Transcript of the Healthy People 2010 Regional Meeting
New Orleans, Louisiana
October 21-22, 1998

U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion

Comment On:
Framework and Goals

DR. CLINTON: As you can see, it takes a lot of technology to have to have a public hearing, but we are delighted that we have everything, I think, reasonably working.

Good morning. I am Jarrett Clinton. I am the regional health administrator in Atlanta, Georgia. I am very pleased to welcome you to this session, in which we hear from you the specific comments from the public specific comments regarding the draft document, Healthy People 2010.

I would like to acknowledge these folks who are joining me on the podium this morning. Representing Region VI, Jim Doss, who is the acting RHA in Dallas, Texas, can’t be with us today. Mary Bowers from that office is here and will be leading one of the subsequent concurrent sessions.

With me also is my colleague in Atlanta, Beaumont Hagebak, the senior public health advisor in my office, and he will be handling the other concurrent session, the three concurrent sessions that begin around 9:00 o’clock.

With us also today is Linda Meyers, the acting director of the Office of Health Promotion and Disease Prevention in Washington, D.C.

She will be making some brief comments about the structure of the plenary session this morning, as we talk about some specific chapters in our first session.

During the fall of 1998, the U.S. Department of Health and Human Services is convening five regional meetings, of which this is one, to discuss progress toward achieving the national health goals for the Healthy People 2010 activity, and to hear comments from the public about the draft goals for the year 2010.

The meeting here in New Orleans is the second of five regional meetings. The purpose of today’s session is to hear your comments on the draft Healthy People 2010 document, which was made public in the middle of September this year.

Your input is vital and will be used to finalize the health objectives for the nation for the year 2010. I encourage all of you to provide all statements about the draft document.

In addition to your oral statement, I encourage you to submit written comments via the Internet or the mail.

You could provide written comments to the registration desk today. You can provide written comments by mail. It would be delightful if we could receive it in a standard electronic format on a disk. That would accelerate our putting all these materials together.

You can send it in by the Internet, and those addresses, both mailing addresses and internet addresses, are available in the material that was given to you at registration.

If you find that you don’t have it, the registration desk can provide it again.

A transcript of today’s session will be made public and posted on the Healthy People web site. In addition, all written comments received between September 15 and December 15 of this year will be posted on the web site. The address for this, as I indicated, is in your materials.

To help assure a fair opportunity for everyone to participate in today’s hearing, we will be using the following procedures, and I need you to follow these rather carefully.

First, each oral statement will be limited to three minutes, so that we can hear from the greatest number of participants.

Further to that, we will spend a specified time on each of the chapters. Indeed, if there were 25 presenters on one chapter, it may not be that we can get through all of those oral statements.

So, we are dividing each commentary into not more than three minutes and specifying a limit to the number of minutes that we can spend on a single chapter, so that we can provide some opportunity for everyone, or almost everyone, to make a comment. That has not been a constraint in the other meeting. I don’t believe that will be a problem here.

Second, each individual and organization will be limited to one oral statement for the opening session and for each of the three focus areas.

If time permits, at the end of the concurrent session, the floor will be open for general comments today.

From 8:15 to 9:00 this morning, we will be hearing you comments on the framework, the goals and the leading health indicators for the Healthy People 2010. That will be done here in the concurrent session.

Then at 9:00, we will break into three concurrent sessions. Session one, promoting healthy behaviors and healthy and safe communities, will be convened by Dr. Beaumont Hagebak, and will be in the Rosedown Room on the second floor.

Session two, improving systems for personal and public health, will be convened by Mary Bowers and will be in the Crescent A room here on the 16^th floor.

I will convene session three, focusing on prevention and reducing diseases and disorders, here in the Ballroom.

We expect that this session would end at 1:00 o’clock today. We look forward to your participation in this and we will now begin to formally open the commentary on framework, goals and leading health indicators.

Before we do that, however, I would like to ask Linda Meyers to make a few brief comments about the focus of our discussion for these 45 minutes or so.

DR. MEYERS: Thank you. Good morning. I would like to deviate from the script and add an additional welcome to you from the Office of Disease Prevention and Health Promotion and its terrific staff.

