A member commented that this would require formative research and usability testing with these user groups. That could occur in two stages: first, research could be undertaken to understand users' informational needs and habits and the things that would influence their use of Healthy People 2020. And second, web-usability studies could explore the human-computer interface aspect of it.

Dr. Fielding asked the Committee whether there was agreement that Healthy People 2020 should enable user groups to define how this database can be accessed (e.g., by risk factors, by life stages, etc.), rather than making an a priori decision about focus areas. Committee members voted to approve this approach to organizing the Healthy People 2020 objectives (12 votes in favor, 1 absent).

Advisory Committee Recommendation #4: Approach to Organizing the Objectives.

• The relational database should enable user groups to define how they will access and organize the objectives.  Thus, a priori focus groups need not be defined.

RADM Royall offered to explain how the FIW is approaching this issue. She indicated that the FIW is in agreement with the Committee on including a health determinants approach in Healthy People 2020. As a practical matter, the FIW has suggested mobilizing the current Healthy People state coordinators around the current 2010 focus areas, with a focus toward developing the 2020 objectives. Those topics would not necessarily be the focus areas for 2020, and groups are likely to form around new topic areas as discussions progress. Since technology enables the creation of a searchable database, objectives can be reconfigured to represent a more cross-cutting approach after they have been developed. Federal teams responsible for coordinating Healthy People can also be rearranged at a later point in time.

Dr. Fielding asked Committee members for their thoughts on the FIW's approach of starting the work to develop objectives in workgroups organized around the original twenty-eight focus areas of Healthy People 2010. He noted that the Committee did not want to impede the FIW's progress in any way. Yet based on their last vote, he also said the Committee did not necessarily want to bless the previously existing 28 categories as being the "right way" to organize Healthy People 2020. The objectives can be organized in other ways.

One member cautioned that other issues have emerged in the decade since these focus areas were developed (e.g., such as socio-economic determinants and early developmental milestones) that are not covered by an existing Healthy People 2010 focus area. Such topics may be overlooked in this early period of the FIW's work. The Advisory Committee may want to help bring some of these issues forward to ensure they receive appropriate attention. RADM Royall agreed with this point, adding that preparedness and health information technology have also emerged as important issues since the drafting of Healthy People 2010.

Dr. Kumanyika brought up the fact that, as the Healthy People initiative has evolved over the decades, the term "priority areas" was used in early decades, and then later it became "focus areas." She expressed concern about the differences between these two terms, and the fact that they leave different impressions. She felt it is important to clarify that "focus areas" offer a way to group objectives, but they are not priorities. A Committee member said that vote #4 should be clarified to indicate that the approach was to organize objectives into focus areas, rather than priority areas. Dr. Fielding clarified that vote #4 was simply about ensuring that the database enables user groups to easily search for areas of their concern.

Dr. Fielding said the committee supported the FIW's decision to move forward with the existing 28 focus areas without necessarily agreeing that these should be the primary areas of emphasis or the focus. A member added that the group should go further and state explicitly that the term should be "focus areas," not "priority areas." Dr. Fielding stated that, for Healthy People 2020, the group hasn't suggested that focus areas will really be a component—apart from user-defined focus areas. Another member commented that the issue is not that the Committee members don't have an opinion about focus areas; it's that they're not ready to address this issue yet. This is simply the best way for the FIW to start their work. RADM Royall thanked the Committee for their feedback.

Dr. Kumanyika expressed concern that if the FIW does too much work using an approach that lacks any particular conceptual organization, the results will be inconsistent across focus groups. She asked whether it would be possible for the FIW to try to arrange the objectives using some of the concepts in the Healthy People 2020 model (i.e., determinants, pathways, outcomes). She asked whether there was a guiding principle that would help the focus areas to fit with the model once the work is done. RADM Royall explained that ODPHP has already done that. They have assigned interns within the office to go through all of the Healthy People 2010 objectives and put them into cross-cutting categories. Dr. Fielding noted that this work will be useful to the Committee, as it will highlight areas where there is a great deal of emphasis, and other areas where attention is inadequate.

RADM Royall indicated that ODPHP's work is almost ready to share.

VII.  Preparing Final Report of the Committee to the Secretary

Dr. Fielding said that NORC would draft sections of the final report for each of the subcommittees for September, working with the Committee members for review and editing. Writing teams can parallel the subcommittees, but they can involve more people if necessary. He emphasized that the real issue is integration, at this point—not having separate subcommittee reports. At this point, the voting will not be on subcommittee products, but on the final report itself. The subcommittee reports will be excellent background material for those who want to delve deeper into particular issues. The subcommittee reports will be useful background for preparing report sections.