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Minutes: Seventeenth Meeting: April 1, 2010

Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020Phase II: Update on Phase II Contributions of theCommittee & Focus of Activities in Months to ComeVia WebExSeventeenth Meeting: April 1, 2010 Committee Recommendations (Approved by Vote)

  1. The Committee voted unanimously to approve the recommendations of the Ad Hoc Group on Social and Physical Environmental Determinants of Health, pending the inclusion of the revisions discussed and approved.
  2. The Committee voted unanimously to approve the recommendations of the Ad Hoc Group on Social and Physical Environmental Determinants of Health, pending the inclusion of the revisions discussed and approved.
  3. The Committee voted unanimously to approve the recommendations of Subcommittee on Strategic Communications, pending the inclusion of the revisions discussed and approved.

Committee Decisions (By Consensus)

  • No decisions were made by consensus.

Next Steps

  • All revisions to the Committee recommendations that were proposed during the meeting discussion will be incorporated into the documents.
  • The revised versions of these documents will be sent to Jonathan Fielding and Shirki Kumanyica for review and final approval. All approved recommendations will then be sent to the Secretary.
  • The Committee members will determine whether a Web-based meeting will be needed in advance of their next in-person meeting.
  • NORC will schedule the next meeting of the full Committee.

I. Welcome and Introduction

Dr. Jonathan Fielding welcomed members of the public to the meeting and provided a brief overview of issues to be discussed. Key issues to be discussed included the connection between Healthy People and health care reform, a review of the Committee’s progress during the second phase of its efforts, and discussion and voting on recent activities of the subcommittees. In addition, participants would hear updates on HHS’ progress in developing Healthy People 2020, findings of the Healthy People 2010 Users Study, and the future role of the Committee in supporting the launch of Healthy People 2020.

Healthy People’s Connection to Health Reform

Dr. Fielding provided an overview of several relevant provisions of Senate bill HR3590, the health reform bill that was signed into law in March. He noted that a National Prevention, Health Promotion, and Public Health Council will be created. Chaired by the Surgeon General, it will be composed of the Secretaries of various Federal departments, including Agriculture, Labor, Health and Human Services, Transportation, and others. The Council will be advised by the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health, whose members will be appointed by the President. These groups will be working on a National Prevention and Health Promotion Strategy to improve the health of U.S. population. The first progress report on the strategy is due July 1, 2010 and annually thereafter.

The Council’s report will include a list of national priorities on health promotion and disease prevention. Issues to be addressed include: lifestyle behavior modification; strategies to achieve Healthy People goals for nutrition, exercise and smoking cessation; and interventions to address the five leading-disease causes of death in the U.S.

Dr. Fielding also offered information on several other new HHS initiatives for disease prevention and health promotion. The Communities Putting Prevention to Work (CPPW) initiatives are funded by ARRA and emphasize strategies to address obesity, smoking, and chronic disease. The Community Health Data Initiative is a collaborative of governmental and non-governmental partners that establishes a network of suppliers and demanders of community health data, indicators, and interventions, in order to help Americans better understand health and health care system performance in their communities. Healthy People will be one of several indicator reports available through this data hub.

Phase II Update: Contributions of the Committee

Dr. Fielding reminded the Committee of their accomplishments during Phase II of Healthy People 2020 development, which began in December 2008. He noted that the Committee has approved the following five recommendations and reports to-date:

  1. An “Immediate Actions” memo, highlighting issues of particular urgency for population health in light of the economic downturn;
  2. A “System Specifications” report, which provided practical guidance for an approach to developing an interactive, Web-based version of Healthy People 2020;
  3. A “Proposed List of Topic Area Categories,” offering 49 topics that could be used to organize the Healthy People objectives, as well as observations about the function of topic areas in HP2020.
  4. An “Approach to Developing Healthy People 2020 Target-setting Methods,” which recommended using a variety of data sources and processes to set realistic but “aspirational” targets for objectives, incorporating knowledge of effective interventions when it is available.
  5. A letter to the Secretary, emphasizing the need for a Web-based format for Healthy People 2020.

