Phase II:

Voting on Outstanding Products &

Deciding on Future Activities of the Committee

Secretary’s Advisory Committee on

National Health Promotion &

Disease Prevention Objectives for 2020

Committee Chair: Jonathan Fielding, MD, MPH, MA, MBA

Director, Los Angeles County Department of Public Health

& Health Officer, Los Angeles County

July 26, 2010

Desired Outcomes for the Meeting

Obtain an update from HHS on the timeline for development

of Healthy People 2020

Learn about the HHS Community Health Data Initiative

Discuss and vote on outstanding Subcommittee products

Discuss the future work of the Committee

2

Healthy People 2020 Update

RADM Penelope Slade-Sawyer

Office of Disease Prevention and Health Promotion

US Department of Health and Human Services

Secretary’s Advisory Committee

July 26, 2010

Update on HHS Activities

Status of Healthy People 2020

Objectives

Timeline and Launch

Leading Health Indicators

Implementation Activities — 5th Annual Meeting for Healthy People State

and Territorial Coordinators

— State and CBO Awards

— National Meeting in 2012

HHS Community Health Data Initiative

Todd Parks,

Chief Technology Officer

U.S. Department of Health and Human Services

[See separate slides]

5

Discussion and Voting on

Outstanding Subcommittee Products

Jonathan Fielding, Committee Chair

Subcommittee on

Action Steps and Evidence

Jonathan Fielding, MD, MPH, MA, MBA Subcommittee Co-Chair

Los Angeles County Department of Public Health

Steven Teutsch, MD, MPHSubcommittee Co-Chair

Los Angeles County Department of Public Health

Subcommittee on ASE:Two documents to be reviewed

Recommendations of the Subcommittee on

Action Steps and Evidence

Report on Evidence-based Clinical and Public

Health: Generating and Applying the Evidence

8

Subcommittee on ASE: Charge

How can HHS best show HP 2020 stakeholders

how to use the exhaustive list of objectives?

How can HHS maximize adoption and use of

HP2020?

What processes can HHS use to ensure that

action steps included in HP 2020 are grounded

in solid scientific evidence?

9

Subcommittee on ASE:History of this group’s efforts

Ad Hoc group met once, in June 2009, to

provide input into an earlier draft of the report.

Subcommittee met four times between

2/26/2010 and 5/25/2010 to respond to the

Subcommittee’s charge.

10

Ad Hoc Group on ASE: June, 2009 Members

Russ Glasgow, PhD, Kaiser Permanente

J. Michael McGinnis, MD, MPP,

Institute of Medicine

Ned Calonge, MD, MPH,

Colorado Department of Public Health and

Environment

Tracy Orleans, PhD,

Robert Wood Johnson Foundation

11

Subcommittee on ASE: March 2010 Members

Alice Ammerman, DrPH, UNC Chapel Hill

Ross Brownson, PhD, Washington University

Martin Fenstersheib, MD, MPH, Santa Clara County

David Fleming, MD, Seattle King County

George Isham, MD, MS, HealthPartners, Inc.

Lynn Silver, MD, MPH,

NYC Department of Health & Mental Hygiene

12

Prioritizing Evidence-based Actions

For all objectives, implement interventions that have clear evidence of effectiveness whenever it is available.

If this level of evidence is not available, consider whether intervening against this objective, versus other objectives that have interventions with clear evidence of effectiveness, is the best use of scarce resources.

If objectives must be addressed due to disease/ injury burden and or trends, use best available evidence based on table on the next slide.

If using interventions that lack clear evidence of effectiveness, evaluate carefully to add to the science base.

Interventions should be adapted to the specific context in which they will take place.

14

Typology for classifying interventions

by levels of scientific evidence

Category How Established Considerations for Level of

Scientific Evidence

Data Source Examples

Proven Peer review via

systematic or narrative

review

Based on study design and execution

External validity

Potential side benefits or harms

Costs and cost-effectiveness

Community Guide

Cochrane reviews

Narrative reviews based on

published literature

Likely

Effective

Peer Review Based on study design and execution

External validity

Potential side benefits or harms

Costs and cost-effectiveness

Articles in the scientific literature

Research-tested intervention

programs (123)

Technical reports with peer review

Promising Written program

evaluation without

formal peer review

Summative evidence of effectiveness

Formative evaluation data

Theory-consistent, plausible, potentially

high-reach, low-cost, replicable

State or federal government

reports

(without peer review)

Conference presentations

Emerging Ongoing work, practice-

based summaries, or

evaluation works in

progress

Formative evaluation data

Theory-consistent, plausible, potentially

high-reaching, low-cost, replicable

Face validity

Evaluability assessments*

Pilot studies

NIH CRISP database

Projects funded by health

foundations

Recommendations of the

Subcommittee on Action Steps & Evidence

Discussion

Changes needed?

