1. Healthy People 2020: Implications for Research, Academics, Policy, and Service
Eva Moya, PhD, LMSW
Assistant Professor, Department of Social Work
Healthy People 2020 Task Force Chair
The University of Texas at El Paso

2. What is Healthy People?
A National agenda that communicates a vision for improving the population’s health and achieving health equity.
A set of specific, measurable objectives with targets to be achieved by the year These objectives are organized within distinct topic areas.

3. A National Set of Health Objectives
Creates a comprehensive, strategic framework.
Requires tracking of data-driven outcomes.
Engages a network of stakeholders.
Guides national research, program planning, and policy efforts.
Establishes accountability.

4. 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/ Measures
226/NA
312/NA
467/1,000
>580/1200
For 3 decades, Healthy People has provided a comprehensive set of national 10-year objectives that have served as a framework for public health activities at all levels and across the public health community. Healthy People has evolved as the Nation’s public health priorities have changed.
The number of objectives has increased with each decade. Healthy People 1990 set forth 226 objectives, Healthy People 2000 included 312 objectives, Healthy People 2010 identified 467 objectives with 1,000 measures, and Healthy People 2020 has nearly 600 objectives with 1,200 measures.
39* With objectives

5. Healthy People 2020 Development, Framework, Topic Areas, and Objectives
Moving on to the development of HP2020…

7. Stakeholder Input
Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020
Public Meetings
Public Comment
Web Site
Healthy People
Consortium
Federal Interagency
Workgroup (FIW)
In addition to the Advisory Committee, public input was sought during a series of 9 regional meetings that were held across the country in 2008 and Throughout the development process, input was solicited through formal public comment periods.
Within the Federal government, the Federal Interagency Workgroup (FIW) was charged with drafting the initial framework and objectives. This workgroup included representatives from across HHS as well as from other Federal agencies.

8. 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 stakeholders 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.
Through the highly collaborative process, Healthy People 2020’s mission, goals, and framework were developed. Here you see the Mission.

9. This graphic visually depicts the ecological and determinants approach that Healthy People 2020 takes in framing the national health objectives. The concept of determinants describes how the conditions in which we live and work, such our physical and social environments and access to health services, as well as our individual behavior and biology, can have an enormous impact on our health.
The graphic framework attempts to illustrate the fundamental degree of overlap among the determinants of health, as well as emphasize their collective impact and influence on health outcomes and conditions. The framework also underscores a continued focus on population disparities, including those categorized by race/ethnicity, socioeconomic status, gender, age, disability status, sexual orientation, and geographic location.

10. Why are the determinants of health important?
The rationale for focusing on determinants includes:
The need to move beyond controlling disease to address factors that are root causes of disease;
The importance of achieving health equity; and
Practical considerations related to national prosperity and security.
Achieving health requires more than just controlling disease. It requires us to assure conditions in which people can be healthy. Health results from the choices that people are able to make in response to the options that they have. Conditions in the social and physical environments determine the range of options that are available, their attractiveness, and their relative ease or difficulty of use.
Extensive evidence points to ways that environmental factors influence health.
A close examination of the underlying causes of specific diseases reveals many of the same factors are at play and, over time, can result in physiologic changes that exacerbate chronic disease. Therefore, focusing on these common underlying determinants has the potential to impact many different health and disease outcomes. Because the effects of determinants begin to take hold well before disease processes appear on the clinical horizons, addressing these factors can offer an opportunity to prevent or delay the development of disease.

