the subcommittee chairs to think about how the various pieces come together, and to integrate them for a more fruitful discussion in June. Other members agreed that some themes seem to recur across areas. A Committee member added that staying in touch with external members would be important because their feedback and expertise has been valuable.
Suggestion # 2: Invite HHS representative to take part in Health Equity discussions
Dr. Manderscheid mentioned that his subcommittee could benefit from speaking with HHS representatives who are working on parallel issues. Dr. Fielding encouraged the suggestion, and mentioned that other subcommittee chairs can decide whether a similar effort would benefit them. He noted that ODPHP could provide specific recommendations to the chairs if he was helpful.
Suggestion # 3: Clarify what the Secretary’s Advisory Committee means by
Dr. Kumanyika mentioned that the priorities subcommittee has a difficult job because of the number of objectives and the question of where to focus. Their work will be critical to the June Meeting. She suggested that the Advisory Committee discuss how to resolve some of challenges facing this subcommittee. Which direction is the prioritization framework or concept is going in? A couple of options could be: 1) If we had a list of objectives, how would we decide which ones were most important? And (2) what important priorities can we develop to guide the objective setting process?
There seems to be some overlap between the issue of a framework that would help us set specific objectives, and a framework for deciding what health issues are important (the risk level, the severity, the population affected, how far we are from the goals, etc.). The Committee has many different ideas of what priorities are. Dr. Kumanyika felt there is a need for more clarification on what we is meant by prioritization. There can’t be 800 priorities. Dr. Kumanyika recommended that this be a topic on the subcommittee chairs call and on the priorities subcommittee.
Suggestion # 4: Decide whether priorities should vary by user group
Dr. Fielding commented that there are a lot of different users of Healthy People, and the priorities will look different depending on who those users are. He wasn’t sure whether the Committee should propose one set of priorities, or help people to think about priorities, given their opportunities to influence health. He felt this could be another topic for the agenda. Dr. Evans asked whether Dr. Fielding was suggesting that there should be some interaction between the thinking about user groups and priorities. Dr. Fielding confirmed his view that priorities are different, for example, among clinicians, versus staff at a state or local health departments, versus staff at NIH.
Dr. Remington said the Committee should look at federal programs that use Healthy People a way to highlight their programs, and how that differs from the needs of a state or local health officer. Local health officers may feel that at the community level, the many different categories that federal and state agencies think about aren’t as important—communities are more holistic. But the reality is that categorical funding isn’t going to go away. The document needs to be responsive to the importance of state and federal agencies, but also useful to communities. State and federal agencies need the depth and detail of a document this big, but users at the community-level want straightforward information about how to help people live longer healthier lives with fewer disparities, and the most cost-effectiveness approaches.
Dr. Fielding suggested the Committee spend time on this issue in June. How the document is organized and how it looks will affect who uses it. Dr. Evans suggested conceptualizing the document as a dynamic information source, rather than a static report. Users could approach the resource (e.g., through a
Web-based format) with queries, and there could be multiple entry points depending on the user’s needs. That would enable tailoring to user needs and interests. Dr. King envisioned a set of algorithms that would vary by user, to help them get the information they need.
Issues and Challenges Related to Prioritization
Dr. Kumanyika pointed out the difference between setting priorities for the health of nation and tools for prioritizing specific objectives. One is a task of deciding which interventions are most appropriate for a particular user to choose, given a wide range of options. But there’s also set of health issues that should be everyone’s priorities, before one gets to a user-specific perspective. Is there a set of guidelines for setting overarching priorities so everyone feels they’re pulling towards improving health in certain key areas that were decided upon using a set of criteria? And then, within their corners, this is how specific users could go about figuring out what their contribution is.