1. – Is there a gap in reaching the grass-roots level? HEALTHY PEOPLE 2010 – Is there a gap in reaching the grass-roots level? William C. Andress, DrPH, CHES, Renee Laszczak, and Stafford C. Rorke, D.Phil., FACSM Wellness, Health Promotion, and Injury Prevention Program School of Health Sciences Oakland University Rochester, Michigan Presented at the134th annual meeting of the American Public Health Association

2. Abstract Students enrolled in an undergraduate course in community health in southeastern Michigan conducted interviews at discrete non- governmental social service, health, and fitness facilities to determine agency contribution in making healthier communities. Summative reports suggested that knowledge regarding Healthy People 2010 goals and objectives was inadequate at the grass roots community level. It was disturbing that less than a third of respondents (29.9%) affirmed awareness of the Healthy People 2010 publication. And, of those indicating familiarity, only slightly more than 50% (n=22 of 43) had ever read portions of it although the entire document is readily available on the Internet (www.healthypeople.gov). www.healthypeople.gov It was concluded that more aggressive efforts need to be put forth to educate local health agencies regarding the contents of Healthy People 2010.

3. Background 1977: Alma Atta, U.S.S.R – WHO initiative: “Health for All by the Year 2000” 1979: Surgeon General's Report on Health Promotion and Disease Prevention 1980: Promoting Health/Preventing Disease: Objectives for the Nation 1990: Healthy People 2000: National Health Promotion and Disease Prevention Objectives 2000: Healthy People 2010: Understanding and Improving Health

4. Document Overview Healthy People 2010 provides a framework for prevention for the Nation. It is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats. Healthy People 2010 provides a framework for prevention for the Nation. It is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats. http://healthypeople.gov/About /

5. Document Overview Goals: Goal 1: Increase Quality and Years of Healthy Life Goal 2: Eliminate Health Disparities Document: –28 Focus Areas –467 Objectives

6. Healthy People 2010 Focus Areas 1. Access to Quality Health Services 2. Arthritis, Osteoporosis, and Chronic Back Conditions 3. Cancer 4. Chronic Kidney Disease 5. Diabetes 6. Disability and Secondary Conditions 7. Educational and Community- based Programs 8. Environmental Health 9. Family Planning 10. Food Safety 11. Health Communication 12. Heart Disease and Stroke 13. HIV 14. Immunization and Infectious Disease 15. Injury and Violence Prevention 16. Maternal, Infant, and Child Health 17. Medical Product Safety 18. Mental Health and Mental Disorders 19. Occupational Safety and Health 20. Nutrition/Overweight 21. Oral Health 22. Physical Activity and Fitness 23. Public Health Infrastructure 24. Respiratory Disease 25. Sexually Transmitted Disease 26. Substance Abuse 27. Tobacco Use 28. Vision and Hearing

7. Declared Purpose Individuals, groups, and organizations are encouraged to integrate Healthy People 2010 into current programs, special events, publications, and meetings…Health care providers can encourage their patients to pursue healthier lifestyles and to participate in community-based programs. By selecting from among the national objectives, individuals and organizations can build an agenda for community health improvement and can monitor results over time. Individuals, groups, and organizations are encouraged to integrate Healthy People 2010 into current programs, special events, publications, and meetings…Health care providers can encourage their patients to pursue healthier lifestyles and to participate in community-based programs. By selecting from among the national objectives, individuals and organizations can build an agenda for community health improvement and can monitor results over time. http://healthypeople.gov/About/objused.htm

8. Research Methodology Descriptive study design Students taking an undergraduate course in community health education at Oakland University, Rochester, Michigan, interviewed 160 non-government health institutions regarding their knowledge of Healthy People 2010. Actual number analyzed were 144 due to some duplications of agencies and errors of interviewer reliability.

9. Sampling of Survey Questions Are you familiar with Healthy People 2010? Have you ever read parts of the document? Which are the major goals of Healthy People 2010? What focus areas can you name? Give two specific objectives that show how your organization is working towards the goals of Healthy People 2010.

10. Other Questions of Interest What activities do you have that target your own employee’s health? What percentage of Americans engage in the following activities? –Don’t smoke –Maintain a BMI below 25. –Exercise at least 30 min/day for at least 5x/week –Eat five servings of fruits/vegetables daily.

11. 29.9% 70.1% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% Percent Familiar with HP2010Unfamiliar with HP2010 Figure 1: Percentage Familiar with Healthy People(n=144)

12. 51.2% 48.8% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% Percent Familiar/Have read HP2010Familiar/Not read HP2010 Figure 2: Percentage of familiar with who have read Healthy People 2010 (n=43)

13. 11.1% 16.0% 72.9% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% Percent Figure 3: Ability to identify major Healthy People 2010 goals (n=144) Identified both goalsIdentified one goalUnable to identify goals

14. Figure 4: Knowledge of focus areas among those familiar with Healthy People 2010 (n=43) 51.2% 25.6% 14.0% 9.3% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% Percent Knew at least 3 focus areas Knew 1 or 2 focus areas Knew at least 3 focus areas with prompting Unfamiliar with focus areas 3

15. Figure 5: Awareness of specific focus area objectives (n=144) 7.6% 31.9% 60.4% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% Percent Aware of more than one objectiveAware of one objectiveUnaware of objectives

16. 38.2% 9.7% 52.1% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% Percent Figure 6: Provide Employee Health/Wellness Interventions (n=144) Provide wellness interventionsProvide minimal interventionsDo not provide interventions

17. Figure 7: Knowledge of percentage of Americans engaged in health promoting activities (n=144) 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% Percent Refrain from smokingMaintain BMI below 25 Exercise 30 minutes/day for 5 days/weekEat 5 servings of fruits/vegetables daily 43.4% 12.5% 57.6% 52.1%

18. 0.7% 20.1% 37.5% 26.4% 15.3% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% Percent Figure 8: Percentage with correct knowledge of Americans engaged in health promoting activities (n=144) 4 correct3 correct2 correct1 correct0 correct

19. Conclusions Among the organizations surveyed, there appears to be a regional disconnect between the U.S. Department of Health and Human Services and community based health agencies. Despite a history of more than 25 years, among agencies surveyed in this study, there appears to be lack of awareness of Healthy People 2010 goals and objectives This suggests lack of rigorous implementation of the Healthy People 2010 objectives at the local level. Our findings may suggest a reason why, among various ethnic, cultural, age, and gender groups, there are 100 areas in which the disparities are greater than 25%.

20. Recommendations 1. The Department of Health and Human Services may wish to determine whether these regional findings apply nationwide. 2. If a nationwide trend exists, The Department of Health and Human Services, together with the Centers for Disease Control, would need to more aggressively promote Healthy People at the local level. 3. University and college community health education courses can, and should be, used as a vehicle to heighten Healthy People awareness within local health agencies. 4. State and county departments of health should produce 10-year plans that parallel Healthy People 2010 and encourage all health agencies within their jurisdiction to work towards common goals. 5. Federal funding incentives should be given to states to encourage more aggressive and successful implementation strategies. 6. As public health professionals, each should be committed to collaborating with local agencies to ensure successful implementation of Healthy People 2010 goals and objectives.