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Healthy People and the Affordable Care Act

By Dr. Charlie Preston
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From the bully pulpit of the White House’s Let’s Move initiative to the billions of dollars invested by the Affordable Care Act (ACA), prevention is getting more high-profile attention than ever before. But there’s another landmark prevention program that’s just around the corner and most people don’t even know it is coming. Healthy People 2020 is set to be released in December of 2010 (http://www.healthypeople.gov/hp2020/).

In some ways it isn’t difficult to understand why Healthy People is often overshadowed. After all, it is the work of a small office within Health and Human Services, located in Rockville, Maryland, and far removed from the bustling downtown headquarters a few blocks from the capitol. It doesn’t exactly move quickly; one initiative is launched every 10 years. It is big and can be cumbersome. The 2010 version had 28 topic areas and 467 objectives. And it doesn’t carry its own budget beyond what is necessary to pay the staff members that develop it.

All of this is unfortunate because Healthy People has a lot to offer. In fact, the government workers implementing new provisions of health reform would be wise to draw on its experiences. Congress saw the benefits of Healthy People and mentioned it in the law 4 separate times.

At its core, Healthy People is a set of health goals for the nation. It is organized into topic areas, like diabetes and heart disease, and specific objectives for these topic areas. For example, an objective might be to reduce amputations from diabetes by 10% over the next decade. Progress towards goals is then tracked using data. The overarching principle is that setting national objectives and monitoring progress can motivate action.

Though some consider it a weakness, the size of Healthy People is actually a strength. Its public health goals are comprehensive, unlike other streamlined programs such as the CDC’s six winnable battles. Its goals are also a gold-standard for the nation. For example, the ACA says that annual reports from the national prevention council must consider whether the goals of Healthy People are being met.

Another strong point of Healthy People is data. Everything is data driven. Topic areas and objectives cannot be included if there isn’t a corresponding data source. And soon it will be easier for stakeholders to access data on-line (and better craft health programs for their constituencies) because of a new IT resource being introduced in conjunction with Healthy People’s release, the Health Indicators Warehouse.

Arguably the biggest strength of Health People is the process by which stakeholders provide feedback. It is one of the most extensive and rigorous of any inside the federal government and is based on the principle that partners must be involved in creating objectives before they can be engaged in implementing them. For 3-4 years before launch, program officials field input from 1) a federal advisory committee of outside experts, 2) a federal interagency workgroup, and 3) the public at large. In Healthy People 2020, each and every one of the more than 8,000 public comments was formally considered.

So, Healthy People has a lot of strengths and the folks who help create it have a lot of wisdom and experience. There should be more consultation with them as the prevention provisions in health reform are implemented. Specifically, officials at Healthy People have vast experience with federal advisory committees, federal interagency work groups, and public comment. The national prevention council is struggling with some of these same issues right now. The White House needs to release its nominations so that an advisory group can be established. And in general, the council needs to solicit more public and stakeholder input. The sooner the better, the national prevention strategy is due in just a few months.

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