11. Multi-Sectoral Efforts are Needed
Health is created through the conditions of our daily lives
The commitment of all is needed:
To implement evidence-based strategies to improve health, and
To build the evidence base for such strategies.
For three decades, the Healthy People initiative has led efforts to educate the nation that health is about more than the absence of disease, and is created through the conditions of our daily lives—not at the doctor’s office. Healthy People has long provided a vehicle for channeling diverse and distinct disease prevention and health promotion efforts throughout the U.S. toward the common goal of improving the nation’s health. It has offered an undergirding structure for tracking and monitoring health and disease, and has sought to inspire action by setting science-based targets for progress.
As we begin a new decade, Healthy People 2020 re-energizes this long-standing vision, infusing it with a new focus on creating a society in which all people live long and healthy lives. Yet this vision cannot become reality without the active and deep engagement of many sectors of our society.
Healthy People 2020 can be used as a tool to convene partners from across sectors—including housing, urban planning, education, transportation, and the environment— to improve the health of the nation.
Indeed, examples of the type of multi-sectoral efforts needed to accomplish the goals of Healthy People and improve the health of the nation, are already occurring. An important example is the National Prevention Council, whose members include the Secretaries of the Departments of Agriculture, Education, Transportation, the FTC, the Environmental Protection Agency, the Department of Homeland Security, and others.

12. Social determinants of health: A new area of focus for HP2020
A video on Social Determinants of Health is viewable on the Healthy People 2020 website at:
A new topic area narrative explaining social determinants of health is available on the Healthy People 2020 website.
New objectives addressing social determinants of health are under development for Healthy People 2020.
The goals and objectives of Healthy People 2020 are intended to be aspirational, yet achievable. Translating noble aspirations into tangible progress will require the commitment of all to implementing evidence-based strategies to improve health, and to build the evidence base for such actions where it does not currently exist. A key focus of these efforts must be on addressing the social and physical environmental factors that affect population health.

13. New Healthy People 2020 Topic Areas
Life Stages
Adolescent Health
Early and Middle Childhood
Older Adults
Blood Disorders and Blood Safety
Dementias, including Alzheimer’s Disease
Genomics
Global Health
Healthcare-Associated Infections
Preparedness
Sleep Health
In Development
Lesbian, Gay, Bisexual, and Transgender Health
Health-Related Quality of Life and Well-being
Social Determinants of Health
Here are the Topic Areas that are new in 2020, including Adolescent Health, Early & Middle Childhood, Older Adults… (read list from slide)
Three new topics areas are in development – meaning they do not yet have objectives. Subject-matter-expert workgroups are in process of developing those currently.

14. Healthy People 2020 Objectives
Represent quantitative values to be achieved over the decade.
Organized within the Topic Areas.
Managed by lead Federal agencies.
Supported by scientific evidence.
Address population disparities.
Data driven and prevention oriented.
The Healthy People 2020 proposed objectives were made available online for public comment in the fall of 2009 on the Healthy People Web site. Each individual comment was then reviewed and discussed before the Federal Interagency Workgroup (FIW).

15. Leading Health Indicators
Small set of health issues that are recognized a major influences on the public’s health
Linked to specific Healthy People 2020 objectives
Represent major determinants of health across the life stages
Used to assess the health of the Nation, facilitate collaboration across sectors, and motivate action at the national, State, and community levels to improve the health of the U.S. population
As part of the Healthy People 2020 implementation process, a smaller set of Healthy People 2020 objectives, called Leading Health Indicators, have been selected to communicate high-priority health issues and actions that can be taken to address them. The indicators will be used to assess the health of the Nation, facilitate collaboration across sectors, and motivate action at the national, State, and community levels to improve the health of the U.S. population.
These indicators were selected through a collaborative process which included public input through the IOM and Secretary’s Advisory Committee, and federal input through the FIW.

16. Leading Health Indicator Topics
Access to Health Services
Clinical Preventive Services
Environmental Quality
Injury and Violence
Maternal, Infant, and Child Health
Mental Health
Nutrition, Physical Activity, and Obesity
Oral Health
Reproductive and Sexual Health
Social Determinants
Substance Abuse
Tobacco
Here are the 12 Leading Health Indicator Topics.
Each topic is supported by up to four specific indicators, selected from among the Healthy People 2020 objectives.

17. Redesigned Web Site: www.healthypeople.gov
The Healthy People 2020 redesigned Web site was launched in December 2010.