The draft framework for Healthy People 2010, for which we want to hear your comments, includes two goals, four major sections, 26 focus areas, and the graphic depiction of the structure, which should be in your folders on the right side.

You can see from this graphic depiction that the two goals are to increase the quality and years of healthy life, and to eliminate health disparities.

The four major sections, three of which surround the goals, are promote healthy behavior, promote healthy and safe communities, and prevent and reduce diseases and disorders.

Surrounding it all, improved systems for personal and public health.

The 26 focus areas are listed on your agenda. The last area for which we are seeking comment in this section, leading health indicators, these are intended to be a small set of objectives that could be presented to the general public and to non-health professionals as an introduction to Healthy People.

Thank you. We look forward now to your comments.

DR. CLINTON: Okay, at this point I invite you to queue up behind the microphone, which is here in the center. The process will be you go to the microphone, queue up if that is necessary.

You understand the three minutes. My colleague here will be running the timer device. When it is yellow, you have one minute, and when it is red, we are in trouble and you are out of time.

After you make your comment, we need to make specific notation of who is making that comment. If you will move to the table which is in the back, where my colleague will help you register, to make sure that the voice on the tape and the name hook together.

I think that is enough about rules. So, I invite anyone who might want to make a comment to step forward. Please introduce yourselves, whether you are speaking for yourself as an individual, or representing an organization, and proceed. The first speaker, please?

MR. STEWART: My name is Larry Stewart. I am a biology professor here in New Orleans at Holy Cross College, and an adjunct professor at Tulane School of Public Health.

What I would like to share with you is a pet peeve I have in my teaching of wellness, and also classes in exercise physiology.

I would like to propose that the use of the word overweight be eliminated from all of our discussions about health and wellness and the word over-fat be used instead.

The health problem with too many Americans is the fact that they are over-fat. Overweight is really an ambiguous term. Mark McGwire is overweight for his body frame, but certainly he is not over-fat.

Our total body weight, or mass, is a sum of four weights, our skeletal weight, our muscle weight, our internal organs, and especially our fat weight.

It is the fat weight that is the major health problem for too many Americans. Even the use of the new body mass index can be a fallacy, particularly in people such as Mark McGwire or anyone who does engage in strength training. You give an erroneous impression that they have too much bulk.

A far better measure of a person’s body fatness is the determination of a body fat percent, using either skin fold calipers or underwater weighing or some other method of instrumentation.

What I would like to propose and recommend, and I strongly urge, is the use of the term over-fat in place of overweight in all of our discussions and especially in the documents that are produced.

The sooner we can get into the American consciousness the fact that excess fat is one of our major health problems, the better off we will all be. Thank you.

MS. MC PARTLAND: Hi. I am Patricia McPartland and I am the executive director of the Southeastern Massachusetts Area Health Education Center.

First of all, I would like to start by congratulating you. Healthy People 2010 represents a lot of research and a lot of hard work, so congratulations.

I also want to express to you how essential it is that you have as your overall goal to also include objectives that specifically eliminates health disparities in race. This is crucial and I am glad to see it as an overall goal and hope it remains so.

Also, to add other groups to this, including gender, age, lifestyle, disabilities, et cetera.

Furthermore, cultural competency must be included in the training curriculum of all health care professionals, including medicine, nursing, allied health, health education, et cetera.

We must offer continuing education in cultural competency for those already practicing in the health field.

Finally, trained medical interpreters are necessary in our health facilities.

I will elaborate on these points in my written comments. Thank you.

MS. STREETT: I am Betty Street. I direct chemical dependency programs for Region I mental health.

I felt like, in a sense, a voice crying in the wilderness, and I expected to have that feeling here. I opened up the big yellow book and saw physical fitness as one of the first objectives, or the first objective. So, I was really excited.

I think that in our modern society probably the worst thing we did was come indoors and sit down. I am sure that depression is one of the worst plagues in our society, and especially among our children.

What research is showing now is that depression is associated with violence, conduct disorder, suicide and also substance abuse.

