Healthy People Initiative: A Brief History (Part I, with David Huang)
HOST: David Huang is the chief of the health promotion statistics branch at NCHS, and serves as the center’s primary statistical advisor on the Healthy People initiative. Healthy People for decades now has been identifying science-based objectives with targets to monitor progress and motivate and focus action aimed at improving the health of the nation.
David joined us to discuss the history of the program, what is going on presently, and what the future directions are.
HOST: David can you start by telling us a little bit about the history of the Healthy People program?
DAVID HUANG: Sure. Established in 1979, Healthy People is a science-based 10-year national initiative for improving the health of all Americans based on the latest available scientific evidence. And at its core Healthy People provides a strategic framework for a national prevention agenda that communicates a vision for improving health and achieving health equity but at the heart of the initiative are the science-based measurable objectives with targets to be achieved by the end of each decade. With the recent release of Healthy People 2030 last August, we’re actually now in our fifth decade of the initiative and while the Department of Health and Human Services or HHS leads the initiative through the Office of the Assistant Secretary for Health Office of Disease Prevention and Health Promotion or ODPHP, NCHS has served as the statistical advisor to the initiative since the first iteration of Healthy People.
HOST: This program has been going on for quite a while – now how important is it in public health to have specific goals to work towards?
DAVID HUANG: Well there are many federal health indicator projects, but the inclusion of a quantifiable target for each objective is a unique feature that distinguishes Healthy People from other broad federal prevention initiatives. The use of targets was inspired by the “Management by Objectives” movement which emphasize setting of organizational goals and objectives and was outlined by Peter Drucker in his 1954 book called “The Practice of Management.” Targets have been an integral part of Healthy People since its inception in 1979. The examination of data relative to targets is considered critical to the usefulness of Healthy People as targets do communicate policy expectations and expert or evidence based recommendations to a wide range of stakeholders. Moreover, targets offer a marker for assessing progress for each objective and for the initiative as a whole.
HOST: How do you decide what the target is – is there any way of gauging whether it might be too lofty of a goal or too easy of a goal. How is that process?
DAVID HUANG: Targets are actually set by subject matter experts that are on topic area work groups and these are folks from across the Department. Some from actually outside of HHS who provide subject matter expertise and at the end of the day these are the folks who are responsible for determining targets. As policy constructs, NCHS does not advise one way or the other but we do provide statistical support as needed because there are certainly many cases where statistical methods are used to calculate targets.
HOST: So there’s a lot of folks involved in this, is that correct?
DAVID HUANG: Yes I would say probably hundreds from across the Department and certainly if you look at the stakeholder base of Healthy People, there are folks outside of government at the sub-national level, nonprofits… and really the intention is for Healthy People to reach the individual level. In an ideal world that’s how I think the Department would like to see it.
HOST: I wanted to then ask you what generally happens when you achieve one of these goals? What happens to that health issue or condition as far as Healthy People goes?
DAVID HUANG: Sure that’s definitely an interesting question and certainly one that has come up historically, particularly when targets are met or exceeded early in the decade. In the last decade, for example, there was an objective in the Immunization and Infectious Diseases topic area. They reached out to us in 2014 and actually asked to increase the Healthy People 2020 target for a specific objective IID 14 – that was one that tracked that percentage of adults 60 years and older who are vaccinated against zoster or shingles. Ultimately, we decided for consistency and simplicity not to officially set new in Healthy People when targets are met, but to continue tracking and reporting data throughout the decade. The work groups that as I mentioned manage Healthy People objectives have also been given the option to set unofficial secondary targets if desired. Sometimes targets are adjusted for other reasons. For example, some targets are set to be aligned with national policies, programs or laws and if there is some sort of change to that underlying policy program or law we do have the flexibility to make the same change to the corresponding Healthy People target. Another example is if an objective baseline changes due to a change in science or data collection. In those cases, targets are generally adjusted using the same target-setting method if possible. And finally I’ll just note that there are certainly opportunities for further progress even after targets have been met. So for example we continued to track the further reduction in overall cancer death rates, which is objective C1 for Healthy People 2020, even though the target for that objective was met in the year 2014. Moreover, most population-based objectives continue to have underlying health disparities by various sociodemographic factors such as race, ethnicity or family income whether they have met their targets or not. One of the overarching goals for Healthy People is actually to eliminate health disparities and achieve health equity. And of course this is a topic that has been further highlighted by COVID-19.
HOST: So you’re saying the official policy is not to make any adjustments if you’ve already met an objective. Is that also true on the flip side – if there’s no progress being made and it might become apparent that maybe the goal is a little too ambitious? Is it the same sort of approach on that side?
DAVID HUANG: Yeah it is a similar approach for… consistency and simplicity, not to change targets. I think in those situations where an objective is moving in the wrong direction… these certainly highlight opportunities for further work in disease prevention and health promotion. In addition, this could be a consideration for the target-setting for the following decade if that objective happens to be carried over from one 10-year iteration to the next.
HOST: Our thanks to David Huang for joining us on this edition of “Statcast.”