Importance of Data: Connecting the Dots Between Healthy People 2020 and Affordable Care Act

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Importance of Data Connecting the Dots Between
Healthy People 2020 and Affordable Care Act

• USPHS Scientific Training Symposium
• New Orleans, LA
• June 21, 2011
• CDR Samuel Wu, Pharm.D.
• Senior Public Health Advisor
• Office of Special Health Affairs
• Office of Health Equity

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Objectives

• Describe what is Healthy People 2020
• Describe how data are the foundation in creating
  and supporting public health initiatives
• Describe how law is implemented through the
  process of review and feedback of various
  workgroups

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Healthy People
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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
• Objectives are organized within distinct Topic
  Areas

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History of Healthy People

• 1979ASH/SG Julius Richmond establishes first
  national prevention agenda Healthy People
  Surgeon Generals Report on Health Promotion and
  Disease Prevention
• HP 1990Promoting Health/Preventing Disease
  Objectives for the Nation
• HP 2000Healthy People 2000 National Health
  Promotion and Disease Prevention Objectives
• HP 2010Healthy People 2010 Objectives for
  Improving Health
• Healthy People 2020 Launched December 2010

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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 42
Objectives 226 312 467 gt 580
39 Topic areas with objectives
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Key Features of Healthy People

• Creates a comprehensive health promotion and
  disease strategic framework
• Tracks data-driven outcomes to monitor progress
• Engages a network of stakeholders at all levels
• Guides national research, program planning, and
  policy efforts to promote health and prevent
  disease
• Establishes accountability requiring all PHS
  grants to demonstrate support of Healthy People
  objectives

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Federally Led, Stakeholder-Driven
HHS Secretarys Advisory Committee
State Local Governments (50 state coordinators)
National-level Stakeholders, including members of
the Healthy People Consortium (2,200
organizations)
Community-Based Organizations, Community Health
Clinics, Social Service Organizations, etc.
Individuals, Families, Neighborhoods across
America
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Aligns Strategic Public HealthGoals and Efforts
Across the Nation
Non-Aligned Effort Random Acts of Innovation
Aligned Effort Strategic Goals
Healthy People
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How Stakeholders Use Healthy People

• Data tool for measuring program performance
• Framework for program planning development
• Goal setting and agenda building
• Teaching public health courses
• Benchmarks to compare national, state, and local
  data
• Way to develop nontraditional partnerships

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Healthy People 2020
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Healthy People 2020 Vision

• A society in which all people live long, healthy
  lives

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Healthy People 2020 Mission

• Identify nationwide health improvement priorities
• Increase public awareness and understanding of
  the determinants of health, disease, and
  disability, and the opportunities for progress
• Provide measurable objectives and goals that are
  applicable at the national, state, and local
  levels
• Engage multiple sectors to take actions to
  strengthen policies and improve practices that
  are driven by the best available evidence and
  knowledge
• Identify critical research, evaluation, and data
  collection needs

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Focus on Determinants of Health

• A renewed focus on identifying, measuring,
  tracking, and reducing health disparities through
  a determinants of health approach

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Health Disparity

• A particular type of health difference that is
  closely linked with social, economic, and/or
  environmental disadvantage. Health disparities
  adversely affect groups of people who have
  systematically experienced greater obstacles to
  health based on their racial or ethnic group
  religion socioeconomic status gender age
  mental health cognitive, sensory, or physical
  disability sexual orientation or gender
  identity geographic location or other
  characteristics historically linked to
  discrimination or exclusion.

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Healthy Equity

• Attainment of the highest level of health for all
  people. Achieving health equity requires valuing
  everyone equally with focused and ongoing
  societal efforts to address avoidable
  inequalities, historical and contemporary
  injustices, and the elimination of health and
  health care disparities.

