Healthy People 2020 is a large-scale public health initiative of the U.S. Department of Health and Human Services (HHS). Healthy People 2020 is based on the accomplishments of four previous Healthy People initiatives: Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention issued in 1979, Healthy People 1990: Promoting Health/Preventing Disease: Objectives for the Nation, Healthy People 2000: National Health Promotion and Disease Prevention Objectives, and Healthy People 2010: Objectives for Improving Health. Each initiative lasts one decade, and the year in the title is followed by the vision for that initiative. The vision for Healthy People 2020 is “A Society in Which All People Live Long, Healthy Lives.”
The Healthy People initiative is grounded in the principle that setting national objectives and monitoring progress can motivate action and improve health. Throughout the United States, health departments at the city, county, and state levels use the Healthy People program as a way to track the effectiveness of local health initiatives.
Healthy People is a systematic, science-based approach to improving the health of all Americans. It is based on the premise that clear objectives and scientifically based benchmarks for tracking progress will both motivate and focus public health activities. Healthy People's objectives are broad based and designed to promote healthy practices by individuals and institutions to improve disease prevention. Each new Healthy People initiative utilizes public health data from the previous decade to identify emerging public health priorities and realign strategies, research, and resources to address those priorities.
Healthy People promotes collaborations across various professional sectors and administrative levels. Its objectives, targets, and generated data have become important strategic management tools for various public and private agencies and organizations at the federal, state, and local levels. Of particular importance is Healthy People's focus on measuring progress toward health objectives within specific populations. Each Healthy People initiative formulates broad or overarching public health goals.
HEALTHY PEOPLE 2000 GOALS. The goals of Healthy People 2000 were to:
HEALTHY PEOPLE 2010 GOALS. The goals of Healthy People 2010 were to:
HEALTHY PEOPLE 2020 GOALS. The goals of Healthy People 2020 are to:
Healthy People initiatives collect data, monitor and assess outcomes, and evaluate the successes and failures of health improvement programs and activities nationwide according to specified health indicators. The National Center for Health Statistics (NCHS), within the Centers for Disease Control and Prevention (CDC), is responsible for tracking progress toward objectives. NCHS works with HHS to update data as it becomes available. Progress reviews are also done periodically by topic area. Throughout the years 2010–2020, HHS will monitor the direction that the initiative moves from the baselines set at the beginning of the decade.
“Healthy People 2000: National Health Promotion and Disease Prevention Objectives” was released in September 1990. It consisted of 376 objectives in 22 priority areas, for a total of 319 primary objectives, since some were duplicated in different priority areas.
Healthy People 2000 health-status indicators included total deaths and specific causes of death such as cancer, cardiovascular disease, and motor-vehicle crashes. Other indicators included the incidences of various infectious and sexually transmitted diseases, prenatal care, births to adolescents, low-birth-weight newborns, childhood poverty, and poor air quality.
Priority data requirements for Healthy People 2000 included data on immunizations, water quality, pap tests and mammograms, and cigarette smoking and alcohol misuse. There was also a need for data on medical insurance coverage, access to primary care and dental services, and the incidences of people who are overweight or suffering from hypertension (high blood pressure), hypercholesterolemia (high blood cholesterol), hepatitis B, high blood lead levels in young children, childhood tooth decay, and child abuse and neglect.
HEALTHY PEOPLE 2000 RESULTS. Healthy People 2000 Final Review was released in October 2001. The targets for reducing deaths from coronary heart disease and cancer were surpassed. Health disparities were reduced for more than one-half of the special populations identified as being at increased risk. Sixty-eight objectives (21%) were met. Another 129 objectives (41%) progressed toward their targets. Thirty-five objectives (11%) showed mixed results. Seven objectives (2%) showed no change. Fortyseven objectives (15%) moved away from their targets. Assessments could not be obtained for 32 objectives (10%).
Healthy People 2010, launched in January 2000, consisted of 467 objectives in 28 focus areas. Healthy People 2010's leading health indicators were a select set of objectives chosen based on their ability to motivate action, their relevance as broad public health issues, and the availability of data for measuring progress. These included physical activity, tobacco use, responsible sexual behavior, injury and violence, immunization, overweight and obesity, substance abuse, mental health, environmental quality, and access to health care.
HEALTHY PEOPLE 2010 RESULTS. The data sets for Healthy People 2010 were collected from more than 190 different sources. HHS released the assessment of Healthy People 2010 objectives on October 6, 2011, in a report titled Healthy People 2010 Final Review. The report indicated that Americans met or were moving toward meeting 71% of 2010 targets, including those associated with reducing deaths from coronary heart disease and stroke. However, health disparities had not changed for approximately 80% of the health objectives and increased for an additional 13%. In addition, obesity rates increased in all age groups.