The least expensive way to treat depression is through physical activity, and especially physical activity outside in the sunshine, which is another wonderful anti-depressant.

We take our children and we put them inside in artificial light and we make them sit all day long, and then we wonder why they act out when they get out at 3:00 o’clock.

I think that probably the only way we are going to effect an effective exercise program in the schools is if it is mandated by the federal government and gets tied to funding some way or another.

I think that would eliminate violence. I think it would prevent a lot of substance abuse and suicide. As Dr. Satcher said, there were three deaths to suicide to every two to violence. Thank you.

MS. GIMARC: I am Jerry Dell Gimarc from the state health department in South Carolina, and speaking as an individual.

I see that the underlying causes of death are referenced in the health disparities section, talking about poverty, talking about socioeconomic status, talking about those kinds of issues that we know provide the framework either for good health or poor health.

I would like to see those as the specific objectives in the Healthy People 2010 brought out as a way of, not that we alone affect it, but within the context of how we improve health, I think that is a critical issue as we look at health disparities.

The second comment I would like to make is, as we look at the key indicators, I would like to see that we include at least one environmental health indicator.

Thinking about it, I am not sure if it should be air quality; certainly drinking water quality, because of the aquifer being ultimately the place where contaminants in the air, contaminants in the soil and up.

I think it is really critical to have a key indicator that is an environmental on in our key set of indicators.

MS. FERNANDEZ: My name is Rosa Vivian Fernandez, and I represent First Nations Community Health Source, which is an urban Indian health center located in Albuquerque, New Mexico.

My comment is really on structure. I was fascinated to see that, although one of the goals is eliminating disparities, eliminating disparities was a section and not the overall plenary for this meeting.

I would encourage the planning committee or members that have influence in the future meetings that we look at that.

If eliminating disparities is truly one of the goals, it should be the overall plenary for the meeting and we should not be choosing from attending a section on eliminating disparities and data, when data is actually -- the discussions around data and other items should focus on the elimination of disparities.

MS. COOKE: Good morning. My name is Mary Bobbitt Cooke, and I am the director of the Office of Healthy Carolinians in the North Carolina Department of Health and Human Services.

I wanted to say first off, thank you for holding this meeting. I see this as a real genuine effort to communicate with states, communicate with communities, about the health of our nation.

You are to be commended not only for having a crisp meeting, but a real genuine effort for communication.

I do have two points that I would like to say officially for the record. One, the Healthy People objectives are not written so communities can understand them, and they cannot use them.

I would encourage the authors to try to break away from the biomedical approach to health and identify issues and use language that communities can really rally around.

I think that if we believed health is created in the community where people work and play, pray, learn and live, then our goals and objectives should really describe those goals and objectives that will rally these people.

We should be looking at whole people, whole neighborhoods, whole organizations, whole communities, not just the disease or the risk behavior that they have.

The second point I would like to just raise, although I am not sure the Healthy People document can do this, but it is a need, we need funding not tied to a disease or a risk behavior, but funding that will go to the communities, to the local health departments, so that they can engage communities in creating health.

They need facilitators there to mobilize, influence and gather people together to create a healthy nation. Thank you.

MR. ESPINOZA: Good morning. My name is Renato Espinoza, and I am the director of the Office of Minority Health at the Texas Department of Health.

The Office of Minority Health was created by the legislature six years ago. When I saw that we have changed from the year 2000 goals, from three goals to two for the year 2010, I was very happy to see that eliminating disparities had become one of the two major overarching goals.

At the time the first document came out, I proposed within the department that we make eliminating the disparities the single overarching goal.

That position went through a review and, unfortunately, for some clerical errors, it didn’t make it to the official comments.

I would like to reiterate that position again. Texas is the second largest state and the second most diverse state. Forty percent of our population is minorities.

Therefore, it is critical that we adopt this as the overarching goal, at least for our state, and I think it should be done for the nation.

If you look at the second goal that is remaining, extending the years of life, the five first goals are all having to do with disparities and six through ten have to do with quality of life.

