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Dr. Fielding felt these changes would be consistent with the information in the main body of the report. He asked the Committee members to review the recommendations, and to email their comments to NORC staff. He and Dr. Kumanyika would make a final decision on the wording of the mission statement, based on the members’ final comments. A Committee member did not entirely agree with the proposed changes. He offered his understanding of the intent of the suggestions, as well as some alternate phrasing (see Table 1, below). Dr. Kumanyika suggested the phrase "best available knowledge" be used instead of "best available evidence" or "best available information." This would be a point to consider during later word-smithing. Dr. Fielding asked Dr. Patrick Remington to e-mail suggestions for mission statement revisions to the entire Advisory Committee.

Table 1. External Reviewers’ Suggestions for the Mission Statement, and Committee Reactions
External Reviewer Suggestions Committee Reactions Next Step
Bullet #1.
"Increasing public understanding of the underlying determinants of health, disease, and disability—and the opportunities for improvement." (Michael McGinnis)
The focus on increasing public awareness should be captured in the third bullet, not the first. Dr. Remington will email suggested revisions to the Advisory Committee members.
Bullet #3:
"Catalyzing action directed by the evidence and engaging multiple sectors." (Michael McGinnis)
"Catalyzing action using the best available evidence and information." (Lawrence Green)
 
Use "Best available knowledge," not "best available information." To be determined during future word-smithing.

External Reviewers’ Suggested Revisions to the Body of the Report
Dr. Fielding said Dr. McGinnis had offered corrections to some of the historical background information about Healthy People that had been provided in the report. For example, Dr. McGinnis emphasized the important role of states and localities in Healthy People and said this had not been adequately addressed. Dr. Fielding felt it would be appropriate to make this and other corrections.

Dr. Georges Benjamin, another external reviewer, had submitted comments suggesting that the report did not address in a concentrated way the issues of public health infrastructure or ensuring a trained public health workforce. In his written suggestions to the Committee, he suggested the report should discuss these issues; information and communication systems to collect and disseminate accurate data; the role of public health organizations at the state and local levels; and the need for multi-disciplinary, intersectoral partnerships. These suggestions had been incorporated into page 26 of the revised draft report. Dr. Fielding asked if the Committee members had any concerns about this change.

A Committee member suggested the Committee craft a paragraph to define what is meant by a multi-sectoral approach, offering specific examples. Dr. Fielding said that many specific examples are already included in the report, but he urged this member to review the relevant section and see whether any additions are needed. Dr. Manderscheid agreed to review pages 26 and 27 of the draft report and submit any suggested revisions or additions.

Revised Audience Matrix
Dr. Kumanyika explained that revisions had been made to the audience matrix (page 38 of the final draft). It had originally classified audiences into "information seekers" and audiences that "need awareness raised." In the updated version, the audiences were classified as "primary" and "secondary," rather than active and passive. The secondary audiences are "targets for information about Healthy People," and the primary audiences are "seekers of information." Dr. Kumanyika asked Dr. Douglas Evans, Chair of the Subcommittee on User Questions and Needs, if the changes were acceptable. Dr. Evans said that he had not had a chance to discuss the changes with members of the Subcommittee, but he felt they were useful. Other members agreed that the changes were an improvement.

Additional Changes to the Report
Dr. Fielding briefly reviewed additional substantive changes that had been made to the report. For example, the language in the section describing the importance of prevention was reworked emphasize balance between over-selling the monetary savings of prevention versus under-selling the importance of prevention. The current version of the report mentions that not all prevention activities save healthcare dollars, but some prevention activities remain valuable because they improve the health and well-being of individuals.

Other changes included adding more emphasis of the importance of meeting the needs of diverse audiences (e.g., in terms of race, ethnicity, language, background); clarifying what is meant by "upstream;" and noting the need for measuring actual interventions (e.g. policies, programs, etc.)—not just measures of outcomes.

Dr. Fielding asked the Committee members if they had found any other changes in the report to be problematic. The members did not raise any issues. Dr. Fielding stated that the only remaining revisions to be made were minor adjustments to the mission statement, and an additional paragraph from Dr. Manderschied to clarify the meaning of "multi-sectoral partnerships." He also noted that Dr. Vincent Felitti (Committee member) had submitted comments on the report earlier that day and that his remarks would be reviewed. Dr. Fielding asked whether members wanted to wordsmith the mission statement by full Committee, or if they would delegate that task to the Chair and Vice-Chair. (Dr. Remington had offered to provide preliminary revisions). The Committee members agreed to entrust Dr. Fielding and Dr. Kumanyika with making final changes to the mission statement, with Dr. Remington’s help.

A Committee member asked whether it would be possible to invite other individuals with relevant experience or insight to review the report and offer comments at this stage. Dr. Fielding responded that individuals have been able to comment on the ongoing work of the Advisory Committee through the Healthy People web site, regional meetings and public comment at the June 2008 meeting of the Advisory committee, and while there was no doubt that they could obtain other comments, it was necessary to finalize the report and move forward. This would not preclude others from making their own comments, continuing to submit comments through the Healthy People web site, or blogging, or providing feedback in other ways. However, Dr. Fielding said that on balance the report was strong, and that it was time to finalize it.