HEALTHY PEOPLE 2010 – – Is there a gap in reaching Is there a gap in reaching

the grass-roots level?the grass-roots level?

William C. Andress, DrPH, CHES, Renee William C. Andress, DrPH, CHES, Renee Laszczak, and Stafford C. Rorke, D.Phil., FACSMLaszczak, and Stafford C. Rorke, D.Phil., FACSMWellness, Health Promotion, and Injury Prevention Wellness, Health Promotion, and Injury Prevention

ProgramProgramSchool of Health SciencesSchool of Health Sciences

Oakland UniversityOakland UniversityRochester, MichiganRochester, Michigan

Presented at the134th annual meeting of the American Public Health Association

AbstractAbstractStudents enrolled in an undergraduate course in community health Students enrolled in an undergraduate course in community health in southeastern Michigan conducted interviews at discrete non-in southeastern Michigan conducted interviews at discrete non-governmental social service, health, and fitness facilities to governmental social service, health, and fitness facilities to determine agency contribution in making healthier communities. determine agency contribution in making healthier communities. Summative reports suggested that knowledge regarding Summative reports suggested that knowledge regarding Healthy Healthy People 2010People 2010 goals and objectives was inadequate at the grass roots goals and objectives was inadequate at the grass roots community level. community level.

It was disturbing that less than a third of respondents (29.9%) It was disturbing that less than a third of respondents (29.9%) affirmed awareness of the affirmed awareness of the Healthy People 2010 Healthy People 2010 publication. And, of publication. And, of those indicating familiarity, only slightly more than 50% (n=22 of 43) those indicating familiarity, only slightly more than 50% (n=22 of 43) had ever read portions of it although the entire document is readily had ever read portions of it although the entire document is readily available on the Internet (available on the Internet (www.healthypeople.govwww.healthypeople.gov).).

It was concluded that more aggressive efforts need to be put forth to It was concluded that more aggressive efforts need to be put forth to educate local health agencies regarding the contents of educate local health agencies regarding the contents of Healthy Healthy People 2010.People 2010.

BackgroundBackground

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

Document OverviewDocument Overview

Healthy People 2010 provides a Healthy People 2010 provides a framework for prevention for the framework for prevention for the

Nation. It is a statement of national Nation. It is a statement of national health objectives designed to identify health objectives designed to identify

the most significant preventable threats the most significant preventable threats to health and to establish national to health and to establish national

goals to reduce these threats. goals to reduce these threats. 

http://healthypeople.gov/About/

Document OverviewDocument Overview

Goals:Goals:Goal 1Goal 1: Increase Quality and Years of : Increase Quality and Years of

Healthy Life Healthy LifeGoal 2Goal 2: Eliminate Health Disparities: Eliminate Health Disparities

Document:Document:– 28 Focus Areas28 Focus Areas– 467 Objectives467 Objectives

Healthy People 2010 Focus AreasHealthy People 2010 Focus Areas1.1. Access to Quality Health Access to Quality Health

ServicesServices2.2. Arthritis, Osteoporosis, and Arthritis, Osteoporosis, and

Chronic Back ConditionsChronic Back Conditions3.3. CancerCancer4.4. Chronic Kidney DiseaseChronic Kidney Disease5.5. DiabetesDiabetes6.6. Disability and Secondary Disability and Secondary

ConditionsConditions7.7. Educational and Community-Educational and Community-

based Programsbased Programs8.8. Environmental HealthEnvironmental Health9.9. Family PlanningFamily Planning10.10. Food SafetyFood Safety11.11. Health CommunicationHealth Communication12.12. Heart Disease and StrokeHeart Disease and Stroke13.13. HIVHIV14.14. Immunization and Infectious Immunization and Infectious

DiseaseDisease

15.15. Injury and Violence PreventionInjury and Violence Prevention16.16. Maternal, Infant, and Child Maternal, Infant, and Child

HealthHealth17.17. Medical Product SafetyMedical Product Safety18.18. Mental Health and Mental Mental Health and Mental

DisordersDisorders19.19. Occupational Safety and HealthOccupational Safety and Health20.20. Nutrition/OverweightNutrition/Overweight21.21. Oral HealthOral Health22.22. Physical Activity and FitnessPhysical Activity and Fitness23.23. Public Health InfrastructurePublic Health Infrastructure24.24. Respiratory DiseaseRespiratory Disease25.25. Sexually Transmitted DiseaseSexually Transmitted Disease26.26. Substance AbuseSubstance Abuse27.27. Tobacco UseTobacco Use28.28. Vision and HearingVision and Hearing