Two items were discussed at previous meetings, but have not yet been formally approved by vote:

  1. The “Implementation Recommendations” was a list of specific strategies that Committee members believed were important to ensure the adoption and effectiveness of Healthy People efforts.
  2. “Evaluating Sources of Knowledge for Evidence-based Actions” offered a realistic but rigorous approach to ensuring that implementation strategies for Healthy People are grounded in science.

II. HHS UpdateHHS Response to Committee Recommendations

RADM Penelope Slade-Sawyer explained that all of the Committee’s Phase II recommendations have been delivered to the Secretary. The Federal Interagency Workgroup (FIW) has reviewed system specifications report for an online version of Healthy People 2020, as well as the proposed list of topic area categories and the Committee’s proposed approach to target-setting. As a result of the Committee’s recommendations, several divisions within HHS are working to secure the funding needed for the online, relational database in time for the Healthy People 2020 launch. The Committee’s recommendations for the list of topic area categories guided the FIW’s selection of Healthy People 2020’s topic areas; HHS has built on the existing 2010 focus areas to create the list of 2020 topic areas.

The FIW has used the Committee’s target setting recommendations as a foundation for the Healthy People 2020 target setting guidance. The targets have been set primarily using available science and information, modeling existing policies and laws, and maintaining consistency with other Federal targets or programs. When the information needed to employ these methods is not available, the target will be set using a method of ten percent improvement above baseline. Topic area work groups are required to submit a written justification for the targets to increase transparency and improve the public’s understanding of the process.

FIW Progress and Activities

The public comment period for Healthy People 2020 objectives ended on December 31, 2009. Approximately 8,000 comments were received through the Web site, regular mail, and the public meetings that were held across the country last fall. All comments were reviewed by the appropriate topic area Workgroup Coordinators. Beginning in February and ending in May of this year, the FIW has met to discuss about 180 proposed revisions to the objectives based on public comment. Currently, there is a net increase of approximately 25 measures, and there will be approximately 1,315 measures in Healthy People 2020.

The topic area workgroups are writing introductory material for each topic area, setting targets, and establishing operational definitions that will be used to measure the 2020 objectives. The FIW and its subgroups on social determinants of health, health related quality of life, and the newly formed “Foundations” subgroup, are developing a narrative and specific measures that will underpin all of Healthy People 2020.

Status of the Healthy People 2020 Objectives

HHS is concurrently developing a relational database that will seamlessly link Healthy People 2020 objectives with Data 2020 and the Community Health Data Initiative. The information will be organized within an HHS data warehouse. The interface for the database and the redesigned Healthy People Web site will be developed through a user-centered design process involving a variety of stakeholders. Several offices within HHS are working to create the database. Major challenges to this project include funding, maintenance, and designing the database to be dynamic yet functional.

FIW’s Social Determinants of Health Subgroup

After identifying an interdisciplinary group of representatives to serve on the subgroup, which held its first meeting in March, HHS is recommending an incremental approach to developing objectives and related products for the social determinants of health topic area. Key areas for development for Healthy People 2020 are being prepared, but no actual objectives will be developed until after departmental clearance for the Healthy People 2020 launch.

HHS anticipates that a final set of objectives will be submitted for departmental clearance in June of 2010, and clearance revisions will be made this summer. The final Healthy People 2020 document will be submitted to the Secretary for approval. HHS is planning a December launch and a public call to action for stakeholders to implement Healthy People objectives. HHS is also planning to hold a National Healthy People Prevention Summit in the spring of 2012. Stakeholders will be convened to share their implementation efforts with others.

Guidance to FACA for the Coming Months

In the coming months, HHS is interested in receiving guidance from the Committee in two areas: 1) recommendations for implementation, and 2) identifying opportunities to leverage Healthy People to benefit the implementation of health reform.

III. Updates From the Subcommittees

Dr. Fielding noted that, since the last meeting in December 2009, several subcommittees have presented draft recommendations to the Committee for approval. He opened discussion of recent subcommittee activities.

