HEALTHY PEOPLE 2010

The Healthy People initiative was started in 1979 in the United States Department of Health and Human Services (HHS) by Dr. Julius Richmond, who was the Surgeon General and Assistant Secretary for Health. He released a Surgeon General's Report called Healthy People, which laid the groundwork for Healthy People 1990. It was followed by the second decade-long Healthy People plan, Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Healthy People 2010 is the third set of national health objectives. It was released on January 25, 2000, under the leadership of HHS Secretary Donna Shalala and the Assistant Secretary for Health and Surgeon General, David Satcher.

Building on initiatives pursued over the past two decades, Healthy People 2010 contains two major goals: 28 focus areas, or chapters; and 467 broad-reaching national health objectives for the first decade of the millennium. These objectives and goals will serve as the basis for the development of state and community plans.

The first major goal is to increase the years and quality of healthy life. This goal was developed in response to America's rapidly aging population— during the twentieth century, Americans gained thirty years of life expectancy. In 1900, life expectancy in the United States was about 47 years of age; in 2000, it was 77, and rising. As of 2000, there were 35 million Americans over 65 years of age; and those over 85 constituted the fastest growing age group in the nation. That's why this first goal focuses on increasing quality as well as years of life, paying careful attention to such areas as Alzheimer's disease, arthritis, osteoporosis, the management of chronic pain, and the aggressive diagnosis and treatment of depression of the elderly.

The second major goal is to eliminate disparities in health among different racial and ethnic groups. This goal was issued in response to the nation's rapidly increasing population diversity, with an eye toward imminent increasing demands on the health care system if the current disparities are not addressed. Eliminating disparities is not a zero-sum game; all groups benefit when the needs of the most vulnerable are met.

President Bill Clinton's Race Initiative, which he announced in June 1997, set the stage for this goal. Responding to the president's call that each Cabinet head support the Race Initiative, the Department of Health and Human Services developed the Race and Health Initiative, which was later incorporated into Healthy People 2010, becoming one of its two major goals.

In many ways, Americans of all ages and in every race and ethnic group have better health today than ever before—due to tremendous advances in medical research and technology, and in health care. But not all groups share theses benefits equally, and considerable disparities remain. In many areas, minorities are lagging behind their white counterparts. For example, in the area of infant mortality, a baby born to an African-American mother has more than twice the risk of dying during the first year of life than a white American baby. Vietnamese women living in this country experience cervical cancer at five times the rate of white women; Hispanic women over age sixty-five have twice the risk. Asian Americans are three to five times more likely to die from liver cancer. Heart disease strikes African-American men at a rate 25 percent higher than whites; and African-American women are 40 percent more likely to die from heart disease than white women. American Indians suffer from diabetes at nearly three times the average rate; for Hispanics, the rate is nearly double that of whites. African Americans have a rate of diabetes that is 70 percent higher than whites and the highest death rate of any group. When it was first identified in this country in 1981, HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) was predominantly a disease among white gay men. However, it has become increasingly a disease of people of color, of women, and of the young. No racial or ethnic group is doing well when it comes to immunizations for older people. Only 67 percent of older white persons, 58 percent of elderly Hispanics, and 50 percent of African-American senior citizens reported getting a vaccination against influenza, and the numbers are even more grim for the pneumococcal vaccine.

LEADING HEALTH INDICATORS

Healthy People 2010 is the first Healthy People plan to include ten Leading Health Indicators, which will be used in a manner similar to that of the leading economic indicators—they will serve as the mechanism for monitoring national progress to see how well the country is doing in meeting its goals and objectives.

Five of the ten indicators focus on lifestyle: tobacco use, overweight and obesity, physical activity, substance abuse (especially alcohol), and responsible sexual behavior. These are included in a specially developed Surgeon General's Prescription for Healthy Living, which was designed to help communicate important health messages.

Physical Activity. When coupled with dietary factors, physical inactivity is the second leading cause of preventable deaths in the United States, resulting in over 300,000 deaths each year. The Surgeon General's Prescription recommends "moderate physical activity at least 5 days a week/30 minutes a day."