18. Texas’ rankings: view to the future (Nohlan, E. 2011)
Outcomes
13th cancer deaths
17th infant mortality
______________
27th high blood pressure
28th poor mental health days
28th premature death
30th cardiovascular deaths
34th diabetes
36th poor physical health days
36th preventable hospitalizations
37th health status
46th infectious disease
Interventions
17th smoking
22nd binge drinking
22nd diet, fruit and vegetable
________________
34th occupational fatalities
36th violent crime
37th immunizations
39th public health funding
42nd primary care physicians
45th annual dental visit
46th high cholesterol/checks
48th teen birth rate
50th health insurance coverage
50th early prenatal care
Investments
20th unemployment
_________________
32nd air pollution
35th high school graduation
43rd income disparity
45th child poverty

19. The Challenges Low rankings
Recent cuts to health and human services, education
Near term: shrinking pie for health services and social determinants of health; unclear pathway toward increasing insurance coverage; some opportunity within interim charges
Longer term: need to grow the pie, especially in terms of investment in health care and social determinants of health
Low rankings on many indicators related to health outcomes, access to care, and key social determinants of health
Recent significant cuts to health and human services; cuts to education
Near term: preservation of some women’s health services but likely at the expense of other health and human services; further cuts to health and human services; unclear pathway toward universal access to care; some attention to priority health issues in interim charges
Longer term: major increasing burdens of Medicaid on state budget, likely at expense of other health and human services and educati

20. Policy Imperatives
Policy focus on health (not just health care)
Strengthen primary prevention and changing social norms
Move toward determinants of health and cross-sector investments and accountability
Reduce policy conflicts
Reduce use of “trading” funding between health-related budgets as a policy solution for funding shortfalls
Lessen politicization of health issues
Strengthen expectations and use of evidence-based policy
Focus on health not just health care
Strengthen primary prevention and changing social norms through institutional and policy supports, e.g. smoking bans, increased provision of healthy foods at the workplace and in schools, etc.
Move toward determinants of health and cross-sector investments and accountability
Reduce policy conflicts (Historic: tobacco subsidies; contemporary: sugar subsidies)
Reduce externalization of health harms produced by businesses and policies (Internalizing costs due to on-the-job injuries; consumer safety/protections; pollution)
Recognize and highlight the limited effectiveness of trading funding between health, human services, and key social determinants of health
Lessen politicization of health issues
Strengthen expectations and use of evidence-based policy

21. Tool: The Spectrum of Prevention
Prevention Institute (Cohen, L. 2011)
multiple levels of intervention
action beyond teaching healthy behaviors
leverages actions
has been used to address traffic safety, violence prevention, injury prevention, nutrition, fitness, etc.
Prevention Institute
identifies multiple levels of intervention and encourages action beyond teaching healthy behaviors
produces a synergy that results in greater effectiveness than would be possible by implementing any single activity
has been used nationally in prevention on traffic safety, violence prevention, injury prevention, nutrition, and fitness

22. Workforce Development
Researchers: policy-relevant research; knowledge translation, communication skills
Public health workers: Social Determinants of Health (SDH) into programming; primary prevention and norms change
Policy makers: health research literacy
Health care professionals: health systems, health care financing, SDH, policy processes, leadership skills
Administrative and other leadership: joint goal setting and budgeting
Students: SDH impact and interventions; planning strategies; health impact assessments; new management structures; cross training with other sectors
Training needs:
Researchers: development of policy-relevant research; knowledge translation and communication skills
Public health workers: incorporating social determinants into programming; methods for strengthening primary prevention and norms change
Policy makers: increased understanding of health research
Physicians: stronger understanding of health system issues, health care financing, social determinants of health, policy processes, leadership skills, etc.
Administrative and other leadership: training in joint goal setting and budgeting
Students: evidence on SDH impact and interventions; planning strategies; use of health Impact assessments; use of new management structures; cross training with other sectors