Ad hoc Group on Social and Physical Environmental Determinants

Dr. Abby King, chair of the Ad Hoc Group on Social Determinants, explained that the group had met twice since December 2009. A draft report on the social determinants of health had been distributed to the Committee for review. The ad hoc group identified concrete examples that HHS could use to work across topic areas. Dr. King said that members would be willing to provide appropriate specific guidance to the FIW as needed, as well as implementation strategies for Healthy People 2020.

The ad hoc group presented five recommendations to the full Committee, including:

  1. Encourage and support the FIW’s role in operationalizing the cross-cutting elements of HP2020 that pertain to physical and social environments and extend beyond the health field and making it a priority to focus on social determinants that will impact multiple determinants of health;
  2. Identify and select specific measures that can be used to track processes and impacts related to initiatives to influence social determinants. Such tools should be applicable to both the population at-large, and subpopulations that experience health disparities;
  3. Provide practical and useful information collection tools related to these identified measures, where available; and examples of ways to synthesize the relevant data;
  4. Wherever possible, give specific examples for topic areas that demonstrate how programs and policies to affect SDOH can be implemented; and
  5. Evaluate recommendations and activities being undertaken by other nations in the social and environmental determinants arena.

Dr. Fielding commented that the first recommendation should specifically mention the National Health Promotion and Disease Prevention Council and how it could serve as a vehicle for raising these issues and get consensus on opportunities. With regard to the second recommendation, since every group experiences some disparities, the statement should refer only to those groups that are subject to particular negative disparities. The third recommendation should reference the UCLA HIA-clic Web site (http://www.hiaguide.org/). 

David Siegel motioned to approve the recommendations of Ad Hoc Group on Social and Physical Environmental Determinants, with the changes incorporated, and Eva Moya seconded the motion. The recommendations of the Ad Hoc group were approved by a unanimous vote.

Subcommittee on Priorities

Abby King provided an update on the activities of the Subcommittee on Priorities. The subcommittee met three times between October 2009 and March 2010. The group’s overarching determination was that, given the sheer number of objectives, it would be necessary to give users the tools to prioritize them.

The subcommittee proposed a multilevel approach to priority-setting based on the following ideas: 1) public health priorities should be set by localities, states and at the national level; 2) processes used to set priorities should engage civic participation; and 3) HHS should identify national priorities for the coming decade.

The subcommittee has also indicated that priority-setting should be conducted for: interventions to address specific topic areas (e.g., “Cancer” or “Early and Middle Childhood”); interventions to address the major risk and protective factors for common diseases; and interventions that address determinants of health outside the traditional health sector.

The Subcommittee proposes the following recommendations:

  1. Priorities should be set at each level of government—federal, state, and local.
  2. Each level should incorporate public input into its priority-setting processes.
  3. Priority-setting should be informed by specific criteria (e.g., overall burden, preventability, potential to reduce health disparities, and cost-effectiveness).

Dr. Fielding commented that the language recognizing the various capabilities of stakeholders should be amended to say, “recognizing the various missions’ interests, needs and capabilities.” It should be clear that priorities depend on the nature of the organization that is setting them. He also suggested that when the document mentions setting priorities, explicit language should be added about the notion of preventable burden. The new Prevention and Health Promotion Council should be integrated into the document where it currently mentions the Domestic Policy Council. With respect to the second recommendation on public input, Dr. Fielding suggested changing the wording to encourage the input of all stakeholders including, but not limited to, the public. Dr. Kumanyika suggested that when discussing the need for priorities to be set at each level of government, the subcommittee should separate out the issue of setting national priorities as a separate recommendation. Because the national level priorities are going to be different, this would give the recommendation more visibility.

Dr. Fielding asked for a motion to approve the recommendations contingent on those changes being made. Patrick Remington motioned to approve the recommendations, and Eva Moya seconded the motion. The recommendations of the subcommittee on priorities were approved by unanimous vote.

