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

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

Healthy People

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

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

Target Year 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 * # Objectives > 580 Evolution of Healthy People *39 Topic areas with objectives

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

State & Local Governments (50 state coordinators) Community-Based Organizations, Community Health Clinics, Social Service Organizations, etc. National-level Stakeholders, including members of the Healthy People Consortium (2,200+ organizations) Federal Interagency Workgroup (28 federal agencies) Federally Led, Stakeholder-Driven Individuals, Families, & Neighborhoods across America HHS Secretary’s Advisory Committee

Aligns Strategic Public Health Goals and Efforts Across the Nation Healthy People Non-Aligned Effort Random Acts of Innovation Aligned Effort Strategic Goals

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

Healthy People 2020

Healthy People 2020 Vision A society in which all people live long, healthy lives

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

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

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.

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.

What’s New in Healthy People 2020 New Topic Areas (13) Focus on determinants of health Web-based Data linked to the Health Indicators Warehouse

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 Alzheimer’s 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

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

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

New Topic Areas Adolescent Health Blood Disorders and Blood Safety Dementias, including Alzheimer’s 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

About the Data…

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

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)

Affordable Care Act

Section 4302 Understanding Health Disparities: Data Collection and Analysis

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

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

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)

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

Connecting the Dots Affordable Care Act’s 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

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.

Questions?

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

CDR Samuel Wu