Healthy People Initiative: Interview with David Huang, Part Three

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:  Why don’t we turn to the new tables that you’ve released.  Can you tell us a little bit about what’s going on, what’s new with Healthy People?

DAVID HUANG:  Sure.  So although we’ve launched Healthy People 2030 – and it’s been about a year now – we aren’t done with Healthy People 2020 yet.  “Healthy People 2020 Final Review” is a quantitative assessment of the progress  made towards the 2020 goals and objectives by the end of the decade.  Unlike previous Healthy People data publications like the “Healthy People 2020 Midcourse review” that were released as complete publications, the “Healthy People 2020 Final Review” actually consists of a suite of products that will be released by NCHS on a rolling basis over the course of the next year.  Many of these final review components will be released in a web-based format.  The first release in this suite of products is the web-based “Healthy People 2020 Progress Table” which was released on March 31st.  This table provides the final progress status for 1100 measurable objectives, which are those with at least baseline data. And note that this set of 1100 is actually broader than the 985 trackable objectives mentioned earlier, and those are objectives with the baseline and at least one followed data point.  Final progress was generally measured using the latest available data as of January 2020.  The web format will allow users to dynamically filter the table by any of the following categories in any combination: Healthy People 2020 topic area, key term, and final progress status.  This format will also allow users to download customized tables for future use.  We’re really hopeful that this new format is beneficial for users.  One notable feature about these new tables is the ability to look at objectives by topics and themes – also referred to as ‘key terms’ – that cut across Healthy People 2020 topic areas.  And this is actually a feature that also exists on the Healthy People 2030 website.  This ability to look at objectives not just by topic area but also across these broad topics and themes.

HOST:  Earlier you said that about a third of the 2020 objectives have been met or exceeded, I guess.  Could you give us some highlights from the tables that have been released?

DAVID HUANG:  Sure.  Certainly there are a lot of objectives.  For example, in chronic diseases like cancer, the overall cancer death rate, as well as many of the individual cancer death rate targets have been met.  There are also objectives across other topic areas not related to chronic disease that have been met. For example, persons who are unable to obtain or delay needing medical care is another example in the access to health services topic area.  But all in all, a third of objective targets have been met, and these objectives do stand many of the topic areas across Healthy People 2020.

HOST:  I was just scrolling down some of these and there’s some measures dealing with school and education.  It kind of looks like kids are doing better in school – was that sort of what the data show?

DAVID HUANG:  I think it definitely depends on the objective, but yes there is a very large topic area in “Healthy People 2020” on education and community-based programs.  And there are many objectives in that topic area that have met their targets.  Not all of them are necessarily related to how kids are doing in school.  For example, there’s an objective on the nurse to student ratio.  That’s an example of an objective in that topic area that’s been met.

HOST:  It was interesting because there was one measure that showed that kids were doing better than they were at the baseline, but at the same time fewer thought that school was meaningful or important. I thought that was kind of interesting, almost a contradiction if you will.

DAVID HUANG:  Right and you know there’s also consideration that should be given to the data source. I think there there’s obviously a broad range of not just topics but data sources in “Healthy People.” I think that the progress tables do provide a nice, high-level summary of how we’re doing on broad health indicators and hopefully will be useful for stakeholders.

HOST:  It looks like there’s progress made in some of the health care measures –  more people with medical and dental insurance, more with the source of ongoing care, ER wait times above normal were down – most of that looked pretty positive I guess.  But there were some measures that looked like they weren’t necessarily going in the right direction, such as people unable to get prescription medication when they needed.  It looked like that was lower, is that correct?

DAVID HUANG:  Yes that’s correct and that particular objective is actually part of a series of objectives that look at persons unable to obtain or delaying receipt of medical care, dental care, and then prescription medications as you mentioned is the one that is moving in the wrong direction.

HOST:  And just for people who don’t have the level of statistical sophistication, how the tables are laid out is you have a baseline percentage that you started with, and then at the cut point you have what the percentage did – if it changed either up or down – but then also you have another column that determines whether any change was statistically significant, is that correct?

DAVID HUANG:  Yeah and it is actually a little bit more nuanced than that.  The way that we measure movement when objectives are moving towards their targets is really the percentage of the targeted change that’s achieved.  That number will be equal to 100% if an objective exactly meets its target.  And it’s basically a sliding scale for other objectives that are moving in the right direction.  On the other hand, for objectives that are not moving in the right direction, you simply use the magnitude of the percent change from the baseline to assess movement away.  And then there is that column that you mentioned which does let the user know whether this movement – whether it’s in a positive or negative direction relative to the target is statistically significant or not.

HOST:  Anything else you’d like to talk about with regard to the new tables that have been posted?

DAVID HUANG:  Well, as I mentioned this is part of a larger set of components – the full ”Healthy People 2020 Final Review” will be released in components over the next several months.  So we are definitely looking forward to other components being released.  We will actually be working next on a series of pie charts that will actually use the information in this table and summarize it in pie charts so that users can see at a glance, for example, for their set of objectives that they filter down to, what proportion have met, or exceeded, improved, or got worse, for example.

HOST: Our thanks to David Huang for joining us on this edition of “Statcast.”