top of page

HEALTHY PEOPLE

HEALTHY PEOPLE PROGRAM

Healthy People is a national public health program which identifies national priorities and develops initiatives to market social and experimental ideologies to individuals, NGO's, and communities across the United States.  The goal of Health People is to reduce healthcare expenditures by preventing illness before it manifests. Healthy People 2030, the initiative's fifth decade of this program, builds on knowledge gained over the first 4 decades.  Healthy People program sets national goals in 10 year consecutive blocks.The Healthy People program first goals were set in 1979, "in response to an emergency consensus among scientists and health authorities that national health priorities should emphasize disease prevention."  Healthy People was originally issued by the department of health, education and welfare.  The first issue contained, "a report announcing goals for a 10 year plan to reduce controllable health risks", which was focused on nutrition at that time.  The goals were subsequently updated for Healthy People 2000, 2010, 2020 and 2030.  Healthy People 2010 started in January 2000 by the US Department of HHS, was a set of nation wide health-promotion and disease-preventiion goals to be achieved by the year 2010.  Programs such as the HealthCorps.  Healthy People 2010 was developed through consultation with private industry and designed to measure the programs overtime.  The 2 goals were "increase quality in years of healthy life and to eliminate health disparities".  
In order to track Healthy People 2010 objectives, national data is being gathered from 190 sources.  However, the program fails to identify what these sources are.  
10 "Leading Health Indicators" were selected as major health concerns.
  1. physical activity
  2. overweight and obesity
  3. tobacco use
  4. substance abuse
  5. responsible sexual behavior
  6. mental health
  7. injury and violence
  8. environmental quality
  9. immunization
  10. access to healthcare

​The campaign identifies 6 major factors (social identities) that contributes to disparities in the health of Americans.
  1. Gender
  2. race or ethnicity
  3. education or income
  4. disability
  5. geographic location
  6. sexual orientation

Healthy People 2010 expanded and updated on the 1979 "Healthy People" and the 1990 "Healthy People 2000" efforts.  
Healthy People 2020 expanded on HP 2010 and was presented in December of 2010.
 
HP 2020 has 4 overarching goals
  1. higher quality and longer lives without preventable disease, disabilities, injury and premature death.
  2. health equity, elimination of disparities and improvement of health in all demographic groups. 
  3. creating social and physical environments that create good health for all.
  4. promoting higher quality of life, healthy development and behaviors across every stage of life.

HP 2020 approach included 12 leading health indicators, which address determinants of health effecting quality of life, behaviors and healthy age development.  
  1. Access to health services
  2. clinical preventative services
  3. environmental quality
  4. injury and violence
  5. maternal, infant and child health
  6. mental health
  7. nutrition, physical activity and obesity
  8. oral health
  9. reproductive and sexual health
  10. social determinants
  11. substance abuse
  12. tobacco


 
Vision
A society in which all people can achieve their full potential for health and well-being across the lifespan.

Mission
To promote, strengthen, and evaluate the nation’s efforts to improve the health and well-being of all people.

Foundational Principles
The health and well-being of all people and communities is essential to a thriving, equitable society.  The following foundational principles guide decisions about Healthy People 2030:
  • Promoting health and well-being and preventing disease are linked efforts that encompass physical, mental, and social health dimensions.
  • Investing to achieve the full potential for health and well-being for all provides valuable benefits to society.
  • Achieving health and well-being requires eliminating health disparities, achieving health equity, and attaining health literacy.
  • Healthy physical, social, and economic environments strengthen the potential to achieve health and well-being.
  • Promoting and achieving health and well-being nationwide is a shared responsibility that is distributed across the national, state, tribal, and community levels, including the public, private, and not-for-profit sectors.
  • Working to attain the full potential for health and well-being of the population is a component of decision-making and policy formulation across all sectors.

Overarching Goals 
Attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death.  Achieving these broad and ambitious goals requires setting, working toward, and achieving a wide variety of much more specific goals.
​
Healthy People 2030’s overarching goals are to: Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.
  • Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.
  • Promote healthy development, healthy behaviors, and well-being across all life stages.
  • Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all.

