Healthy People 2020 can be viewed as a strategic approach for improving the health of the US population over a ten-year timeline, applicable nationally, regionally, and in states, counties, cities and towns. … The Healthy People strategy was designed to define and promote a common sense of purpose and goals, with specific targets.
—JonathanFielding, Shiriki Kumanyika, & Ronald Manderscheid

The effects of the continuous effort of various health care reform initiatives to improve a population’s health are difficult to track, measure, sustain, and analyze, but evaluating the impact of changing guidelines and requirements is part of effective operational management. How are improvements aligned with an appropriate return on investment, and how can this be measured?

To prepare for this Discussion:

Read the three articles provided this week, and reflect on how these initiatives have impacted health care organizations.

Post a cohesive response to the following:

Describe how health care reform initiatives and mandates have impacted your organization. What changes in operations have been made in response to these initiatives? How well-organized were these changes? How have they offered measureable improvements in both clinical practice and performance? Explain how these improvements were a result of the reform initiative.

Since the late 1970s, the federal Healthy People Initiative has been a visible component of the United States’ approach to improving population health. In each decade, a new version of Healthy People is issued, featuring updated goals and identifying topic areas and quantifiable objectives for health improvement during the succeeding ten years, with assessment at that point of progress or lack thereof. Progress has been limited for many objectives, leading to concerns about the effectiveness of Healthy People in shaping outcomes in the context of a decentralized and uncoordinated US health system. This article describes development of Healthy People 2020, launched in December of 2010, from the perspectives of three members of a public advisory committee appointed to guide the process: The Secretary’s Advisory Committee on Health Promotion and Disease Prevention Objectives for 2020 (SAC). The SAC made recommendations, almost all of which were adopted in some form, based on extensive assessments of strengths and weaknesses of the program and deliberations about critical areas to update. As a result, compared to prior versions, Healthy People 2020 gives more prominence to health promotion and preventive approaches, and adds a substantive focus on the importance of addressing societal determinants of health. A new expanded digital interface facilitates use and dissemination rather than bulky printed books as produced in the past. The impact of these changes to Healthy People will be determined in the coming years.

1 Director of Public Health and Health Officer, Los Angeles County, Department of Public Health; Professor, Schools of Public Health and Medicine, University of California at Los Angeles; Los Angeles, CA, USA. 2 Associate Dean for Health Promotion & Disease Prevention, Professor of Epidemiology, Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine; Philadelphia, PA, USA. 3 Executive Director, National Association of County Behavioral Health and Developmental Disability Directors; Washington, DC; Adjunct Professor, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University; Baltimore, MD, USA.

Corresponding Author Contact Information: Jonathan E. Fielding at jfielding@ph.lacounty. gov; Director of Public Health and Health Officer, Los Angeles County, Department of Public Health, 313 North Figueroa Street, Room 806, Los Angeles CA, 90012, USA.

2� Public�Health�Reviews,�Vol.�35,�No�1

Key Words: Healthy People, population health, health objectives, health promotion, disparities

Recommended Citation: Fielding JE, Kumanyika S, Manderscheid RW. A perspective on the development of the Healthy People 2020 Framework for improving U.S. population health. Public�Health�Reviews. 2013;35: epub ahead of print.

INTRODUCTION

The United States federal Healthy People Initiative is intended to play a crucial, integrative role in guiding national, state, and local approaches to setting quantifiable health objectives and monitoring progress. First conceptualized in 1979, when working toward health targets was a new concept in health policy, Healthy People was strategically envisioned as a national mechanism for action and investment prioritization through the identification and measurement of progress towards a common set of major health objectives.1 From that point forward, this process has continued to define a set of national health objectives at the beginning of each decade, with specific targets for the end of the decade. The Healthy People goals and objectives have the potential to serve as a call to action to states and local authorities because they are issued by the federal government and are linked to national health statistics.

Although Healthy People does not carry statutory authority to direct the activities of or hold accountable components of the US health system, it constitutes a detailed framework and plan for improving the Nation’s health and can be adopted for use in policies and programs. The objectives and targets address health and health care issues across a broad spectrum. They can be used for assessing and reporting progress within and across local and state jurisdictions, as well as at the federal level. For example, an authoritative annual reporting of county level health rankings relies heavily on Healthy People objectives and targets for benchmarking.2

The effectiveness of Healthy People has been measured by comparing initial status (baseline data) with mid-course and final assessments made at the national level to determine how much change actually has occurred over the decade and whether targets actually have been achieved.3-5 Of note, these assessments have often revealed a lack of progress toward many targets and a widening of health disparities in relation to many health indicators (see Table 1). The lack of progress raises awareness of the weaknesses of the US health care system and questions the ability of Healthy People to overcome these weaknesses.

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