Healthy People 2020 A Resource for Promoting Health and Preventing Disease Throughout the Nation Presented by Beverly A Isman, RDH, MPH, ELS Acknowledgments: Chris Farrell, MDCH Gina Thornton Evans, CDC Kathy Mangskau, ASTDD Richard Watt, University College, London Healthy People Website 1
Today s Session Purpose and History of Healthy People Development of Healthy People 2020 Healthy People 2020 Framework, Topic Areas, and Objectives Assessing Progress and an Overview of Data Sources Using Healthy People 2020 What Is Healthy People? A national agenda that communicates a vision for improving health and achieving health equity. A set of specific, measurable objectives with targets to be achieved over the decade. These objectives are organized within distinct Topic Areas. 2
Key Features of Healthy People Creates a comprehensive, strategic framework that unites health promotion and disease prevention issues under a single umbrella. Requires tracking of data-driven outcomes to monitor progress and to motivate, guide, and focus action. Engages a network of multidisciplinary, multisectoral stakeholders at all levels. Guides national research, program planning, and policy efforts to promote health and prevent disease. Establishes accountabilityrequiring all PHS grants to demonstrate support of Healthy People objectives. Federally Led, Stakeholder- Driven Process HHS Secretary s Advisory Committee Federal Interagency Workgroup (28 Federal Agencies) State and Local Governments (50 State Coordinators) National-Level Stakeholders, Including Members of the Healthy People Consortium (2,200+ Volunteers) Community-Based Organizations, Community Health Clinics, Social Service Organizations, etc. Individuals, Families, and Neighborhoods Across America 3
History of Healthy People 1979 ASH/SG Julius Richmond establishes first national prevention agenda: Healthy People: Surgeon General s Report on Health Promotion and Disease Prevention HP 1990 Promoting Health/Preventing Disease: Objectives for the Nation HP 2000 Healthy People 2000: National Health Promotion and Disease Prevention Objectives HP 2010 Healthy People 2010: Objectives for Improving Health Healthy People 2020 Launched December 2010 Evolution of Healthy People Target Year 1990 2000 2010 2020 Overarching Goals Decrease mortality: infants adults Increase independence among older adults Increase span of healthy life Reduce health disparities Achieve access to preventive services for all Increase quality and years of healthy life Eliminate health disparities Attain high-quality, longer lives free of preventable disease Achieve health equity; eliminate disparities Create social and physical environments that promote good health Promote quality of life, healthy development, healthy behaviors across life stages # Topic Areas 15 22 28 39* # Objectives/ Measures * With objectives 226/NA 312/NA 467/1,000 >580/1200 4
Healthy People 2020 Development, Framework, Topic Areas, and Objectives HP 2020 OH Workgroup 5
Determinants of Oral Health Fisher-Owens et al., 2007 6
Common Risk Factor Approach: Conditions Model Risk Factors Diseases Risk Factors Diet Obesity Tobacco School Stress Cancers Heart disease Alcohol Workplace Respiratory disease Control Dental caries Exercise Policy Hygiene Periodontal diseases Trauma Injuries Housing Political environment Physical environment Social environment Involving Non-Health Sectors To Address Determinants of Health Healthy People 2020 will emphasize involving health sectors and sectors outside health, including: Education Housing Environment Transportation Labor Agriculture 7
HP 2020 Format Web-based Interactive document http://www.healthypeople.gov Previous versions had numbered Chapters: Oral Health objectives were designated by 21-1, 21-2, etc Topics are now in an alphabetical index, with new topics noted with a symbol 42 Topic Areas including Oral health (see handout) Each topic area includes tabs for an Overview of the Topic, the Objectives, and Implementation and Resources See handout for details of each OH objective Framework for an Objective: Example Objective OH-3: Reduce the proportion of adults aged 35-44 years with untreated tooth decay. Target: 25.0% Baseline: 27.8% of adults aged 35-44 yrs had untreated decay in at least one permanent tooth in 1999-2004 Target setting method: 10% improvement Data Source: NHANES 8
HP 2020 Oral Health Objectives (HP 2010 Objective) see handout for details Children and Adolescents OH 1 Dental caries experience (21.1) OH 2 Untreated dental decay in children and adolescents (21.2) Adults OH 3 Untreated dental decay in adults (21.2) OH 4 No permanent tooth loss (21.3/21.4) OH 5 Destructive periodontal disease (21.5) OH 6 Early detection of oral and pharyngeal cancers (21.6) Oral Health Objectives Cont. Access to Preventive Services OH 7 Use of oral health care system (21.10) OH 8 Dental services for low-income children and adolescents (21.12) OH 9 School-based centers with an oral health component (21.13) OH 10 Health centers with oral health component (21.14) OH 11 Receipt of oral health services at health centers (NEW) 9