Final Vote

15

Report on Evidence-based Clinical and

Public Health: Generating and Applying the Evidence

Discussion

Changes needed?

Final Vote

16

Recommendations of the

Subcommittee on Implementation

Adewale Troutman, MD, MPHLouisville Metropolitan Dept. of Public Health and Wellness

Eva Moya, LMSW, PhDProject Concern International

Subcommittee on Implementation

Charge to the Subcommittee:• How do we move from framework recommendations

to action?

• What are users’ needs for tools, aids, and guidance?

• What are the incentives for user groups? What

examples can be put in place for implementation?

• How can we ensure accountability?

18

Subcommittee on Implementation:History of this group’s efforts

Subcommittee held 5 meetings between

3/2/09 and 6/26/09• Recommendations for immediate and longer-term

actions for effective implementation were presented in

July, and again in September, 2009.

—Ideas were explored for ways that the recommendations

could be enhanced or reorganized, but the document did not

come up for vote again at subsequent meetings.

—A vote is needed so that the document can be put forward to

the Secretary.

19

Immediate Recommendations for

Implementing Healthy People 2020

20

Summary of Immediate Recommendations

1. Make the proposed interactive Web site a major priority for resources

2. Foster continuity of HP actions and build on current activities strengths

3. Jump-start and support innovation, and recognize excellence

4. Provide leadership regarding program planning and prioritization

5. Assess and meet technical assistance needs

6. Facilitate evaluation

Longer-Term Recommendations

21

Summary of Longer-Term Recommendations

1. Provide more detail about how to implement HP at the state and local levels (toolkit)

2. Identify and disseminate models of excellence

3. Ensure an accountability infrastructure is in place at all levels of government,

including Federal

4. Create a clear, empowered role for the Healthy People State Coordinators

5. Present a self-assessment and planning tool on the Website to help users at the local

and state levels bridge their current programmatic activities to HP2020

6. Leverage resources through partnerships and networks

7. Make participation in the Healthy People consortium significant and meaningful

8. Engage business (esp. business-led coalitions already working with public health) in

educating stakeholders and providing support for the use of Healthy People

9. Ensure that HP is incorporated into the strategic plans of other Federal agencies

10. Use a Health in All Policies approach to map social determinants to health outcomes

Recommendations of the

Subcommittee on Implementation

Discussion

Changes needed?

Final Vote

22

Supplementary Report on

Social Determinants of Health

Shiriki Kumanyika, PhD, MPHCommittee Vice-Chair

Supplementary Report on SDOH:History of this report

In July, 2009 the Committee leadership saw

need for a supplementary report to:

• Further explicate ideas and concepts related to

societal determinants of health that had been

discussed in other Committee documents;

• Articulate the rationale for focusing on societal

determinants of health

• Provide guidance for how Healthy People 2020 can

prompt action on societal determinants.

24

Supplementary Report on SDOH:History of this report, ct.

SDOH-related content from other Committee

documents was integrated into a single report,

which was then circulated to external reviewers;

Several iterations of the draft have been

developed to yield the current version.

25

Supplementary Report on SDOH:Outline of Content

I. HP 2020: New focus on SDOH

II. Rationale for focusing on SDOH

III. Where do we begin?

IV. Specific Actions to Address “Societal

Determinants”

V. Health Impact Assessment: A Tool for Making

Health-informed Decisions

VI. Conclusions

26

“Societal” Determinants of Health

“Conditions in the social, physical, and

economic environment in which people are

born, live, work, and age. They consist of

policies, programs, and institutions and

other aspects of the social structure,

including the government and private

sectors, as well as community factors.”

27

“Societal” Determinants of Health

The Committee uses the term “societal” to clarify

that aspects of the social structure influence the

health of populations through both the social

and physical environments.

28

Supplementary Report on Societal

Determinants of Health

Discussion

Changes needed?

Final Vote

29

Summary and Next Steps

Future meeting dates and plans

Other issues

30