23. Strategic alignment for health
Strategically align with others to support research, policy and planning to achieve health goals
Strengthen and expand health-related coalitions
Agree on priority health issues, goals, interventions, investments
Identify policy entry points and funding
Coordinate research, change strategies, funding, and communication
Engage strategic research, and strengthen education and skills development
Leverage resources, relationships and skills
There is lots of work happening across the state, but it is not aligned. Given the challenges in relation to resources as well as public understanding and political will, we will not be successful in protecting the health of our state if we don’t strengthen coordination for policy change and action.
Strengthen and expand health-related coalitions: public/private; researchers, front-line workers, policymakers and planners; donors
Agree on priority health issues, policy and intervention goals, intervention needs, and areas for investment
Identify policy entry points and appropriate funding mechanisms to support change processes
Coordinate research, change strategies, funding streams, and communication platforms and processes. E.g. in terms of research, we need HIAs on non-health policies, comparative effectiveness studies related to policies and proposed interventions, and health return on investment analyses (e.g. business and eco development funds: are they contributing to creation of middle class jobs, which would benefit health significantly, or to low and high wage jobs, which only increase social inequities and worsen health inequities, population health, and set us further behind in achieving HP2020 goals).
Engage strategic Research aimed at answering decisionmakers’ questions, support engagement of researchers in communicating findings for policymakers, and strengthen education and skills development to move research to policy to practice
Leverage resources, relationships and skills including academia, civil society and the private sector: e.g. to convene for communication and joint planning, Align research priorities and skills with needs, support training of future managers, develop cross-sector inter-institutional funding proposals

24. Examples of Healthy People 2020 in Instruction, Research, and Service
University of Texas at El Paso Healthy People College of Health Sciences Task Force
Community Academic Partnerships for Health Research in El Paso
Nuestra Casa Exhibit: Health Equity.
Workshops and capacity building

25. Our Story March 2011 Formed the Healthy People 2020 Task Force
12 UTEP faculty representing 12 departments and programs
2 community partners
Administration guidance and direction
Connie

26. Our Values Healthy People 2020 Equity Accountability
Community Engagement
Interdisciplinarity
Equity

27. Our Story March-August 2011 January 2012-May 2012
Identified research within HP topics (Matrix)
Developed recommendations and presented to faculty
Introduced HP to Community and Academic Partnerships for Health Sciences Research (CAPHSR)
January 2012-May 2012
Incorporating HP topics and objective into curriculum and research

28. Healthy People 2020 Our Vision
 Healthy people in healthy border communities
Our Mission
 As members of the academic community our mission is to achieve and maintain optimal health and well being for all people in El Paso, Texas. We do this by working in partnership with communities to conduct and translate research, instruct students, promote healthy behaviors and environments, prevent illness and injury, protect against disease and health threats, eliminate health inequities and advocate for social and environmental justice.
Moya, Eva 2005 28

29. Healthy People 2020
Incorporate HP 2020 in UTEP College of Health Sciences and School of Nursing strategic plan updates through research, academia, service and policy. Reaffirm a priority to prevention, population health and interdisciplinary learning by motivating students and faculty to consider the social and physical determinants of health in all aspects of their work through the generation of interdisciplinary opportunities;
Engage community organizations, partners and public agencies in research, curriculum and service based on Healthy People 2020 through participation in the Community and Academic Partnerships for Health and Sciences Research (CAPHSR); and
Align faculty and students’ research, proposal requests and announcements with Healthy People objectives for faculty and students to implement effective population-level and policy solutions

30. Instruction
Educate the next generation of professionals on the social and environmental determinants of health and to foster a commitment to prevention and service learning
Identify experiential learning opportunities outside of the classroom while promoting critical and creative thinking, intercultural competence, ethical reasoning and action and team work

31. Research Create the next generation of health science scholars
Integrate HP 2020 in research, grant writing, research projects (including affinity groups, thesis and dissertations), community-based research, and dissemination (professional publication and dissemination opportunities).

