HHS Strategic Goals and Objectives - FY 2001 . Appendix B - External Factors


In some cases, achieving our strategic goals and objectives may be impeded by factors that are beyond the control of the Department of Health and Human Services (HHS). For example, national or local economic conditions can influence whether we are successful in helping families on welfare become economically independent. In some cases, there may be ways to ameliorate the impact of these conditions on our strategies and objectives. In other cases, there may not. The following table (Table B) provides a list of the significant external factors (economic, human, environmental, etc.) that could present challenges for management and could affect whether or how well we achieve our strategic goals and objectives. The table also provides an indication of actions that might be taken to ameliorate these factors, should they arise.



External Factor Effect on Strategies/ Goal/Objective HHS Response to Mitigate Factor
GOAL 1: Reduce the Major Threats to the Health and Productivity of All Americans
Objective 1.1
Reduce tobacco use, especially among youth States use of tobacco settlement funds, to conduct campaigns to encourage youth and adults not to smoke State use of settlement money for anti-smoking purposes would assist HHS efforts/strategies Work with our state partners to foster effective use of settlement money
  Federal cigarette tax rate Higher rates would discourage smoking among youth Work toward Congressional action
Objective 1.2
Reduce the incidence and impact of injuries and violence in American society Demographic and economic trends Higher rates of violence are associated with economic distress and the size of the population below age 25 Expand effective youth development programs; maintain safety net programs
  Increases or decreases of violence in the media Violent behaviors influenced by media exposure may increase or decrease with level of violence shown in the media Encourage media to reduce display/ presentation of violence
  Trends in requirements for the use of occupational and recreational safety equipment (e.g., safety helmets) Safety equipment reduces amount and extent of injuries Promote increased collaboration and sharing of information between public safety interest groups and all levels of government to strengthen safety requirements
Objective 1.3
Improve the diet and the level of physical activity of Americans Decreases in availability of public facilities, such as biking and walking trails, to promote physical activity Decreasing availability of, proximity to, and access to local recreational facilities can influence amount of physical exercise Promote studies of excellent facilities and provide communities with tools to assess their own community facilities
  Availability of time and other resources available to adopt and maintain a healthy diet and exercise program Many Americans (e.g., single working mothers) are too pressed by daily schedules or finances to exercise regularly or eat nutritious meals Promote adoption of family-friendly workplaces; work with Department of Education to encourage schools to further increase proportion of schools that provide access to physical activity spaces and facilities for people, outside of normal school hours
Objective 1.4
Reduce alcohol abuse and prevent underage drinking Reluctance of states and local governments to develop community policies that limit the accessibility of alcohol, impose low blood alcohol concentration levels, and impose swift and severe penalties for drunk driving The presence of these community policies is linked to decreases in alcohol abuse Promote increased collaboration with and sharing of information between public interest groups and all levels of government to strengthen alcohol policies
Objective 1.5
Reduce the abuse and illicit use of drugs Unforeseen emergence of new "designer" drugs that are initially seen as benign New epidemics could emerge and increase the level of drug use Maintain surveillance systems and react quickly to proscribe and publicize dangers and consequences of new drugs
  Increase in size of the 12 to 20 population cohort Increase in number of people in most vulnerable age group for initiation of drug use Intensify prevention efforts for 12 to 20 age group
Objective 1.6
Reduce unsafe sexual behaviors No major external factors identified    
Objective 1.7
Reduce the incidence and impact of infectious diseases Periodic outbreaks as a result of emerging and re-emerging drug-resistant bacteria and viruses, imported food products, and immigration These factors may result in fluctuations in the rates of infectious diseases in the U.S.; prevention efforts may not be entirely successful in areas such as illegal immigration and drug-resistant microbes Continue directing medical research toward difficulties such as drug-resistant microbes; cooperate with other countries on control and eradication of infectious diseases and food importation standards
Objective 1.8
Reduce the impact of environmental factors on human health Successful lawsuits weakening environmental laws and regulations May result in worsening conditions despite efforts to link environmental factors to health and increase public awareness Continue providing good science to educate policy makers of the health consequences of environmental conditions
GOAL 2: Improve the Economic and Social Well-being of Individuals, Families, and Communities in the United States
Objective 2.1
