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June 25, 2014

Healthy People 2020: A Report Card on the Health of the Nation

Author Affiliations
  • 1US Department of Health and Human Services, Washington, DC
JAMA. 2014;311(24):2475-2476. doi:10.1001/jama.2014.6446

For 4 decades, Healthy People has represented the United States’ vision for a healthier future. Each decade, it serves as a public health road map and compass for the nation by establishing a broad set of overarching health goals while specifying actions to improve length and quality of life. For the current decade, this comprehensive national health promotion and disease prevention agenda encompasses more than a thousand specific objectives organized into 42 topic areas.

To focus particular attention on the leading causes of preventable death and illness, Healthy People 2020 features Leading Health Indicators. This subset of 26 indicators from 12 topic areas offers high-priority targets for which concerted action could lead to major improvements for public health. This article reviews newly available Leading Health Indicators’ data for the first third of the decade, thereby offering a timely snapshot of the nation’s progress toward better health (eTable in the Supplement).

The data demonstrate areas of both improvement and continued need. On the positive side, 14 of the 26 Leading Health Indicators (54%) have documented improvement, and 4 have met or exceeded their Healthy People 2020 targets. For example, for Environmental Quality, both indicators have surpassed their targets for improved air quality and reduced exposure of children to secondhand smoke. With respect to Nutrition, Physical Activity, and Obesity, the percentage of adults meeting federal guidelines for aerobic physical activity and muscle-strengthening activity has also met the 2020 target. Further progress extends to Injury and Violence, with the age-adjusted rate of homicides decreasing to reach, and even exceed, the Healthy People 2020 target.1

Other topic areas reflecting improvement include the following: Clinical Preventive Services showed improvement in 3 of 4 of its indicators—colorectal cancer screening, hypertension control, and childhood immunizations; Maternal, Infant, and Child Health showed decreases in infant deaths and improvement in preterm live births; Substance Abuse showed a decrease in adolescents’ use of alcohol or illicit drugs over the past 30 days; Tobacco showed declining cigarette smoking rates among adults; and Reproductive and Sexual Health showed that more individuals who are HIV positive know their serostatus. In the key area of Social Determinants of Health, the interrelated worlds of education and health2 marked an improvement in the percentage of students who earned a high school diploma 4 years after starting ninth grade.1

The new data also document no improvement for 11 of the 26 indicators (42%) and, of those, 3 show worsening health outcomes. For example, in the area of Mental Health, the indicators of major depressive episodes in adolescents and suicides reflect worsening outcomes. In contrast to the improvements in the indicators for Injury and Violence, suicide deaths have increased. To date, the data show no overall improvements in rates of adult or childhood obesity or in the rates of total vegetable intake. In Clinical Preventive Services, the data show no detectable change in the indicator related to diabetes control. In Oral Health, the indicator for dental visits is losing ground.1

One of the 4 overarching goals of Healthy People 2020 is to achieve health equity and eliminate disparities. To cite an example of progress, with the overall decrease in infant mortality between 2006 (baseline year) and 2010, the differential in such rates between non-Hispanic black and non-Hispanic white mothers has narrowed.3 Similarly, with the overall decline in homicide rates between 2007 (baseline year) and 2010, the gap between the non-Hispanic black and the Asian or Pacific Islander populations also has narrowed.4 But for other areas, progress overall has not translated into reduced disparities for some racial, ethnic, educational level, and income groups. For example, even though the overall target is achieved for reducing exposure of children to secondhand smoke, non-Hispanic black children experience greater rates of exposure to secondhand smoke than do Hispanic children.5

The Affordable Care Act (ACA)—which offers the promise of improved insurance coverage, care coordination, and public health—could potentially improve future health outcomes in a number of ways. Although Access to Health Services has not documented major improvements to date, the data cited herein precede full 2014 implementation of the ACA; one recent estimate now suggests that a total of 9.3 million have newly gained insurance access through health insurance marketplaces, Medicaid expansion, and other venues.6 Also, the ACA brings new dental coverage opportunities for children. Moreover, the ACA now requires provision of substance abuse and mental health services as 1 of the 10 Essential Health Benefit categories for all non–grandfathered health insurance plans, potentially bringing 62 million people access in the future.7 With respect to care coordination, the ACA includes new incentives for clinicians to deliver better care at lower cost. For example, increasingly, Medicare payments to providers now have some link to quality and the Centers for Medicare & Medicaid Services is testing more than 20 models to give health care organizations new incentives to manage the health of populations.8

The ACA also has established a host of disease prevention and health promotion opportunities, including a dedicated prevention and public health fund already in its fifth year and a broad range of health promotion initiatives affecting individuals, insurance plans, communities, and the nation at large.8 For example, the ACA has now enabled access to high-value preventive services without cost sharing for more than 100 million people, including 71 million US residents with private health plans9 and 37 million who have already accessed wellness visits and new preventive services through Medicare.10

Although this report offers some hope and direction for a healthier nation only one-third of the way through the decade, public health always represents unfinished business. Further analyses to explain the changes noted herein can amplify national discussions about aspirations for a healthier nation. For indicators with documented improvement so far, the country must redouble efforts to accelerate advances even further. For areas of no improvement or worsening of outcomes, new energy and efforts are needed to address them. Although Healthy People is federally coordinated, it represents a stakeholder-driven process involving state, community, and local leaders, among many others. More research must explore the potential link between positive changes in some indicators relating to health activities to documented improved health outcomes. Additional data releases throughout the upcoming decade can serve as the impetus to drive future commitments and action by all. The unity of purpose represented by the Healthy People 2020 Leading Health Indicators can not only reinvigorate the commitments for the future but also focus the nation’s vision and hopes for what is yet to come.

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Article Information

Corresponding Author: Howard K. Koh, MD, MPH, US Department of Health and Human Services, 200 Independence Ave SW, Ste 716-G, Washington, DC 20201 (howard.koh@hhs.gov).

Published Online: May 28, 2014. doi:10.1001/jama.2014.6446.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Additional Contributions: We thank Rebecca Hines, MHS, and David Huang, PhD, MPH, both of the National Center for Health Statistics, Centers for Disease Control and Prevention, for their invaluable help on this article. Neither were compensated for their work.

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