Performance Improvement 1998. Stakeholders Revisit Healthy People 2000 to Maximize the Impact for 2010

02/01/1998

Highlights

This report presents an assessment by Healthy People 2000 stakeholders on how to restructure the goals and objectives of Healthy People 2000 for the next decade. Healthy People 2000 is a set of national objectives for improving the health of Americans through effective prevention strategies. These objectives form a model framework for results-oriented performance measurements that are relevant to both population- and individual-based health care initiatives. They also serve as benchmarks against which performance can be measured over time. The development of Healthy People 2010 provides an opportunity to reflect on the successes and shortcomings of Healthy People 2000 in achieving these important functions. Healthy People 2000 stakeholders comprise a Steering Committee and Consortium. The Steering Committee consists of representatives from all agencies within the Department of Health and Human Services (HHS). The Consortium consists of representatives from a broad array of 350 organizations, including professional societies, volunteer groups, and trade associations. In addition, State public health, mental health, substance abuse, and environmental agencies are members of the Consortium. Formed in 1987 by the Institute of Medicine, the Consortium is engaged in developing and implementing national prevention objectives.

The report explores new approaches for the development of Healthy People 2010, taking into consideration the many major changes in health care since 1990 and past experience with Healthy People 2000 and the health objectives for 1990. Both the Federal and private sector stakeholders who participated in the focus group review process felt that Healthy People 2010 would benefit from an updated presentation, taking advantage of new information and communication technology and creating a flexible electronic data base on CD-ROM and the Internet, in addition to the reference document. Healthy People 2010 needs to be targeted at an audience broader than the previously targeted public health community.

Purpose

The purpose of this study was to determine whether various stakeholders believed that the Healthy People 2000 document was useful as a framework for results-oriented performance measurement. A review of the successes and shortcomings of Healthy People 2000 in achieving its goals and objectives can facilitate improvement and new approaches in the content, format, and dissemination of its next iteration, Healthy People 2010.

Background

Healthy People 2000 serves as a vision for improving the health of Americans through effective prevention. Its multiple goals, objectives, and priorities were designed to guide health-related decisions and actions by organizations and individuals in the public and private sectors. The development of a similar document for the next decade, Healthy People 2010, provides an opportunity to learn from the experiences of various stakeholders about the use of the Healthy People 2000 document as a standard of comparison and as a framework for results-oriented performance measurement. The creative review of Healthy People 2000 is especially important in light of increased national emphasis on performance and accountability, and various changes in the health care system, such as the growth in managed care arrangements, limits on access-to-care and insurance coverage, and the intersection of public health and personal health care functions. High quality input from the people and organizations who have the commitment and resources to endorse the Nation's health goals, objectives, and priorities, and from those who provide health care services is essential before a new framework for Healthy People 2010 can be developed. Consequently, creative ideas for revision of Healthy People 2000 and thoughtful responses to these ideas were sought from the Healthy People 2000 Steering Committee and Consortium.

Methods

Two major activities were undertaken: (1) a Steering Committee retreat and (2) 7 focus groups, involving a total of 58 participants from various member organizations in the Healthy People 2000 Consortium. Various themes were identified in the process of gathering data, review, and revision. Questions and options were revised based on Steering Committee input and a pilot focus group of Consortium members. The final set of questions for the focus groups dealt with issues involving the extent of a required overhaul of the Healthy People 2000 document; what works and does not work about the functioning of the document; and the implications of changing the document, its priority areas, and the criteria for selecting objectives. Each successive focus group allowed for further review of issues raised in the preceding focus groups. For example, the last focus group included representatives from employers/purchasers and managed care providers in order to address the recurrent theme of the growing importance of business, employers, and managed care.

Findings

Major findings were gleaned from the comments of the Steering Committee and the Consortium focus groups, both collectively and individually. The primary finding was that the Healthy People 2010 document should serve as a voice for public health. Other recommendations were to include the goals of establishing a healthy environment, increasing years of quality life, and making the Healthy People 2010 document relevant to purchasers of health care services. The most prevalent theme in the Steering Committee retreat was the size of the Healthy People 2000 document and the number of objectives and priority areas. Some Steering Committee members thought that the new document should be reduced in size. However, most members felt that local policymakers would want more options to specifically address their circumstances. Others believed that continuity would be ensured if the document were not substantially changed.

Steering Committee members were more willing than Consortium members to make major changes in the organization and content of the document. "Life stages" were considered as an alternative way to conceptually organize the document because it would make Healthy People 2000 more about people and less about health departments. However, many Consortium members believed that most groups who use Healthy People 2000 at State and community levels would find it difficult to change their plans given organizational structure and funding streams. Most Consortium members emphasized other creative changes in the presentation, including taking advantage of the Internet and related technologies and allowing for more flexibility in how the document is organized and accessed. Important themes discussed in all settings were the presentation, comprehensibility, and marketability of the document. Consortium members were concerned about the potential usefulness of the document in communicating with different audiences, including community coalitions, business partners, and the public.

Use of Results

This report provided the opportunity for wide-ranging discussion of Healthy People 2000's impact on the health of the Nation. This discussion helped to identify areas for improvement and modification in the next iteration of national public health goals and objectives, Healthy People 2010. The suggestions for change in content, format, and dissemination of Healthy People 2000 are based on the experience of organizations and people on the front line of public health, health care service delivery, and resource utilization. As such, Healthy People 2010 will benefit from the insight and commitment of those who have not only endorsed national health goals but who have the responsibility to achieve them. The full report is available on the Internet at http://web.health.gov/healthypeople.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Deborah R. Maiese

PHONE NUMBER: (202) 401-5809

PIC ID: 6491

PERFORMER ORGANIZATION: Academy for State and Local Government, Washington, DC