Plan of Action
It’s important to provide information and tools to help communities, states, and organizations use Healthy People. The Healthy People 2030 plan of action is to:
Set national goals and measurable objectives to guide evidence-based policies, programs, and other actions to improve health and well-being.
Provide accurate, timely, and accessible data that can drive targeted actions to address regions and populations that have poor health or are at high risk for poor health.
Foster impact through public and private efforts to improve health and well-being for people of all ages and the communities in which they live.
Provide tools for the public, programs, policymakers, and others to evaluate progress toward improving health and well-being.
Share and support the implementation of evidence-based programs and policies that are replicable, scalable, and sustainable.
Report biennially on progress throughout the decade from 2020 to 2030.
Stimulate research and innovation toward meeting Healthy People 2030 goals and highlight critical research, data, and evaluation needs.
Facilitate the development and availability of affordable means of health promotion, disease prevention, and treatment.
Developed by the HHS Office of Disease Prevention and Health Promotion.  The program launched in April 2020, and increases the focus on health equity, social determinants of health, and health literacy as well as adding a new focus on well-being.

The plan consists of three types of objectives; in order to become a core objective, a research objective needs reliable baseline data and associated evidence based interventions.  
  • Core objectives are defined as high-priority objectives with an identified data source. If a research objective evolves to meet these criteria, a healthy people workgroup may propose to the federal interagency workgroup that it becomes a core objective.
  • Developmental objectives are defined as issues that are high-priority, however lack credible or reliable baseline data to provide support.
  • Research objectives are defined as areas that present health or economic burdens, however research is needed to identify interventions based on evidence to improve health.​​  Research objectives represent health issues with a high health or economic burden or significant disparities between population groups-but they aren't yet associated with evidence based interventions.
​
*HP 2030 has 355 core objectives, 115 developmental objectives and 40 newly added research objectives for the advancement in areas that have limited research.
​
The HHS secretaries advisory committee for 2030 The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 provided recommendations to the Secretary of the U.S. Department of Health and Human Services for the development and implementation of Healthy People 2030 objectives. The committee was made up of non-federal, independent subject matter experts.
 
All core objectives should be assessed across the following 4 criteria:
  1. Public health burden—relative significance to the health and well-being of the nation
  2. Magnitude of the health disparity and the degree to which health equity would be achieved if the target were met
  3. The degree to which the objective is a sentinel or bellwether
  4. Actionability of the objective​

2030 was informed by current scientific evidence.  The committee provided input on various Healthy People 2030 components, including the:
  • Mission and vision statements
  • Framework
  • Selection criteria for developing measurable, nationally representative objectives
​
The committee also provided recommendations to:
  • Ensure that selection criteria help identify objectives that address data-based, high-priority public health issues
  • Limit the number of objectives
  • Implement Healthy People 2030
  • Identify Leading Health Indicators*
​
The selection criteria for the LHI​​
​
Past Meetings and Materials:  Secretary's Advisory Committee on National Health Promotion and Disease Prevention
 
​
Timeline

2020 Launch Healthy People 2030
Release data for core objectives
Set targets for core objectives
Release Leading Health Indicators
Release Overall Health and Well-Being Measures
Release Healthy People 2020 Final Review Executive Summary

2021 - 2029 Release Healthy People 2020 Final Review Report
Add disparities data, state-level data, and demographic data for core objectives
Collect midcourse data and release midcourse report
Add at least 2 data points for each core objective
Release more resources to support implementation, including Stories from the Field and additional Evidence-Based Resources
Conduct ongoing assessment of progress toward achieving national objectives
Conduct ongoing assessment of Leading Health Indicators

2028 - 2030 At the end of the decade
Start developing Healthy People 2040
Collect final Healthy People 2030 data
Start developing the Healthy People 2030 Final Review report
 

Healthy People 2030 includes 8 overall health and well-being measures objective health measures (OHMs). 
Overall Health and Well-Being Measures Summary Mortality and Health
Broad, global outcome measures intended to assess the Healthy People 2030 vision. OHMs can be used to summarize and evaluate progress toward achieving Healthy People objectives.

Healthy People 2030 includes 8 OHMs, organized into 3 tiers: well-being, healthy life expectancy, and summary mortality and health.1 Unlike Healthy People 2030 Leading Health Indicators and core objectives, OHMs do not have targets.
OHM-8: Respondent-assessed health status — in good or better health
Well-Being
OHM-1: Overall well-being [Data not yet available]
Overall well-being is expressed as overall life satisfaction. Well-being reflects the cumulative contributions of health and non-health factor

Summary Mortality and Health
OHM-5: Life expectancy at birth
OHM-6: Free of activity limitation
OHM-7: Free of disability
OHM-8: Respondent-assessed health status — in good or better health

Well Being:
  • Overall well-being

Health Life Expectancy:
  • Life expectancy at birth without activity limitation
  • Life expectancy at birth free of disability
  • Life expectancy at birth in good or better health
     
Mortality and Health:
  • Life expectancy at birth
  • Free of activity limitation
  • Free of disability
  • Respondent-assessed health status
     
The focus of the Healthy People 2030 program is on upstream factors, or similar behaviors amongst populations that may impact people's health and their environments. 