Therefore, if we make eliminating disparities the single overarching goal, we are going to accomplish everything that we wanted to do with these two goals. I have some comments for the other areas later. Thank you.

One more thing. There is a symbolic meaning to number one. If the decision is to keep the two goals, my proposal then becomes, make eliminating the disparities the first goal, rather than the second goal; first priority, important, top, number one. That is the message that we will send to the nation. Thank you.

DR. CLINTON: Just a reminder. We are talking about the overall framework that Linda Meyers described, the pictorial presentation. We are talking about the goals. We have heard some comments on that, and the leading health indicators.

MS. RICHARDSON: Good morning. My name is Lynn Richardson and I am an emergency physician. I spent most of my career in public hospitals serving indigent and minority populations and I would like to speak for a moment to the issue of eliminating health disparities amongst racial and ethnic groups.

As I think everybody in this room knows, there are racial and ethnic inequities in racial and health status. There are racial and ethnic inequities in access to health services. There are racial and ethnic inequities in the quality of the health care that is delivered, and there are racial and ethnic inequities in health outcomes.

All of these disparities, all of these inequities have to be eliminated. So, the elimination, not just the reduction, but the elimination of these disparities, I think, has appropriately been made one of the major goals of Healthy People 2010.

I think the decisions that have been made with respect to the target setting methodologies are the appropriate ones. I think it is very important that there be a single target for all the minority population groups.

I think it is appropriate that the better than the best methodology is used to set those targets, because I think that most accurately reflects the true disparities between these groups.

I think it is very important that there be targets for every group and that the data that we have be presented in each of the objectives.

If we don’t have data, it should be explicitly stated that we don't have data for certain minority population groups, so that the data gaps are quite clear.

I think we are all familiar with the official tendency to feel that if there is no data, then there is no problem.

I congratulate the people who are responsible for the approach that has been taken in the current draft and I strongly urge you to retain that in the final draft of Healthy People 2010. Thank you.

DR. CLINTON: Thank you. Are there any other comments to be made now?

I would suggest, so that we can move along with the schedule, that we reconvene in the three concurrent sessions at a quarter to 9:00, 8:45 or a quarter to 9:00. That leaves about 16 minutes to do the necessaries. Thank you very much.

[Whereupon, the plenary session was recessed, to reconvene following the concurrent sessions.]

PLENARY SESSION II

DR. CLINTON: Given the availability of time, we wanted to reconvene this, to reopen the opportunity for comment about any of the components of the document itself.

I think that for all of us it is a very large document. I am sure that some of you tomorrow are going to find things that strike your interest and concern and so forth.

There is always that possibility of sending in by mail and Internet that we mentioned earlier.

We found it very helpful to hear a range of comments. Some of us have noted that it turns out to be a different set of concerns and issues than was the case in Philadelphia.

My guess is that will be similarly, as this meeting moves on to Chicago and the West Coast, each group expressing different concerns.

A lot of the concerns focus on the strategy for implementation. While those are highly relevant to those who are trying to craft them to be sure that they are implementable at the local level, the document itself is not about the strategy.

Those things predominantly come up at the state and local levels. So, for those of you who have been expressing concern and raising suggestions about the implementation of Healthy People in your community, state or local, I encourage you to re-emphasize that with your state and local leadership.

Nonetheless, as I noted earlier, some of those things are relevant in the formulation of those objectives and that is the primary purpose of our meeting today.

Just as a side note, we have sent out 18,000 invitations to these meetings, to get back to some of the things that the group in here and I were talking about, how did you learn about it.

We might do, since it is a broader group of people, how many are here because you had a direct mailing?

How many of you got a mailing from someone else? That is, they did a subsequent mailing reminding you about it or you read it in one of the association newsletters or something like that?

How many of you heard of it because of a friend or colleague, professional or otherwise?

It is rather evenly divided among those three parts. It is an awfully big nation out there and we are always challenged in trying to get the word broadly to everyone who should be included.

We will follow the same set of rules, the three-minute rule, the move up to the mike, sign in at the back process that you already know. I won’t repeat those again.

