Healthy People 2030 to create objectives for health of nation: Process underway for next 10-year plan
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* Julia Haskins

Now entering its fourth decade, work on the latest iteration of the federally led Healthy People initiative is underway, continuing to outline evidence-based health goals for the nation.

Since 1979, the U.S. Department of Health and Human Services has released 10-year plans for improving Americans’ health outcomes, with a focus on health promotion and disease prevention. Public health professionals and stakeholders are working to determine major health concerns and solutions facing the U.S. for the fifth edition of Healthy People, known as Healthy People 2030. In the first phase of the process, an expert advisory committee will develop recommendations for the HHS secretary on the framework and implementation of Healthy People 2030. Input from members of the public and relevant stakeholders will guide the development of recommendations. During the second phase, a federal interagency workgroup will use the advisory committee’s recommendations to establish objectives for Healthy People 2030.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/47/6/1.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/47/6/1.1/F1)

Elisa Donavan, an assembly worker at Jotul in Gorham, Maine, puts together a cast-iron stove in February. Healthy People 2020 has 16 objectives on occupational health and safety, 94 percent of which have been met or are improving. Work on Healthy People 2030 objectives is now underway.

Photo by Gabe Souza, courtesy Portland Press Herald/Getty Images

Healthy People has played an important role in shaping the health of the nation, said APHA Executive Director Georges Benjamin, MD. Public health workers and organizations have been a key part of that work and will continue to be in the next edition, he said.

“I encourage everyone in public health to take advantage of the Healthy People 2030 development process and provide input in their areas of expertise,” Benjamin told *The Nation’s Health.*

Healthy People lays out broad objectives to move the country toward better health that are further distilled into topic areas. There is also a smaller set of Leading Health Indicators that reflect the most pressing national public health issues. Setting benchmarks for the country’s health serves not only public health workers, but communities and individuals as well. Data from Healthy People is key for making connections to public health across industries, from housing to transportation, according to Chris Alridge, MSW, senior director of infectious disease and informatics at the National Association of County and City Health Officials. The organization served as a partner for Healthy People 2020, helping local health departments and other organizations utilize Healthy People data in their own communities.

“Using data from Healthy People can help us…show partners at the national and state and local level why it’s so important that they’re involved in this and the cost to their industries,” Alridge told *The Nation’s Health.*

Healthy People can also be useful on a local level, even though objectives are established on a broader scale, according to Carter Blakey, deputy director of HHS’ Office of Disease Prevention and Health Promotion, which oversees the initiative. She noted that Healthy People offers a range of tools, including best practices and stories from communities that have implemented programs based on data from Healthy People.

“Folks can look within their own communities and say, ‘Here’s something that’s important at the national level, how are we doing as a community?’” Blakey told *The Nation’s Health,* citing opportunities to address targets such as improving physical activity and nutrition.

Furthermore, Healthy People provides individuals with the information to make their voices heard on a larger platform, with the potential to influence public policy, said Minnesota Commissioner of Health and APHA member Ed Ehlinger, MD, MSPH. Ehlinger is the immediate past president of the Association of State and Territorial Health Officials, which, similar to NACCHO, has helped disseminate Healthy People data to state and territorial health officials to address community health concerns.

ASTHO’s collection of Healthy People 2020 resources provides examples of how states have turned data from the initiative into concrete plans for improving health outcomes. For example, the Iowa Department of Public Health used Healthy People 2020 to develop the Healthy Iowans state health plan, which relied on using existing resources across sectors to address serious health concerns affecting residents. The North Carolina Division of Public Health created the North Carolina Healthy People 2020 plan, putting pressure on local health departments to adopt national objectives for their communities.

“This is all about building democracy, getting information into people’s hands so they can act on it and use the data to hold policymakers accountable for the actions that they take,” Ehlinger told *The Nation’s Health.*

As a roadmap for the country, Healthy People details progress made and areas for improvement. At the halfway point for each version of Healthy People, the initiative releases a midcourse review that shows which goals are succeeding and which ones need to be reassessed. The midcourse review of Healthy People 2020, released in January, showed mixed success among 1,054 measurable objectives: Targets were met or exceeded for 21.1 percent, improving for 19.1 percent, had little or no change for 27.3 percent and were getting worse for 11.1 percent. The assessment for trackable objectives by topic area found objectives related to occupational safety and health, genomics and vision were doing well. While not all findings are equally encouraging, understanding what targets have yet to see positive change can help inform decisionmakers involved in Healthy People 2030.

Healthy People has undergone significant changes over time, reflecting shifting priorities in public health. One of the most salient examples is a growing emphasis on identifying and reducing health disparities as opposed to simply treating illness. According to Ehlinger, feedback from Healthy People 1990 determined that issues of healthy equity needed to be part of the initiative’s national objectives. Public health experts such as former APHA President Shiriki Kumanyika, PhD, MPH, view the increased focus on health disparities as a triumph in the history of Healthy People. Kumanyika served on the Healthy People 2020 advisory committee, which she commended for bringing attention to social determinants of health. Healthy People 2020 was the first edition to include social determinants of health among the now 42 topic areas.

“Our purpose as an advisory committee was really to lift up the issues of prevention and health promotion, especially social determinants of health,” she told *The Nation’s Health.* “There was a focus on access and treatment on the health care side, which is clearly important, but not to really look at health and well-being in a broader sense and try to get earlier in the pipeline...in terms of generating health opportunities.”

Another major development was the introduction of Leading Health Indicators in Healthy People 2010, which highlight the most urgent national health concerns. There are 26 objectives designated as Leading Health Indicators, covering topics such as access to health services, environmental quality, injury, tobacco and mental health. The Healthy People 2020 midcourse review found targets had been met or were improving for more than 60 percent of the indicators.

Blakey said the plan is to include Leading Health Indicators in Healthy People 2030, but it is too early to determine which ones and how many will be in the new edition. They will be shaped by recommendations of the advisory committee — officially known as the Secretary’s Advisory Committee on National Health Promotion and Disease Objectives for 2030.

The framework for Healthy People is also changing, with reducing the number of overall objectives being a top priority for Healthy People 2030. The earliest version of Healthy People had 226 objectives, compared with more than 1,200 for Healthy People 2020. The advisory committee will be tasked with providing recommendations to pare down the current number of objectives by at least half to improve effciency.

“We anticipate that these efforts related to reducing the number of objectives will aid in streamlining the initiative and identifying those topic areas and objectives for (HHS) to track,” said advisory committee co-chair Nico Pronk, PhD, MA, FACSM, FAWHP, in a June Healthy People webinar.

Blakey said she believes that reducing the number of objectives will simplify the process of data collection and analysis, as well as make it easier to zero in on the most important areas of public health. In addition, having fewer objectives will allow organizations more time and resources to put objectives into place.

“With 1,200 objectives, time is spent just collecting data and monitoring and tracking and not as much time can be spent on the actual implementation and activities (related to meeting objectives),” she said.

Healthy People 2030 is projected to take effect in 2020, but in the meantime, public comment is encouraged for shaping the future of the program. The Healthy People 2030 advisory committee will convene Sept. 6 at a meeting that will be open to oral public comment. Comments are also being accepted through the Healthy People website until Sept. 29. Stakeholder input will be ongoing through December 2018.

Attendees at APHA’s 2017 Annual Meeting and Expo can learn about Healthy People during a Nov. 6 session, 3121, that will highlight development of the objectives.

For more information, visit [www.healthypeople.gov](http://www.healthypeople.gov).

*   Copyright The Nation’s Health, American Public Health Association