Healthy People 2030 includes four objectives regarding adverse childhood experiences, or ACEs, such as poverty and abuse. 

Healthy People 2030 also focuses on elderly populations. The Healthy People 2030's core objectives includes improving the health and quality of life for people with Alzheimer's disease and dementia.
  • Increasing the proportion of older adults with dementia, or their caregivers, who know they have it
  • Reducing the proportion of preventable hospitalizations in older adults with dementia
  • Increasing proportion of adults with subjective cognitive decline (SCD) who have consulted a health care professional regarding their memory loss or confusion.
​
​
The National Center for Health Statistics is responsible for monitoring the nations progress towards Healthy People's progress.National Center for Health Statistics (NCHS) is responsible for monitoring the Nation’s progress toward Healthy People targets using data from 81 different data sources.  NCHS data systems are used to monitor 166 or 47% of these objectives.  
NOTE, data sources used are undisclosed to the public.
​
NCHS's Responsibilities:
  • Serve as the statistical advisor to HHS and the Healthy People initiative on the data used to monitor the HP2030 objectives.
  • Conduct research and develop methods for measuring HP2030 progress and overarching goals, including development of an HP2030 disparities tool.
  • Analyze, present, and publish data related to progress towards reaching the HP2030 goals and objectives.
  • Maintain DATA2030, a comprehensive database for all HP2030 data.
  • Provide expertise and technical assistance to national, state, and local health monitoring efforts.​​
Healthy People 2030 reflects a more focused, evidence-based, and statistically rigorous set of objectives. The following data-related criteria were applied in the selection of objectives and data sources: Data are reliable, valid, and nationally representative with no major methodological issues (e.g., limited population coverage, inadequate sample size, unknown or low response rates, and inadequate studies of nonresponse bias).

Data are timely with baseline data no older than 2015 and include a measure of variability and an assurance of at least two additional data points throughout the decade.
Data are publicly available with complete documentation, generally with federal government management or oversight.
HP2030 core objectives were selected based on the following criteria:
National Importance Ability to have direct impact or influence on health, broad and comprehensive applicability, substantial burden, and national health priority.
Evidence Base; existing evidence of effective interventions to achieve the objective.
Disparities and Equity Assessment of health disparities with a focus on health equity.
CURRENT OVERSIGHT

HP2030 Partners: HHS (& Secretary's Advisory Committee)
Office of Disease Prevention and Health Promotion (ODPHP) (Managing Partner)
National Center of Health Statistics
Federal Inter-Agency Workgroup
Topic Area Workgroups
State & Local Governments (50 state coordinators)
National Level Stakeholders (including members of the healthy people consortium)
Community Based Organizations, Community Health Clinics, Social Service Organizations
Individuals, Families and Neighborhoods Across America.

HP2030 reflects high-priority public health issues, and the initiative will allow for changes to objectives throughout the decade to respond to emerging challenges. Serve as the statistical advisor to HHS and the Healthy People initiative on the data used to monitor the HP2030 objectives.

Conduct research and develop methods for measuring HP2030 progress and overarching goals, including development of an HP2030 disparities tool.Analyze, present, and publish data related to progress towards reaching the HP2030 goals and objectives.

Maintain DATA2030, a comprehensive database for all HP2030 data.Provide expertise and technical assistance to national, state, and local health monitoring efforts.

Partnership & Collaboration Board of Scientific Counselors
Interagency Council on Statistical Policy (ICSP)
Interagency Working Group on Summary Measures of Health (IAWG)
National Committee on Vital and Health Statistics (NCVHS)
Public Health Data Standards Consortium (PHDSC)
Washington Group on Disability Statistics
Research Objectives:
Research objectives represent public health issues with a high health or economic burden or significant disparities between population groups — but they aren't yet associated with evidence-based interventions.

To become a core objective, a research objective needs reliable baseline data and associated evidence-based interventions. If a research objective evolves to meet these criteria, a Healthy People workgroup may propose to the Federal Interagency Workgroup (FIW) that it become a core objective.