So, we open this session, then again, to any comment that any of you might want to make. May we have the first commenter? Are we all waiting for someone else to speak first? He or she who speaks first gets a free bagel.

It is fascinating that we are all here to see what someone else has to say. I don’t want to prolong this any longer than we need to.

Let me ask again, are there any comments on any of aspects, then, of the draft document?

MS. GIMARC: Jerry Dell Gimarc from South Carolina. In the year 2000 document, one of the things we used the document for in communicating and tracking, was to break down the objectives by age grouping, basically, life stages.

We had great difficulty because in many cases the objectives went across age groupings. I understand the problems with data collection.

I would just urge that, because I think that people relate to age groupings, life stages in a way, that there be consideration for having consistency in the objectives over specific age groupings, recognizing that you may have data collected in a different way. See if there could be some way to do subsets that are consistent within the document.

DR. CLINTON: Right, that is very helpful.

Are there any comments that any of you would like to make about the meeting, about the process by which we are trying to gather information and the way that you would be included in the future, or any broader comments that we will say doesn’t deal with the document itself, but rather, with some of these gatherings and discussions we may have had yesterday.

MR. STEWART: Larry Stewart here in New Orleans. I would just be interested to know what may have happened at your other regional meeting. What worthwhile information did you pick up there that you could tell us about.

DR. MEYERS: Actually, it was interesting. The meeting in some ways was quite different. There was much greater discussion on the third area of preventing and reducing diseases, and very little discussion in the promoting healthy behaviors. This was an interesting switch.

In terms of actual take-home points, the other members of the ODPHP staff may want to comment on this, but they will be put up on the Internet, so that you can actually see what the transcript shows. Linda, are the summaries going to be up there as well? The summaries from the individual sessions.

DR. CLINTON: Linda, is there anything that you want to add further to that?

MS. BAILEY: I guess just in the way of details, the full transcript of the public comment session should be up within 30 days after each meeting.

We will also have summaries of the breakout sessions that occurred yesterday afternoon, and those should be up at about the same time.

DR. CLINTON: It gives me an opportunity to say thanks, again, to Linda Bailey, who has been a key mover in Washington in making all of this come together. Please, go ahead.

MR. MATTHEWS: Hi. My name is Dan Matthews and I am with the Texas Department of Health. I have a few general comments and, frankly, I wasn’t too sure where to put them in.

It seems to be a little bit outside the box created by that three-inch yellow book.

What really made me think about it was yesterday when Dr. Satcher gave his presentation. Frankly, the part that I found most interesting was an anecdotal story he gave.

He was with the CDC and he was in Africa. There was a group of teenagers there who were involved in all types of risk behaviors, and that is what he was focusing on.

So, he did something that really struck me. He asked them the question, why are you engaged in those activities.

Then the other thing that really struck me was the answer that they gave. It was very different than what I have been hearing over the last two days.

It wasn’t that we don’t have enough money for health care insurance. It wasn’t that, since we live in Africa, there are not enough hospitals.

It was that, our society is changing and where is our community to support us in our lives.

Because of that, that absence in their lives, that alienation in their lives, they try and find ways to solve that problem, and it leads and develops into all types of social pathologies that I think we are all here today to try and address somehow.

Then when I looked in the yellow book, what I saw was 26 indicators, 500-and-some objectives.

We parsed all those different elements of a human life and their experience, which those teenagers summed up into one simple sentence, and we divided it into all those little parts.

Now we are trying to treat those symptoms, whereas in public health I thought primarily we were focused on prevention.

If we don’t put those back together into a holistic approach -- and that is why I think the community involvement is so important, because you actually need to go out there in the community to ask them why, what is going on, as opposed to us going into the community with all our solutions in our briefcase.

It is a very different approach and it is necessary to really understand the problem, the root causes of the problems. Once that happens, we will actually have some hope, I think, of trying to address that, and preventing all those indicators that are presented in that book.

I am not sure where this fits in. It needs to fit in somewhere. I couldn’t find it in the book last night when I went back to look at it.

I hope you take that back to Washington and think about it. Frankly, I got the impression from Dr. Satcher that that is what he was most interested in. That is what he was most impassioned about when he spoke.