Overweight and Obesity. This problem, which results mainly from physical inactivity and poor nutrition, has reached epidemic proportions in both children and adults, especially among African-American and Hispanic women. Even Type 2 diabetes (also called adult-onset diabetes) is showing up in children. The American diet is loaded with fats and sugars, and is deficient in fruit, vegetables, and grains. The Surgeon General's Prescription recommends "eating at least five servings of fruits and vegetables a day."

Tobacco Use and Substance Abuse. Tobacco is the leading cause of preventable death in the United States. Three thousand young people become new smokers every day, and half of them will die prematurely from some tobacco-related illness. Substance abuse—involving illicit drugs and alcohol—is a major public health problem. The leading drug of choice among young people is alcohol. The Surgeon General's Prescription recommends "avoiding toxins—including tobacco, illicit drugs, and abuse of alcohol."

Responsible Sexual Behavior. This means protecting oneself and others against sexually transmitted diseases (including HIV) and unwanted pregnancy when sexually active, and promoting abstinence, where appropriate. It also means understanding that relationships should not begin with sex, but with mutual respect, commitment, communication, and understanding.

The other five Leading Health Indicators are: mental health, injury and violence, environmental quality, immunization, and access to health care.

Mental Health. America's understanding of mental health has evolved significantly over the last twenty-five years, as reported in the landmark Surgeon General's Report on Mental Health (1999). One in five Americans suffers from some sort of mental disorder each year, but because of the stigma and shame, fewer than half seek care. Increased efforts are underway to gain parity of access to mental health services, to erase the stigma associated with mental illness, and to broaden awareness that many mental illnesses come from physical causes in that they result from changes in chemical secretions in the brain, making them treatable by medication.

Immunizations. Children's immunizations have expanded markedly in recent years, but there is still work to be done. The nation has yet to achieve rates that are acceptable in adult immunizations, even among the majority population. For African Americans and Hispanics, the need is even greater.

Violence and Injury Prevention. Homicides, suicides, and vehicle crashes are serious public health challenges, and they are often associated with substance abuse. A Surgeon General's Report on Youth Violence Prevention, presented at the twenty-first annual Health Reporting Conference in San Diego, California, in April 2001, addressed the violence issue in this country.

Environmental Quality. An estimated 25 percent of preventable illnesses worldwide can be attributed to environmental factors, including air, water, soil, and exposure to toxins. While African Americans and Hispanics make up only 25 percent of the U.S. population, they comprise 40 percent of the people who live near hazardous waste sites. That puts children of color at an increased risk for asthma, lead poisoning, and other illnesses.

Access to Health Care. Almost 43 million Americans were uninsured in 2000. Minorities are more likely to be uninsured and underinsured, and therefore less likely to receive regular or quality health care (including oral health care) and less likely to receive screenings for early detection of disease. They are also less likely to receive quality care management. Health care services must ensure that cost, quality, and accessibility do not serve as barriers to care. Also critical are surrounding issues such as socioeconomic status, education, income, and housing. Since minorities are also more likely to be underrepresented in the health professions, the nation must ensure that a diverse pool of culturally competent physicians is available.

The answer to America's health problems lies in a balanced health system—a system that balances health promotion, disease prevention, early detection, and universal access to care. Well over 90 percent of America's health care budget is spent on treating diseases, many of them in their late stages, because of the very small investment in primary prevention—less than 2 percent of America's $1.3 trillion health budget is spent on population-based prevention.

The health of the nation has improved considerably since the first Healthy People initiative was launched in 1980. But many challenges remain, forming the foundation of Healthy People 2010. Improving the health of the nation is a long-term investment requiring participation from all sectors, including citizens, states and communities, leaders, professional organizations, and nonprofit, voluntary groups. Through partnerships, the first ten years of the new millennium can go down in history as the time when health disparities became a public health issue of the past and the quality of life for all Americans was significantly enhanced.

David Satcher

(see also: Ethnicity and Health; Health Goals; Healthy Communities; Inequalities in Health; Surgeon General; United States Department of Health and Human Services [USDHHS] )