Improve the economic independence of low income families, including those receiving welfare Economic conditions Historically, welfare recipients, low income minorities and persons with disabilities are more vulnerable to unemployment during recessions; this may offset efforts in job training and placement Prioritize activities and focus funding, technical, and other resources on the most cost-effective program elements: emphasize job skill acquisition, education, and job placement targeted to higher end, more skilled employment in areas less volatile under changing economic conditions Continue ensuring the provision of safety net services for transition during economic downturns
Objective 2.2
Increase the parental involvement and financial support of non-custodial parents in the lives of their children Economic conditions Non-custodial parents may lose jobs/income resulting in fluctuations in income support ability Increase efforts to achieve more emotional involvement of non-custodial parents with their children to encourage job retention or greater efforts to find employment during economic downturns
  Work/time demands on parents Work stress and parental difficulty in finding time for involvement with children may result in high levels of family conflict and family discord; children may grow up without parental role models See Objective 1.3
Objective 2.3
Improve the healthy development and learning readiness of preschool children No major external factors identified    
Objective 2.4
Improve the safety and security of children and youth Economic conditions Family stress is greater as economic situations deteriorate leading to increased potential for violence and family breakup Maintain integrity of safety net programs
  Impact of welfare reform The success or failure of programs for low-income families as part of welfare reform will have an unknown impact on the child welfare system over the next several years Provide states with training and technical assistance to demonstrate how they might effectively make use of Temporary Assistance to Needy Families (TANF) technical and financial resources to combat any negative impact of welfare reform that might emerge
Objective 2.5
Increase the proportion of older Americans who stay active and healthy See factors identified for Objective 1.3    
Objective 2.6
Increase independence and quality of life of persons with long-term-care needs Economic conditions Putting qualified working-age adults with disabilities to work calls for job availability; decreases in state and local budgets could result in a reduction in funding for home and community-based placements for individuals with disabilities See Objective 2.1
  Success of efforts to make medical insurance available to disabled persons who work Disabled individuals rely on continuing medical insurance to maintain employment; the success of efforts to protect access to affordable insurance will affect decisions of disabled persons to move from dependency to work Monitor recent changes in access to medical insurance to see if further modification to existing legislation is needed
Objective 2.7
Improve the economic and social development of distressed communities Overall economic conditions as well that of particular geographic regions Economic decline is correlated with fewer jobs and lack of economic development Focus technical and financial resources in the most depressed/ vulnerable geographic areas
GOAL 3: Improve Access to Health Services and Ensure the Integrity of the Nation s Health
Objective 3.1
Increase the percentage of the nation s children and adults who have health insurance coverage Economic conditions Economic variables affect business decisions to provide employee health insurance and decreasing family income and job loss cause increases in the uninsured; decisions by state insurance regulators also affect insurance coverage Focus on outreach to enroll eligible persons in insurance programs; monitor trends in coverage and propose legislative or regulatory changes where needed
Objective 3.2
Eliminate disparities in health access and outcome Economic conditions An increase in the number of uninsured persons affects minorities disproportionately, decreasing their access to quality care See Objective 3.1
Objective 3.3
Increase the availability of primary health care services for under-served populations Economic conditions See Objectives 3.1 and 3.2 See Objectives 3.1 and 3.2
Objective 3.4
Protect and improve the health and satisfaction of beneficiaries in Medicare and Medicaid Instability due to structural and financial changes in the health care industry, the changing nature and complexity of health care, and rapid changes in health care technology Possible decline in beneficiary satisfaction with access to and quality of services Utilize data sources to understand health care needs of beneficiaries and develop proposals for improving services where possible; use improved evidence-based processes for addressing Medicare coverage issues
Objective 3.5
Enhance the fiscal integrity of HCFA programs and purchase the best value health care for beneficiaries Increasing amounts and emergence of new types of fraud and abuse Changes in health care delivery, such as increasing managed care enrollment and new coverage (e.g., new preventive benefits) and payment policies (e.g., new prospective payment systems for skilled nursing facilities and home health agencies) introduce new program designs which may bring shifting incentives for waste, fraud, and abuse Conduct continual analysis of patterns of fraud, waste, and abuse; conduct ongoing training of investigators to recognize and deal with new types of fraud that emerge; develop partnerships with public interest groups and health industry organizations to intensify and broaden the fight against fraud
