Ask the Expert: Dr. David Huang
[Editor’s note: NCHS is responsible for monitoring and analyzing data for the HHS Healthy People program. In addition, about one-third of the program’s objectives use NCHS-collected data. We spoke with Dr. David Huang of the Office of Analysis and Epidemiology (OAE) about the Healthy People program.]
Q. Healthy People 2010: Final Review comes out this month. What can you tell us about its findings? How did we do, as a nation?
A. We look at the data in terms of our targets, which are unique to Healthy People as a national initiative. A target is an achievable, measurable goal, like reducing lung cancer by 25 percent. We ask, did the nation move toward or way from the target? Did we meet or exceed it?
Overall, the nation met about 25 percent of the Healthy People 2010 targets, moved toward about 50 percent, and moved away from about 25 percent. So overall, for 75 percent of our targets, we either moved toward or met our objectives. But for those other 25 percent – notably obesity, physical activity targets–not so surprisingly as a nation we're not doing very well. We did do well in areas like occupational safety and health and immunization and infectious diseases. The U.S. met many of the targets in those topic areas.
Some other findings we've highlighted are in the area of disparities. There were some increases, some decreases, but for the majority of objectives, disparities persisted. That's an important takeaway - disparities do persist, whether it's by race/ethnicity, income, education level, disability, geography, and so on. In our Final Review we've highlighted disparities using red tables. The darker the red, the more pronounced the disparity. This gives users an at-a-glance view of where disparities are of greatest magnitude.
Q. Where do the data come from?
A. Data are collected from many different sources, and analyzed by the NCHS/OAE Health Promotion Statistics Branch. We have 17 people in the branch, including our Branch Chief, Rebecca Hines. We serve as the statistical advisor to the Healthy People initiative. We give objective data analysis and help advise the policy component, although we are not charged with giving any policy recommendations.
We collect and integrate data from more than 160 different sources. About one-third of Healthy People objectives are measured using the main NCHS data systems: the National Health Interview Survey, National Health and Nutrition Examination Survey, National Vital Statistics System, National Survey of Family Growth, and the National Health Care Surveys.
We also use data from other surveys within the Department [of Health and Human Services], smaller surveys run by other agencies such as NIH, and smaller data systems run outside of the Department, like Census. We also receive data from some non-governmental data systems, but they tend to be a bit smaller in scope.
All the data in Healthy People are nationally representative; to be included as an objective in Healthy People, a nationally representative data source needs to be available.
Q. Now that Healthy People 2010 is wrapped up, what's in store for Healthy People 2020?
A. For Healthy People 2020, we've expanded the scope and focus. The initiative expanded from 28 focus areas to 42, which we're now calling topic areas. The number of objectives also increased - we had a little under a thousand objectives for 2010, and for 2020 we have 1,200.
Some of the new areas of interest are population-specific, so we have new topic areas on older adults, early and middle childhood, adolescent health, and lesbian, gay, bisexual and transgender health. We are also tracking some emerging areas, like health care-associated infections, preparedness, health-related quality of life and well-being, and social determinants of health.
Q. How do you measure social determinants?
A. In the social determinants group, we actually found that when we looked at the existing Healthy People 2020 objectives, there were a lot that already address social determinants of health. For example, the measure that tracks having health insurance is in the Access to Health Services topic area, and the high school graduation rates measure is already in the Education and Community-Based Programs topic area.
We did a sweep of Healthy People 2020, and tagged those objectives which we determined were closely tied to Social Determinants of Health already. No need to reinvent the wheel. And then we looked at where the gaps were, and looked at some overarching frameworks for considering Social Determinants of Health. For example, we found that the World Health Organization actually has a Committee on Social Determinants of Health and had published a report that served as part of the basis for the Healthy People framework.
We came up with a framework consisting of five different domains which we're basing our work on: Neighborhood/Built Environment, Education, Economic Stability, Health and Health Care, and what we're calling Social and Community Context. We're coming up with a list of objectives – both existing and new -- for each domain.
Our first round of proposed new Social Determinants of Health objectives – those not found elsewhere in Healthy People -- includes measures where we can easily get the data, the low-hanging fruit. We're looking at the portion of children aged 0 to 17 with at least one parent employed year-round. Then there are two objectives related to poverty: poverty for the overall population, and poverty for children aged 0 to 17. Another measure is the proportion of high school completers who are actually enrolled in college the October following graduation. That's either a GED or a regular high school diploma, and then either a two-year or four-year college.
Q. How do you manage all those data from all those different data sources? It sounds challenging, to say the least.
A. One of our programmers here, Bob Francis, has developed an in-house system that collects all these data and puts them into a format that's uniform across all objectives, whether they are programmed by us or not. We provide templates to the programmers working on Healthy People data across and outside the government, they populate them, and when they come in they can be fed directly into our in-house system.
Q. With all these expanded topics and objectives, all this increased activity, are you also expanding the branch?
A. No, we're doing the work with pretty much the same amount of staff [laughs].