WORKGROUPS - HEALTHY PEOPLE

HEALTH IN ALL POLICIES (HiAP)

Health in all policies term was first used in Europe in 2006 with the aim of collaborating across sectors to achieve common goals.  It is a strategy to include health considerations in policy making across different sectors to influence health such as transportations, agriculture, land use, housing, public safety and education.  
In 1994, in the midst of discussion of healthcare reform and lack of clarity of the role of public health, the public health functions steering committee developed the 10 essential public health services (EPHS) as a means of communicating the key public health services needed to protect and promote the health of the public. 



 

FUTURE OF POLICIES

In June 2013, Finland's Ministry of Social Affairs and the World Health Organization hosted the 8th Global Conference on Health Promotion in Helsinki. 

 

The conference addressed the challenges facing the implementation of HiAP, encouraged the exchange of past experiences, which could lead to the design of effective pathways for intersectoral collaboration, and analyzed the impact and advancement of health promotion since the first conference on health promotion in 1987. 

 

In 2017, to improve accountability for the pledges made by countries in the Rio Political Declaration on Social Determinants of Health, the World Health Organization and United Nations Children's Fund called for the monitoring of intersectoral interventions on the social determinants of health that improve health equity, noting that the World Health Organization is developing the first global monitoring system for intersectoral interventions that are known to improve health equity.

10 ESSENTIAL PUBLIC HEALTH SERVICES

  1. Monitor health status to identify community health problems

  2. Diagnose and investigate health problems and health hazards in the community

  3. Inform, educate, and empower people about health issues

  4. Mobilize community partnerships to identify and solve health problems

  5. Develop policies and plans that support individual and community health efforts

  6. Enforce laws and regulations that protect health and ensure safety 

  7. Link people to needed personal health services and assure the provision of health care when otherwise available

  8. Assure a competent public health and personal health care workforce

  9. Evaluate the effectiveness, accessibility, and quality of personal and population-based health services

  10. Research for new insights and innovative solutions to health problems

The EPHS have become the definition of what public health is for both those within and outside the field.  The EPHS was developed through consensus of the major public health organizations and government agencies and designed to explain public health to policy makers and the public, the EPHS have become the foundation for public health work.

Defining Public Health Practice:  25 Years of the 10 Essential Public Health Services
HiAP is built on the rationale that health is determined by multiple factors outside the direct control of the healthcare sector, such as education, income, and the conditions in which people live, work, and play.  Individual decisions made in other sectors can positively or negatively effect the determinants of health. 

The HiAP is an approach to policy making in which decision-makers in other sectors routinely consider health outcomes including benefits, harms, and health related costs. 

Proponents of HiAP have contended that health is not the only domain of societal well-being that can benefit from interdisciplinary policy-making.  They suggest that rather than viewing HiAP as an attempt to increase the influence on health professionals, HiAP might be used as a template for future movements such as "economics in all policies", "education in all policies".

SUPPORT

HiAP has been widely implemented in many parts of the world.  HiAP approach gained support from health advocates in the United States.  The Institute of Medicine recommends implementing a HiAP approach for more fully addressing the determinants of health, better coordinate efforts across sectors and more efficiently using public resources.  

Organizations that endorse HiAP, include but are not limited to: 
  • The American Public Health Association calls HiAP a "gold standard" and calls for increased HiAP infrastructure at all levels of the government, increased funding for HiAP related research, practice and training, as well as the establishment of best practices and a formal national research agenda. 
  • The National Association of County and City Health Officials (NACCHO), advocates for HiAP as a critical method to promote health and encourages local health departments to disseminate HiAP best practices to policy-makers.  
  • The National Network of Public Health Institutes and their member partners see themselves as potential facilitators of the HiAP implementation.
     

CONCERNS

Citizens Interest, among other critics of the HiAP approach, have raised concerns that HiAP breeds "health imperialism".  The IOM acknowledges the fundamental challenges in HiAP.  There are examples where the aim of one interest directly conflicts with another for example, efforts to limit tobacco sales have been in opposition of the tobbacco industry to maintain personal freedom for citizens and a free market environment for cigarette manufacturers.  

Even non controversial outcomes such as increased income and education can also raise contentions through ideological differences for accomplishing these goals.  

Many groups have questioned the rigor in which the health impacts of non health policies can be assessed.  Critics note the difficulties inherent in collecting data that describes the current "baseline' conditions and predicting estimates of a policies potential impact on health and healthcare expenditures.

The most widely promoted and cited mechanism to implementing HiAP is "health impact assessment (HIA)" HIA is defined as " a systematic process that uses an array of data sources and analytical methods and considers impact from stakeholders to determine the effects of proposed policy, plan, program or project on the health of a population and the distribution of those effects within the population.
bottom of page