Oral Health Objectives Cont. Oral Health Interventions OH 12 Dental sealants (21.8) OH 13 Community water fluoridation (21.9) OH 14 Preventive dental screening and counseling (NEW) Monitoring, Surveillance Systems OH 15 Systems that record cleft lip or palate and referrals (21.15) OH 16 Oral and craniofacial State-based health surveillance system (21.16) Public Health Infrastructure OH 17 Health agencies with a dental professional directing their dental program (21.17) Oral Health Objectives Cont. New/Developmental Objectives: currently do not have national baseline but have a confirmed nationally representative data source OH-11 Patients who receive oral health services at Federally Qualified Health Centers (FQHC) each year. OH-14:Increase the proportion of adults who receive preventive interventions in dental offices. reducing tobacco usage or smoking cessation oral and pharyngeal cancer screening from a dentist or dental hygienist (21.7) adults who are tested or referred for glycemic control from a dentist or dental hygienist. 10
Changes to HP 2020 Children and Adolescents (Age groups changed) OH-1 Dental Caries, OH-2 Untreated Decay 2010 2020 2 to 4 3 to 5 6 to 8 6 to 9 15 years 13 to 15 OH-12 Dental Sealants 2010 2020 8 3 to 5 14 years 6 to 9 13 to 15 HP 2020 Changes Cont. OH-3 Untreated Decay Adults (Age groups changed) 2010 2020 35 to 44 35 to 44 65 to 74 (coronal surfaces) 75 and older (root surface) OH-4 No Permanent Tooth Loss 2010 2020 35 to 44 (21.3) 45 to 64 65 to 74 (21.4) 65 to 74 11
HP 2020 Changes Cont. OH-9 School-based health centers with an oral health component Expanded to include a component on topical fluoride OH-15 Systems that record cleft lip and palate and referrals Expanded to include two sub-objectives, one related to a system for recording and the second for a referral system OH Objectives in other Topic Areas Access to Health Services Cancer Diabetes Educational and Community-Based Programs Tobacco Use Older Adults 12
HP 2010 Mid-Course Review: OH Objectives and Subobjectives How to locate on the website There were a total of 26 objectives and subobjectives Two developmental objectives became measureable: OH in school HCs, dental programs in local health agencies No (zero) OH objectives met or exceeded their targets! 4 (15%) moved away from the targets: caries in 2-4 yr olds, early detection of O/P cancer, tribal programs; and 1 had no change: annual dental visits 13 (50%) moved toward their targets but didn t attain them 8 (31%) could not be assessed due to lack of data by Jan 2005 There was some progress in reducing disparities, but access barriers interfered with progress on some objectives Mid-Course Review for All Objectives and Subobjectives 507 objectives with tracking data available (of 955) Three hundred fifty-six (70%) met, exceeded, or moved toward the target. Seventy (14%) met the target. Two hundred eighty-six (56%) moved toward the target. Thirty-eight (8%) demonstrated no change. One hundred thirteen (22%) moved away from the target. 13
Assessing Progress Health Measures General Health Status: e.g., life expectancy, limitation of activity, chronic diseases Disparities and Inequity: e.g., race and ethnicity, gender, sexual identity and orientation, disability status or special health care needs, geographic location Social Determinants of Health: e.g., policymaking, social factors, health services, individual behaviors, biology and genetics Health-Related Quality of Life and Well-Being: e.g., physical, mental, emotional and social functioning Assessing Oral Health Progress Data Sources National Health and Nutrition Examination Survey (NHANES) National Program of Cancer Registries (NPCR); Surveillance, Epidemiology and End Results (SEER) Program Medical Expenditure Panel Survey (MEPS) NASBHC School-based Health Care Census HRSA BPHC Uniform Data System ASTDD Annual State Synopses CDC Water Fluoridation Reporting System (WFRS) Indian Health Service Data System 14
NHANES State Cancer Profiles 15
MEPS NASBHC 16
ASTDD/CDC State Synopses WFRS informs CDC CWF Statistics 17
Tracking State Progress Example: Hawaii Implementing Healthy People 2020 18
How Stakeholders Are Using Healthy People Data tool for measuring program performance Framework for program planning and development Goal setting and agenda building Teaching public health courses Benchmarks to compare State and local data Way to develop nontraditional partnerships ASTDD/CDC NOHSS 19
ASTDD Basic Screening Surveys State HP Plans 20
State HP 2010 Plan with OH Chapter Michigan Oral Health Plan 21