DR. CLINTON: There are several ways to respond to that. I think our group will certainly take it into full consideration.

The actual implementation of Healthy People, however, occurs at the state and the local. It may be that you have got an even greater capacity to make it come together in those communities, having defined those communities, whether it is the state that is the best messenger or the county or however one divides your piece of geography. We all need to think about it.

MR. MATTHEWS: Just so you know, in Texas that is something that we are working on. Thank you.

DR. CLINTON: Thank you for your comments.

DR. MEYERS: One of the things that we have been struggling with and thinking about is how to communicate Healthy People.

You have the huge volume that will be released in January of 2000. Another volume that we are starting to think about is one that would be more directed toward people and the settings in which people live and work, and would probably include the set of leading health indicators as well.

As you comment on the objectives, any thoughts you have about how that might be put together in a way that is more holistic -- and that is the intention of that volume, I think -- your comments on that would be helpful as well.

MS. SMITH: I am Joan Smith from the state health department here. I just have a question. For those folks who don’t have access to the Internet, how do they get the information?

The guy asked the question about can you tell us about and you said, it is going to be on the Internet.

I think that kind of also, a little bit, strikes at the crux of the matter of communication, too. It is like, everybody doesn’t have access to the Internet. So, how do you get to it.

DR. CLINTON: The reason we are so excited about internet is that it doesn’t require paper. It is the paper bill and the printing bill that we run into problems with.

I am told by staff that there will be print copies available for that. It will probably be a very large document and it will be difficult to mail it out to very many people.

If you feel strongly about that, and you want to see that, then I would suggest that you contact the office at the same address to which you would send comments, and Linda Bailey and her staff will think through how that can be accomplished.

It may be that by sending one into the state or one into the county, then you can do either circulation or copying of components that are of particular interest to you.

It may be that other organizations could down load off the Internet, if you could identify people who could do that.

MS. VAN LOON: My name is Susan Van Loon. I am from New Orleans, Our Lady of Holy Cross College. I am a professor there.

I have a comment and a suggestion. The comment is that obviously we see a lot of empty chairs here and we would like to have all of those chairs filled, so that we would increase the number of comments from the public and make this a better document.

My suggestion is that for future regional conferences, that the coordinators and organizers might encourage media attendance, notification of the media.

I would have loved to see Dr. Satcher’s talk covered by both print and TV. Unfortunately, representatives were not there from either the local newspaper or from the local TV stations.

I know that is voluntary on the part of those organizations, to decide whether or not they come. Surely in the budget, in the future, there might be ways to buy print, buy space in the newspaper, to advertise these meetings to the public, and encourage the public, members of the general public, to attend as well.

DR. CLINTON: Dr. Satcher did have a press conference immediately prior to his presentation. It focused on a range of activities. There was also a grant award here to one of the universities here in the area. That had a press conference.

I suppose we should have added a third one. You make a good point. We will take that into consideration.

MS. BAILEY: I wanted to clarify that the Times Picayune was here yesterday for Dr. Satcher’s talk. I didn’t see the paper this morning. I am not sure if they covered it.

Media have been invited. You know, we have sent invitations out to over 18,000 people.

We are also really relying on people who are with organizations to help us get the word out. I think the letters of invitation that went out encouraged people to bring colleagues.

I think the idea of trying to get in the papers before the meeting is a very, very good one, and we would like to do that.

DR. CLINTON: You have really been extremely helpful. You have provided an enormous amount of meeting, providing thoughts that really did not come from the Philadelphia meeting, and I think make a unique contribution.

I think the very substantive discussion about the racial disparities and the issue of engaging ourselves more directly in the minority disparities has been a theme, which has been throughout the discussion here. It was not in one of the earlier meetings.

We are appreciative of the time and the energy you put to it and spending yesterday and today with us.

Thank you very much for being here. We wish you well. We hope this has all been useful to you. It certainly has been for us. Thank you again.

[Applause.]

[Whereupon, at 10:34 a.m., the meeting was adjourned.]

New Orleans Transcripts and Summaries