32. Service
Motivate a new generation of community- minded health professionals
Develop Healthy People 2020 community resource guides to inform community members, providers, and professionals of community resources based on HP topic areas (e.g., HIV/AIDS, Child Health, Substance Abuse) in partnership with the Community and Academic Partnerships for Health and Sciences Research (CAPHSR) membership

33. Policy Equip a new generation of health policy advocates
Provide a healthy environment within the College of Health Sciences that embodies healthy foods, activities, and living.

34. Community and Academic Partnership Alignment with HP 2020
CAPHSR - Community and Academic Partnership for Health Science Research
Conducted Healthy People workshop in April 2011
11 participants - primarily from community
Began to align five focus areas in partnership with Healthy People 2020 objectives
In December 2011, College launched a mini-grant initiative that included requirements to align with HP 2020
March-December 2012, Grantees launch their projects

35. Ways To Connect With Healthy People
Spread the word about 2020 objectives.
Follow Healthy People on
Connect with Healthy People on LinkedIn.
Join the Healthy People listserv.
Join the Healthy People Consortium.
Sign up for updates at the website.
The strength of Healthy People is in the continued engagement and collaboration of the initiatives important stakeholders. So, please help out and spread the word about Healthy People 2020.
Follow Healthy People on
Connect with Healthy People on LinkedIn or get more information on YouTube.
Or course we hope that you will join the Healthy People listserv and the Healthy People Consortium.
Of course, please visit for up-to-date information and announcements.
You can us at
And, you can sign up for updates at healthypeople.gov. The link is in the upper right hand corner of every webpage.

36. Healthy People 2020: In Summary
Web-based interactive resource to expand reach and usability (
Dynamic system to accommodate changing health needs and priorities
“Who’s Leading the Leading Health Indicators?” monthly series
National Health Promotion Summit will be held April , 2012, in Washington, DC.
Finally, in addition to reminding you about our Leading Health Indicator monthly series, I want to let you know about the 2012 National Health Promotion Summit, which will be held April 10-11, 2012, at the Omni Shoreham Hotel in Washington, D.C. It will highlight the vast number of disease prevention and health promotion efforts that are working to improve the health of all Americans. This is not just a Healthy People summit – a variety of national initiatives will be discussed such as the National Prevention Strategy, Let’s Move, the National Partnership for Action to End Health Disparities, and the National HIV/AIDS Strategy, to name just a few.
Its underlying theme is collaboration and alignment of the various initiatives for which Healthy People 2020 serves as a foundation. Presentations will feature programs executed by various sectors that reflect a wide array of pressing national and global health issues.
Confirmed speakers include our Secretary, Kathleen Sebelius, and our Surgeon General, Dr. Regina Benjamin along with many other notable figures.
The link for registration is listed at the bottom of this slide.

37. Nuestra Casa Initiative

38. Inform | Inspire

39. Health Information Links for El Paso County
UTEP Center for Interdisciplinary Health Research and Evaluation (CIHRE)
_city_of_el_paso.php
El Paso City Government - A Snapshot in Time: Selected Health Measures for El Paso, TX 2011
hot%20in%20Time%20%20Selected%20Health%20Measures %20for%20El%20Paso,%20TX%20-% pdf
Texas Department of State Health Services. Healthy Border

40. Health Information Links for El Paso County - Continued
Kaiser Family Foundation. Statehealthfacts.org, (2008). Texas: Number of Deaths due to HIV Disease, =526&cat=11&rgn=45&cmprgn=1
Robert Wood Johnson Foundation. Childhood Obesity Report.

41. Health Information Links for Ciudad Juárez and Chihuahua
UTEP Center for Interdisciplinary Health Research and Evaluation (CIHRE)
d_county_demographics.php
mographics.php

42. Health Information Links: Doña Ana County and New Mexico
UTEP Center for Interdisciplinary Health Research and Evaluation (CIHRE)
mographical_data.php

43. Questions, comments?
Gracias
Thank you