Declared PurposeDeclared PurposeIndividuals, groups, and organizations are Individuals, groups, and organizations are

encouraged to integrate Healthy People 2010 into encouraged to integrate Healthy People 2010 into current programs, special events, publications, and current programs, special events, publications, and

meetings…Health care providers can encourage meetings…Health care providers can encourage their patients to pursue healthier lifestyles and to their patients to pursue healthier lifestyles and to

participate in community-based programs. By participate in community-based programs. By selecting from among the national objectives, selecting from among the national objectives,

individuals and organizations can build an agenda individuals and organizations can build an agenda for community health improvement and can for community health improvement and can

monitor results over time.  monitor results over time. 

http://healthypeople.gov/About/objused.htm

Research MethodologyResearch Methodology

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

Sampling of Survey QuestionsSampling of Survey Questions

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

Other Questions of InterestOther Questions of Interest

What activities do you have that target What activities do you have that target your own employee’s health?your own employee’s health?What percentage of Americans engage in What percentage of Americans engage in the following activities?the following activities?– Don’t smokeDon’t smoke– Maintain a BMI below 25.Maintain a BMI below 25.– Exercise at least 30 min/day for at least Exercise at least 30 min/day for at least

5x/week5x/week– Eat five servings of fruits/vegetables daily.Eat five servings of fruits/vegetables daily.

29.9%

70.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Perc

ent

Familiar with HP2010 Unfamiliar with HP2010

Figure 1: Percentage Familiar with Healthy People (n=144)

51.2% 48.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Perc

ent

Familiar/Have read HP2010 Familiar/Not read HP2010

Figure 2: Percentage of familiar with who have read Healthy People 2010 (n=43)

11.1%16.0%

72.9%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Perc

ent

Figure 3: Ability to identify major Healthy People 2010 goals (n=144)

Identified both goals Identified one goal Unable to identify goals

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%

Perc

ent

Knew at least 3 focus areasKnew 1 or 2 focus areas

Knew at least 3 focus areas with promptingUnfamiliar with focus areas3

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%

Perc

ent

Aware of more than one objective Aware of one objective Unaware of objectives

38.2%

9.7%

52.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Perc

ent

Figure 6: Provide Employee Health/Wellness Interventions (n=144)

Provide wellness interventions Provide minimal interventions Do not provide interventions

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%

Per

cent

Refrain from smoking Maintain BMI below 25

Exercise 30 minutes/day for 5 days/week Eat 5 servings of fruits/vegetables daily

43.4%

12.5%

57.6%52.1%

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%

Perc

ent

Figure 8: Percentage with correct knowledge of Americans engaged in health promoting activities (n=144)

4 correct 3 correct 2 correct 1 correct 0 correct

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

RecommendationsRecommendations1.1. The Department of Health and Human Services may wish to The Department of Health and Human Services may wish to

determine whether these regional findings apply nationwide.determine whether these regional findings apply nationwide.2.2. If a nationwide trend exists, The Department of Health and If a nationwide trend exists, The Department of Health and

Human Services, together with the Centers for Disease Control, Human Services, together with the Centers for Disease Control, would need to more aggressively promote would need to more aggressively promote Healthy People Healthy People at the at the local level.local level.

3.3. University and college community health education courses can, University and college community health education courses can, and should be, used as a vehicle to heighten Healthy People and should be, used as a vehicle to heighten Healthy People awareness within local health agencies.awareness within local health agencies.

4.4. State and county departments of health should produce 10-year State and county departments of health should produce 10-year plans that parallel plans that parallel Healthy PeopleHealthy People 2010 2010 and encourage all health and encourage all health agencies within their jurisdiction to work towards common goals.agencies within their jurisdiction to work towards common goals.

5.5. Federal funding incentives should be given to states to encourage Federal funding incentives should be given to states to encourage more aggressive and successful implementation strategies.more aggressive and successful implementation strategies.

6.6. As public health professionals, each should be committed to As public health professionals, each should be committed to collaborating with local agencies to ensure successful collaborating with local agencies to ensure successful implementation of implementation of Healthy PeopleHealthy People 2010 2010 goals and objectivesgoals and objectives..