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VI.  Organizing Objectives Into Focus Areas

Dr. Fielding said the concept of "focus areas" was important when their purpose was essentially to a organize book of objectives (i.e., the earlier, printed versions of Healthy People) into chapters. He questioned whether focus areas would be the right approach for organizing information within a web-accessible database; "areas of emphasis" might be more useful. Dr. Fielding noted that, when using a relational database, focus areas would be determined by users. For example, if someone is part of the Scleroderma Society the information that they want is about scleroderma (i.e., their focus area). Yet a local or state health department official might be more interested in determining how to prioritize preventable burdens or ameliorable risks. Dr. Fielding asked the Committee to discuss the notion of focus areas and whether Healthy People 2020 should still have them.

A Committee member commented that, over past Healthy People iterations, focus areas evolved to become less conceptual and more advocacy-based. The model discussed earlier in the meeting offers categories that could be used to organize objectives; they could be less advocacy-based, and more conceptually-based. Another member added that Dr. Kumanyika's model provides the opportunity to look at focus areas in multiple ways—in terms of determinants, interventions, and outcomes, but also in terms of specific issue areas. Technology could permit both cross-cutting and issue-specific approaches. It would be a mistake to completely abandon an issue-specific approach, because advocacy groups support the work of Healthy People and will help to drive it forward.

A Committee member asked whether having focus areas helped people to set priorities and motivate change in their communities in the past. While he did not have any specific information on that issue, Dr. Fielding said he believed that not many health departments have used the focus areas for priority setting. People set priorities based on their circumstances. For example, a health department that does not have funds for programs may look for opportunities to improve health through policy. If a health department has a small amount of funding, it may look at interventions that are most likely to be effective, based on a certain effect size. It might seek to implement a program that will produce outcomes within a certain timeframe. Focus areas have been used in a variety of ways, which is why Dr. Fielding believes that a relational database will be so important.

A Committee member noted that search terms will be important to developing the database. Dr. Fielding said that the Advisory Committee could assign a small group of Committee Members, with external help, to delineate requirements for the database. Search terms would be a critical part of that effort. Another member said that Wisconsin had developed eleven priority determinants without mentioning specific diseases, but this may have had an impact and effect in terms of stakeholder buy-in. The best use of the objectives may be as a call to action. The issue of whether objectives are organized within 10 or 27 focus areas may be less important. If past trends continue, Healthy People 2020 could have 45 focus areas. There's no real need to go against this trend because focus areas are simply an organizing concept.

One could take an alternative approach that, instead of having a laundry list of focus areas, the categories of the model/conceptual framework could be used. Another member agreed with the idea of organizing the final product conceptually, rather than having a laundry list. A third member argued for integrating information about users needs into the organization of objectives. Such an approach could reduce the need for having focus areas in the first place. Dr. Fielding agreed that it would be important to ensure that all areas of emphasis for different user groups can be incorporated into search terms for the database so that users can easily access the information they are seeking.

Members discussed various ways to think about focus areas—as entry points to the proposed relational database, or as a way for users to decide where in the process (i.e. determinants, pathways, and outcomes) they want to impact health. Dr. Fielding said the Committee seemed to want to focus on users and to make sure the priority needs of the different user groups are accommodated in the model, rather than making an a priori decision about a certain number of focus areas. He asked if this was the general consensus of the group. Committee members liked the idea of using user groups, but noted that it might be necessary to add other things. Dr. Fielding said the recommendation to the Secretary could be that the user groups should help to define different ways into the database and different questions they might ask, so that the database should be easily searchable.