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Whats New in Healthy People 2020

• New Topic Areas (13)
• Focus on determinants of health
• Web-based
• Data linked to the Health Indicators Warehouse

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Healthy People 2020 Topic Areas

• 1. Access to Health Services
• 2. Adolescent Health
• 3. Arthritis, Osteoporosis, and Chronic Back
  Conditions
• 4. Blood Disorders and Blood Safety
• 5. Cancer
• 6. Chronic Kidney Disease
• 7. Dementias, Including Alzheimers Disease

• 8. Diabetes
• 9. Disability and Health
• 10. Early and Middle Childhood
• 11. Educational and Community-Based Programs
• 12. Environmental Health
• 13. Family Planning
• 14. Food Safety

New for 2020
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Healthy People 2020 Topic Areas (continued)

• 15. Genomics
• 16. Global Health
• 17. Healthcare-Associated Infections
• 18. Health Communication and Health Information
  Technology
• 19. Health-Related Quality of Life
• 20. Hearing and Other Sensory or Communication
  Disorders

• 21. Heart Disease and Stroke
• 22. HIV
• 23. Immunization and Infectious Diseases
• 24. Injury and Violence Prevention
• 25. Lesbian, Gay, Bisexual and Transgender
  Health Issues
• 26. Maternal, Infant and Child Health
• 27. Medical Product Safety

New for 2020
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Healthy People 2020 Topic Areas (continued)

• 28. Mental Health and Mental Disorders
• 29. Nutrition and Weight Status
• 30. Occupational Safety and Health
• 31. Older Adults
• 32. Oral Health
• 33. Physical Activity
• 34. Preparedness

• 35. Public Health Infrastructure
• 36. Respiratory Diseases
• 37. Sexually Transmitted Diseases
• 38. Sleep Health
• 39. Social Determinants of Health
• 40. Substance Abuse
• 41. Tobacco Use
• 42. Vision

New for 2020
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New Topic Areas

• Adolescent Health
• Blood Disorders and Blood Safety
• Dementias, including Alzheimers Disease
• Early and Middle Childhood
• Genomics
• Global Health
• Healthcare-Associated Infections

• Health-Related Quality of Life and Well-Being
• Lesbian, Gay, Bisexual, and Transgender Health
• Older Adults
• Preparedness
• Sleep Health
• Social Determinants of Health

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About the Data
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Data Source

• A national census of events (like the National
  Vital Statistics System)
• Nationally representative sample surveys (like
  the National Health Interview Survey)

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Data Collection Instruments

• Surveys
• Federal
• National Health Interview Survey (NHIS)
• National Health and Nutrition Examination Survey
  (NHANES)
• National Survey on Family and Growth (NSFG)
• State
• Behavioral Risk Factor Surveillance System
  (BRFSS)
• Youth Risk Behavior Surveillance System (YRBSS)
• California Health Interview Survey (CHIS)

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Affordable Care Act
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Section 4302Understanding Health Disparities
Data Collection and Analysis
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Section 4302

• Calls for the Secretary to develop standards for
  uniform data collection on
• Race
• Ethnicity
• Sex
• Primary language
• Disability
• Empowers Secretary to require inclusion of
  additional demographic data on departmental
  surveys and health data collection activities
• To be implemented not later than 2 years after
  the enactment

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4302 Implementation Process

• ACA Prevention Implementation Workgroup
• Oversaw implementation of Section 4302
• ACA Prevention Implementation Section 4302
  Subgroup
• Charged with producing the recommendations
• HHS Data Council
• Proposed recommended data standards under the
  request of 4302 Subgroup
• Section 4302 Standards Workgroup
• Led the task of developing standards

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4302 Implementation Process (continued)

• Public listening sessions
• LGBT Public Engagement Listening Session
• Public Health/Academia Listening Session
• Minority Stakeholders Listening Sessions
• IOM Report
• Race, Ethnicity, and Language Data
  Standardization for Health Care Quality
  Improvement (2009)

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4302 Recommendations Report

• Draft report with OASH for submission to the
  Secretary
• Public comment
• Review of comments and revision of standards
• Implementation agenda
• Timeline
• Funding considerations

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Connecting the Dots

• Affordable Care Acts Section 4302 provides an
  opportunity to collect granular data on all
  federal surveys
• These data can be used to support additional or
  new measurable objectives in Healthy People 2020

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• Data alone cannot reduce disparities, but it can
  serve as a foundation to our efforts to
  understand the causes, design effective
  responses, and evaluate our progress.

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Questions?
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Acknowledgements

• Office of Disease Prevention and Health Promotion
• Office of Minority Health
• CAPT Magda Barini-Garcia, MD, MPH
• CAPT Deborah Willis-Fillinger, MD

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CDR Samuel Wu301-443-8687swu_at_hrsa.gov