Subcommittee on Strategic Communications

Dr. Douglas Evans explained that the subcommittee had met five times between October 2009 and April 2010. The subcommittee worked on developing strategic communication objectives and strategies, using the audience matrix that it had previously developed as a foundation for the discussion. The subcommittee also received updates about the communication efforts with other HHS activities, including Healthfinder.gov, partnerships, and audience research that was conducted by ODPHP. The Subcommittee on Strategic Communications presented the following proposed recommendations:

  1. Commend the Secretary for undertaking internal work that spans across the Department to integrate national epidemiological, services, and encounter-financing data and to share these data in a form that is easily accessible by members of the Healthy People 2020 community in the field;
  2. Recommend that the Department undertake immediate planning work to design and build a national public health information technology infrastructure with the capacity to distribute these data, permit online discussions regarding these data, and apply the data to state, county, local community, and family health issues. This system should also be designed to collect future data; and
  3. Strive for the public health technology infrastructure to have the capacity to facilitate communication, networking, and interactive partnerships and collaboration among public health organizations to achieve the health communication and social marketing objectives of Healthy People 2020.

Dr. Fielding said another important message that should be conveyed is that focusing on these health objectives is essential to achieve the goals of health reform. He said that it is important that they focus on aspects of the health reform bill that accomplish the goals of Healthy People 2020. Dr. Fielding also commented that several of the cells in the audience matrix did not have any information; he suggested that the subcommittee provide some examples for those groups, while explaining that they are not comprehensive. Dr. Fielding also suggested that the subcommittee clarify that for academic research and development, it is not only relevant to research, but also the basis for research, and that should be included.

Patrick Remington commented that, in addition to raising awareness, communication efforts should focus on developing skills and providing technical assistance for those who use the objectives in their planning. He said it is important to be clear about how the large number of objectives will help to advance public health so that users do not get overwhelmed by the sheer number of objectives. Communication should be provided in the context of the electronic platform of Healthy People 2020 as opposed to in written documents, so that users are able to search the objectives easily.

Patrick Remington motioned to approve the recommendations of the Subcommittee on Strategic Communications, and Eva Moya seconded the motion. The Committee voted unanimously to approve the recommendations.

Action Steps and Evidence

Dr. Steve Teutsch provided an update on the activities and discussions of the Subcommittee on Action Steps and Evidence. The Subcommittee’s charge is to look at how stakeholders can be engaged and helped to use the exhaustive list of objectives. The group has examined how to identify evidence-based interventions that could be used within each topic area. They discussed how to employ a hierarchy of evidence since the evidence-base varies for different topic areas. Since some evidence from real world practice may not fit into a hierarchy, the group has considered whether it can use specific models to address this issue. The next step would be to solidify the evidentiary hierarchy and to identify the best evidence.

Dr. Kumanyika noted that some of the documents the Committee was working on, such as the report on Evaluating Sources of Knowledge for Evidence-based Actions in Public Health, provide background for this subcommittee and should be incorporated into this subcommittee’s discussions.

IV. Healthy People Users Study

Caitlin Oppenheimer, NORC Principal Research Scientist, presented the results of the Healthy People Users Study. NORC conducted the study on behalf of ODPHP and ASPE to assess how the Healthy People initiatives were being used by state, local, and tribal health organizations. There were five sample groups: Healthy People state coordinators, state chronic disease directors, a sample of local health organizations, a sample of tribal health organizations, and the full census of the 12 multi-tribal area health boards. The study found that there was a statistically significant increase in awareness of Healthy People between 2005 and 2008; however, there was not a statistical increase in those using Healthy People.

The study asked further questions about how respondents used Healthy People, and the common uses varied between different types of users. In addition, the study asked about the barriers to using Healthy People, and what technical assistance was needed to facilitate the use of Healthy People. The 2008 study also gathered data about using Healthy People 2020 and the future of Healthy People in general. There were diverse opinions on how Healthy People should be organized in the future.

V. Discussion of Next Steps

The Committee needed to decide whether to have a Webinar before the next in-person meeting and would work with HHS staff to circulate a scheduling request to determine Committee members’ availability and the best format for the next meeting.