  Demographic changes/aging of the population Variation in birth rates and improvement in life expectancy, are expected to result in major increases in the number of older persons relative to those of working age beginning in 2010; current analyses based on that projection predict that, with the expected drop in the ratio of active workers to retirees, payroll tax revenues will not keep pace with expected Medicare expenditures; a larger number of elderly beneficiaries has implications for Medicaid as well as Medicare, in part because of Medicaid's role in financing long-term-care services Work with the Executive Branch and the Congress for a bipartisan commitment to address the long-term financial challenges
Objective 3.6
Improve the health status of American Indians and Alaska Natives Continued poor economic conditions in American Indian/Alaska Native (AI/AN) communities Because poverty is correlated with poor health status, making significant progress in improving the health status of AI/AN people is likely to be limited in the face of extreme and persistent poverty Expand efforts to collaborate with agencies and organizations that have the potential to increase economic development in AI/AN communities; expand the development of preventive technologies that are less dependent on individual compliance and refractory to the negative effects of poverty
Objective 3.7
Increase the availability and effectiveness of services for the treatment and management of HIV/AIDS Cost of anti-retroviral therapies and treatment may increase and/or insurance companies may drop coverage Access to therapies and treatment could be restricted if costs escalate Develop better purchasing agreements with drug manufactures; support for program expansions to subsidize purchases and monitoring of Medicaid coverage
Shifting demographics of disease and populations Populations become harder to reach and serve, or longer life expectancy greatly increases the number of persons being treated Develop improved surveillance and outreach strategies; provide assistance to service providers in planning and capacity building to meet sudden demographic shifts
Objective 3.8
Increase the availability and effectiveness of mental health care services No major external factors identified    
Objective 3.9
Increase the availability and effectiveness of health services for children with special health care needs No major external factors identified    
GOAL 4: Improve the Quality of Health Care and Human Services Entitlement and Safety Net Programs
Objective 4.1
Enhance the appropriate use of effective health services Increasing complexity of health care system; ongoing development of new technologies and pharmaceuticals; lack of access to health care by many Americans Increased need for research and the dissemination and implementation of research findings in the outcomes, quality, cost, access, and use of health care Continue building evidence base for the delivery of health care and focus on fostering the implementation of evidence-based research findings into health care practice and making information available to consumers
Objective 4.2
Increase consumer and patient use of health care quality information Increasing complexity of health care system Consumers have had little experience with making choices in health care Promote public/private educational efforts; continue conducting research and evaluation to determine effective strategies
Objective 4.3
Improve consumer and patient protection Congressional passage of the Patient Bill of Rights Patient Bill of Rights will increase the protections legally available Continue implementation of rights and privacy protections within existing authority
Objective 4.4
Develop knowledge that improves the quality and effectiveness of human services practice No major external factors identified    
GOAL 5: Improve the Nation s Public Health Systems
Objective 5.1
Improve the capacity of the public health system to identify and respond to threats to the health of the nation s population New threats emerge that outpace capacity Inadequate preparation for all threats Attempt to improve capacity to identify new strains of pathogenic microorganisms
Objective 5.2
Improve the safety of food, drugs, medical devices, and biological products Increasing age of population The coming "aging" bulge in the U.S. population means that a higher percent of the population may be more susceptible (compromised immune systems) to food-borne illness, which may offset reasonable efforts to reduce illness from this cause Intensify education programs on food safety
  Increasing importation of foods and products from around the world There is an increased risk of food-borne illness appearing or unsafe products being marketed, due to varying foreign standards Develop increased international cooperation and standards
  Technological advances create greater product complexity and diversity Increasingly more complex products may slow review process and delay market approvals; health professionals may have insufficient skills and resources to maintain safety at current levels Improve skills and training and early involvement and communications with scientific community in development of new products
GOAL 6: Strengthen the Nation s Health Science Research Enterprise and Enhance its Productivity
Objective 6.1
Advance the scientific understanding of normal and abnormal biological functions and behaviors The uncertainties and risks intrinsic to the process of research The pace of progress in scientific research is intrinsically uneven and difficult to accurately forecast; history demonstrates the benefits of sustained research effort, but at any given time it is difficult to predict how/from where the next important advance will emerge Broaden the research portfolio; carry out sound management of the research enterprise; encourage the flexibility to respond to changing scientific opportunities and willingness to take risks