Among the promising data was that the United States met the Healthy People objective of reducing cholesterol levels, while making minor strides toward reducing smoking rates. As a result, according to the National Vital Statistics System, the nation experienced a major drop in deaths from heart disease and strokes over the previous decade. Furthermore, overall life expectancy continued to rise, and several objectives that tracked mental health status, treatment, and services met their 2010 targets.
Although life expectancy was increasing, the rising obesity rates could later cause a reduction in life expectancy because obesity also leads to conditions such as heart disease. The 2010 final review showed dramatic rises in obesity in every age group:
The 2010 Final Review also described changes to be made for the Healthy People 2020 initiative. These included revising wording and definitions of the objectives for food and nutrient consumption. This was done so that they were applicable to the 2010 Dietary Guidelines for Americans (DGA) issued by HHS and the U.S. Department of Agriculture (USDA).
Drawing upon findings from the earlier Healthy People initiatives, experts from many federal agencies prepared draft objectives for Healthy People 2020. The objectives were made available for public comment so that Healthy People 2020 would reflect the needs and priorities of all Americans. Public comment was received during a series of nine regional meetings across the country, on a public comment website, during a public meeting of the advisory committee, and through a request for public comment published in the Federal Register.
After the public comment period, the draft objectives were reviewed by the Federal Interagency Workgroup (FIW). The working group included representatives from HHS agencies and the U.S. Departments of Agriculture (USDA), Education (ED), Housing and Urban Development (HUD), Justice (DOJ), Interior (DOI), and Veterans Affairs (VA), as well as the Environmental Protection Agency (EPA).
HHS invited agencies and organizations that supported Healthy People 2020 goals to join the Healthy People Consortium. Members across the nation were committed to achieving Healthy People 2020 goals and objectives. Enrollment in the consortium was ongoing, and consortium members included colleges, universities, private businesses, and religious organizations.
Launched on December 2, 2010, Healthy People 2020 contained 42 topic areas with nearly 600 objectives that encompassed 1,200 measures. A smaller set of Healthy People 2020 objectives, called Leading Health Indicators, was selected to communicate high-priority health issues and actions that could be taken to address them. The Healthy People 2020 Leading Health Indicators placed renewed emphasis on overcoming those challenges as HHS tracked progress over the course of the decade. The indicators were used to assess the health of the nation, facilitate collaboration across sectors, and motivate action at the national, state, and community levels.
NEW FOCUS AREAS. Thirteen new focus areas were identified for Healthy People 2020:
OBJECTIVES. Many objectives focused on interventions that were designed to reduce or eliminate illness, disability, and premature death among individuals and communities. Other objectives focused on broader issues such as:
Nutrition, physical activity, and obesity were leading health indicator topics in Healthy People 2020. Proper nutrition, physical activity, and a healthy body weight are essential to overall health and well-being. Together, they can help decrease the risk of developing serious health conditions such as high blood pressure, high cholesterol, diabetes, heart disease, stroke, and cancer. A healthy diet, regular exercise, and a healthy weight are also crucial to managing health conditions so they do not worsen over time.
Because of these behaviors, the United States had experienced a dramatic increase in obesity. Approximately one in three adults and one in six children and adolescents were obese. Obesity-related conditions include heart disease, stroke, and type 2 diabetes. These conditions were among the leading causes of death in the United States, according to the initiative.
The Healthy People 2020 nutrition and weight status objectives attempted to change those trends by increasing the number of Americans who ate healthier foods and exercised. Objectives in this area were defined by a target for improvement to be reached by 2020. These were measurable goals, such as increasing the percentage of people who exercised. The target was measured in relation to a baseline, which was a percentage from the previous decade. The four priority objectives were:
Other nutrition-related objectives in Healthy People 2020 included:
The primary concern for parents was whether their children were meeting the standards identified in the Healthy People objectives. Parents were to examine the Healthy People 2020 goals in terms of whether their children were eating enough fruits, vegetables, and other healthy foods. Parents were also to implement nutritious eating plans and physical activities for themselves and their children.
See also Coronary heart disease ; Diet and disease prevention ; Dietary counseling ; Dietary guidelines ; Obesity .
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Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA, 30333, (800) CDC-INFO (232-4636), TTY: (888) 232-6348, firstname.lastname@example.org, http://www.cdc.gov .
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U.S. Department of Health and Human Services, 200 Independence Ave. SW, Washington, DC, 20201, (877) 696-6775, http://www.hhs.gov .
Margaret Alic, PhD
Revised by Liz Swain