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Medical News & Perspectives
January 5, 2000

More Healthy People in the 21st Century?

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JAMA. 2000;283(1):37-38. doi:10.1001/jama.283.1.37

With the arrival of a new year often comes the urge to replace unhealthy habits with a more salubrious lifestyle. Poised on the cusp of a new millennium, opportunities for change seem even more propitious. Such is the hope of those working with the Healthy People initiative, a prevention agenda for the nation begun 20 years ago that continues to evolve into the next millennium.

With Healthy People 2000 achieving 15% of its goals—and 44% more "nearly met"—the new millennium will see the advent of Healthy People 2010. (Credit: Jill Ghormley)

With Healthy People 2000 achieving 15% of its goals—and 44% more "nearly met"—the new millennium will see the advent of Healthy People 2010. (Credit: Jill Ghormley)

Launched in 1979 with then Surgeon General Julius Richmond's report on health promotion and disease prevention, the first Healthy People document established targets for 226 health objectives organized into 15 focus areas. The primary goal of this initiative was to reduce mortality rates in infancy, childhood, adolescence, adulthood, and older age. A decade later, these goals were reformulated as the Healthy People 2000 project, which expanded the number of objectives to 315 in 22 areas. The emphasis of this document was on improving quality of life as well as quantity of years lived and on reducing health disparities among different groups.

The third iteration of this agenda is Healthy People 2010. With more than 450 health objectives organized into 28 areas, the new agenda has two overarching goals: to increase years of healthy life and to eliminate racial and ethnic health disparities, said Randolph Wykoff, MD, MPH, director of the Health and Human Services' Office of Disease Prevention and Health Promotion. Healthy People 2010 will be unveiled officially at the conference Partnerships for Health in the New Millennium, to be held in Washington, DC, at the end of this month.

Assessing past performance

A report on the progress of Healthy People 2000 issued last June revealed both positive and negative messages about the nation's health goals. Only 15% of the objectives had been met or exceeded. But Wykoff pointed out that another 44% were moving in the right direction. Many of these "nearly met" objectives, such as reducing infant mortality, are within a fraction of a point from their targets, he explained.

"The process of setting objectives is not an exact science," said Wykoff. "We're doing the best we can to determine where we think we can go." He added that when a target goal is set high—perhaps even higher than would seem attainable—people are challenged to try harder. If you fall a bit short of this sort of goal, he said, "that's not exactly a failure."

But on a less positive note, data from the June report showed that 18% of the objectives have moved in a negative direction away from baseline. For example, the number of overweight persons in the nation has increased in the last decade while physical activity levels have decreased—quite a disturbing trend, said Deborah Maiese, MPH, coordinator for the Healthy People program.

One important approach to reversing these unhealthy trends, Maiese said, is getting children and adolescents to understand just how dangerous sedentary lifestyles and poor dietary habits are to health. She said that such efforts have been somewhat undermined by the elimination of physical education requirements from school curricula, a situation that began in the 1980s in response to budget cutbacks.

Other health objectives were not assessed because baseline and second data points were not obtained, a disappointing situation in a country as wealthy as the United States, said Maiese. In other cases, she said, results were lacking because of the time lag that exists in accumulating and processing data. For example, she said, the objective to create smoke-free environments in the workplace met its target, but information on this success was not released until last September, too late to be included in the June report. Maiese said this information will be included in the final progress report on Healthy People 2000, which should be released by the end of this year.

As Wykoff noted, "The truth is we won't know whether we've met some of these objectives for several years, until all the 1999 data are collected."

Wykoff said that with each decade's reassessment of the Healthy People agenda, the document has been evolving. "Part of the strength of redoing this agenda every 10 years is that it allows us to monitor changes as they happen," he said. "It also allows us to make changes at the end of the decade so we're not bound to keep the same objective, even the same topic area."

Improving on the past

As the document has evolved, continued Wykoff, it has becomes more encyclopedic, and this has increased its usefulness. "For example, if a state wants to set up oral health objectives, they have a chapter in the Healthy People agenda with background, goals, et cetera, to refer to."

The potential downside of this growth, he said, is that too many objectives can become unwieldy for the general public. "This is one of the reasons we think the leading health indicators are a useful addition to the Healthy People document." The health indicators are a small group of highlighted priorities that facilitate understanding of the issues and the progress being made.

Maiese said that the expansion of the Healthy People initiative in recent years has occurred because of greater participation by many sectors of society. Broad public input in the form of regional meetings has helped shape the most recent document, as have thousands of comments received through the mail and electronically. And in addition to input from public health departments and national health care organizations, the opinions of state mental health, substance abuse, and environmental agencies, as well as civic groups such as the Association for Retired Persons and the Boy Scouts and Girl Scouts, are helping to shape the Healthy People agenda, she said.

One important message that was heard loud and clear from public input was the need not only to reduce health disparities among groups but to eliminate them, said Maiese. To set one target for all population groups, whether or not they differ by race, ethnicity, age, economic status, sex, or geographic location, is quite a challenge, she said, particularly for some groups that have a lot further to go than others. But, she added, Healthy People 2010 can help achieve this goal by serving as a tool to assess health status in different populations and to help tailor interventions for diverse situations.

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