  The pace of technological advance Improvements in existing technologies or the availability of radically new capabilities can significantly affect the current array of scientific opportunities; as with research progress, these important developments can be difficult to predict in advance See above
  Level of resources available (size of appropriations), other factors (e.g., rates for indirect cost and inflation) which influence purchasing power of research dollars The year-to-year level of budget authority directly affects the agency s abilities to maintain the existing research effort and to expand to address new opportunities Carry out sound management of the research enterprise; maintain strong support for biomedical research in Congress, the Executive branch, and other public organizations, and in the private sector
  Public acceptance and support The public s willingness to continue to broadly support the biomedical research enterprise is an important factor to the extent to which the frontier of knowledge can be pushed forward in biology and related sciences; among other issues, advances in medical technology and breakthroughs in medical research have created a new set of challenges regarding ethical and moral considerations that are associated with the pursuit of these scientific advances and their incorporation into medical practice Make a strong effort to communicate with the public about new scientific achievements and their important implications for health; institute processes to involve the public in dialogue about these important issues
Objective 6.2
Improve our understanding of how to prevent, diagnose, and treat disease and disability Nature of and rate at which basic research yields new insights about the fundamentals of biological functions and behavior While developing new approaches for prevention, diagnosis, and treatment can be a demanding scientific exercise, the availability of new insights about fundamental processes is often a precondition for development to become feasible Managing for a successful and productive basic research enterprise (see Objective 6.1)
  Various business considerations (e.g., intellectual property issues, technical capabilities, competing opportunities, and other business considerations) The efforts of many different actors are involved in the successful development and commercialization of new approaches; high degrees of concern among researchers from private and public interests and others may hinder cooperation among research entities, thus inhibiting creative and successful development of new approaches Encourage programs that provide for the rapid and widespread dissemination of new scientific findings; support public policies that strengthen technology transfer and encourage the development of innovative products and services
  Level of public acceptance and support for research See also Objective 6.1 for additional external factors and responses Same as for basic research (see Objective 6.1) Same as for basic research (see Objective 6.1)
Objective 6.3
Enhance our understanding of how to improve the quality, effectiveness, utilization, financing, and cost-effectiveness of health services No major external factors identified    
Objective 6.4
Accelerate private-sector development of new drugs, biologic therapies, and medical technology Developmental and liability costs of new drugs can be prohibitive to private organizations developing new therapies New treatment for diseases may not be forthcoming Create public/private partnerships to share the cost of developing new drug therapies
Objective 6.5
Strengthen and diversify the base of well-qualified health researchers Strength of job market for research scientists; extent of opportunities for both new and seasoned researchers; remuneration Realities and the perceptions about potential candidates, as well as candidates' perceptions of job opportunities, salary levels, etc. affect recruitment Encourage successful basic and applied research programs, which continue to yield new scientific knowledge and opportunities, and continuing public support for the biomedical research enterprise provide the greatest leverage in sustaining demand for well qualified and creative researchers; promote career messages
  Level of resources available to support agency programs for training and career development The year-to-year level of budget authority directly affects an agency s ability to maintain existing programs and to expand to address new needs Maintain strong support for training and career development programs with public budget decision makers, with relevant sectors of private industry, and with the general public
Objective 6.6
Improve the communication and application of health research results Degree of public acceptance and support The public s willingness to continue to broadly support the biomedical research enterprise is a critical factor in the progress of the biomedical sciences Strengthen efforts to communicate with the public about the progress of medical research and its impact on their lives; institute processes to better involve the public in addressing important issues on the research agenda
Objective 6.7
Strengthen mechanisms for ensuring the protection of human subjects in research and the integrity of the research process Expansion of private research and pressure to move research from the laboratory to market more quickly to recoup costs Patient protections may erode as competition for volunteers increases; quality of study may decrease under time pressures Expand oversight where authority exists