HP2010- HP2020: State Oral Health Plans SOHP s in nearly half the states (24) do not specifically reference HP2010 targets 20 states (CT, KY, MS, CA,,MI, UT, IN, NV, OH, RI, TX, CO, MA, SD, NE, ID, IA, NC, PA, and SC) explicitly incorporate HP2010 objectives and targets in some cases for community water fluoridation only State targets can be different from the national targets States may have oral health objectives in other HP state documents or plans North Dakota State Oral Health Surveillance Plan 22
Ways To Connect With Healthy People Spread the word about the 2020 objectives. Follow Healthy People on Twitter (@gohealthypeople). Connect with Healthy People on LinkedIn. Join the Healthy People listserv. Visit www.healthypeople.govfor up-to-date information and announcements. E-mail: healthypeople@nhic.org. Using HP 2020 in State and Local Oral Health Programs Mobilize programs and coalitions Needs assessment Strategic planning Priority setting Guide program implementation Framework for program evaluation Collaborative efforts with other programs Making the case for funding Commit to a national health movement Add links to HP 2020 on websites 23
Community Transformation Grants Create healthier communities by 1) building capacity to implement broad evidence and practice-based policy, environmental, programmatic and infrastructure changes, as appropriate, in large counties, and in states, tribes and territories, including in rural and frontier areas and 2) supporting implementation of such interventions in five strategic areas (Strategic Directions) aligning with Healthy People 2020 focus areas and achieving demonstrated progress in the following five performance measures outlined in the Affordable Care Act: 1) changes in weight, 2) changes in proper nutrition, 3) changes in physical activity, 4) changes in tobacco use prevalence, and 5) changes in emotional well being and overall mental health, as well as other program-specific measures. HRSA Application Guidance Review Criteria The extent to which the applicant demonstrates understanding of Healthy People 2010 and the objectives relevant to the oral health of children and how Healthy People 2010 is relevant to the purpose and activities of this cooperative agreement. 24
Using HP 2020 in Communities MAP-IT Mobilize: Coalitions, program staff, partners, collaborative efforts Assess: needs and assets and set priorities Plan: Use priorities to set goals, set objectives specific to the priorities, determine intervention points/strategies, determine evaluation measures Implement: Create a detailed work plan, identify someone to manage the process, set regular check points to assess progress and challenges, get the word out-develop a communication plan Track: Monitor progress and outcomes during planned evaluation points, share progress and successes, request assistance in meeting challenges or overcoming barriers How Businesses Can Use Healthy People To Improve the Oral Health of Their Employees and Communities Understand and discuss oral health issues that may impact the productivity of employees and affect their overall health. Use the Healthy People objectives as guidance for developing worksite wellness programs, and to benchmark employee health against that of the Nation. Create oral health/dental benefits policies and programs that promote reaching HP objectives. 25
How Educators Can Use Healthy People To Integrate Prevention Into Education Understand how oral disease prevention can be integrated across the continuum of education starting from the earliest ages. Understand the correlation between educational status, health literacy and oral health status. Integrate the Healthy People objectives into courses across the curriculum. Use HP objectives as a basis for selecting student projects or during service-learning experiences. How Researchers Can Use Healthy People Document oral health disparities in different population groups and trends over time Compare effectiveness of various preventive measures in different combinations and with different population groups Investigate how improvements in oral health create improvements in overall health Investigate how improvements in selected social determinants of health can improve oral health Investigate if strategies that target common risk factors create improvements in multiple diseases or behaviors 26
How Health Care and Dental Care Providers Can Use Healthy People in their Practices Understand how dental care and oral health services fit into the context of population health. Offer patients relevant counseling, education, and other preventive services. Promote both population-based and individual preventive approaches Help to reduce barriers to receiving regular and comprehensive oral care. Benchmark and track the progress of a community of patients toward HP objectives. Thank You! Any Questions? 27