Healthy People 2020: even "Uncle Sam" can strategically plan

(My impressions of the Healthy People 2020 development process)

Long-term planning has never been a great strength of policymakers in this country, with one possible exception being FDR’s New Deal (which one could argue deserves some critique). Too often nowadays, policy is drafted, revised, combined with other initiatives and amendments, and implemented without critical debate as to the long term consequences of the policy itself. However, every now and then some of us have the opportunity and privilege to sit in a room and observe experts in the field working with members of the public, thinking critically, listening to one another and then taking definitive steps toward the creation of a really fantastic end-product. My visit to Washington D.C. last weekend was one such opportunity.

The Healthy People Campaign, initiated in 1979 with the Surgeon General's report Healthy People, establishes national health objectives and serves as the basis for the development of State and community plans. Today, the mission, vision, goals and objectives for Healthy People 2020 are being developed. It is as much a strategic planning process as a public awareness campaign; it strives to be as much a nationwide dialogue as a tool for experts and practitioners in the field.

Now, it seems obvious that developing a strategic plan for a small health care business (like a private group practice) or a hospital might be difficult; leaders need to spearhead the process without micromanaging, and employees must be involved in the very development of the plan. Ideally, everyone in the organization understands how the mission, vision and goals make sense in the context of their individual and day-to-day work. Now try creating a strategic plan for a company as large as General Motors, with the knowledge that a strategic planning process never really ends – the final product is ideally, and necessarily, dynamic. Now think of our nation as one gigantic and diverse organization, and imagine putting together a visionary document that is not only a strategic plan, but a guide for an over-burdened health system, and a tool with many different end-users. The thought alone is overwhelming.

Yet there are dedicated people who have done this work, and who continue to do this work, over the course of every decade since the 1980s. Other countries face the same challenge in setting national agendas for their health systems, and in developing appropriate implementation strategies to act on their developed goals. The Secretary’s Advisory Committee is charged with making recommendations which will inform the objective setting process for Healthy People 2020 over the next two years, and the committee is striving to make HP2020 an action-oriented, motivational, inclusive document that sets a dynamic agenda to improve population health in the United States. This is no easy task in a country where no national health system exists, and where perverse incentives often encourage practitioners to treat with technology and medication. Questions peppered the two-day committee meeting: What are the resources behind the promotion of this campaign? Can it be a living, breathing document? Can individuals and the federal government take equal ownership? Should they? Is Healthy People a tool kit, an agenda or a plan? Is it all three things? It was fascinating to listen to the debate.

Healthy People, and the individuals working to develop it, have a Herculean task: setting priorities and goals, reaching multiple audiences, being useful to the lay public as well as local health departments. Such a process/outcome cannot be all things to all people, but it can inform how we as a society improve our collective health and well-being. Watching, and briefly participating, in this debate was fascinating as the draft vision and mission were developed and refined. Eventually the committee had drafted a vision and mission, using input gathered over the course of the previous year and multiple regional meetings with members of the lay public. At present, Healthy People 2020 envisions “a society in which all people live long and healthy lives.” In order to achieve this vision, the committee developed the following mission: “to improve the health and well-being of the public by:

• increasing public awareness and understanding of the underlying causes of health, disease and disability
• providing nationwide priorities and measurable objectives and goals
• catalyzing action using the best available evidence
• identifying critical research and data collection needs"

While this language is not yet final, and therefore likely to change, as it stands now it does address many of the issues confronting local public health departments, policy makers, individuals and clinicians:

• In general, very few people pay attention, or are aware of, HP2020. One colleague at this meeting shared that only one in three of his medical students know about the campaign.
  
• Health reform debates are ongoing throughout the nation, but the proposed plans are virtually identical to the concepts proposed by Nixon’s administration in 1972. The lack of an overarching vision for our health system makes for fragmented care that is frustrating for patients and providers alike.
• Evidence is important, yet research still shows that physicians tend to rely more on their own anecdotal experiences rather than evidence-based practice recommendations. There is a time and a place for experience to inform practice, and we should change our practice if good evidence exists and indicates that action is necessary.
• No offense to white men, but there are other populations of people in our country receiving treatment and care. However, white men still comprise the majority of research study patient populations. Without adequate funding for research to address our diverse national population, we cannot begin to improve the nation’s health.

There is obviously a lot of work to be done in many areas of health, but now is the very best time for this dialogue to occur. We are witnessing an evolution of how we think about health, to whom we assign responsibility for health, and how we fund the care we give and receive. Our population demographics are changing, which may change how we as a nation focus our resources in the health (and other) industries.

The exciting thing is that we can each be a part of this process…wouldn’t it be fantastic to have a hand in developing a national strategic plan? One that meant something or that changed the national approach to health? The Secretary’s Advisory Committee will soon present its recommendations to the Secretary of Health and Human Services, Michael Leavitt, incorporating all public comment and work over the course of this previous year. The vision, mission, and goals that are developed out of this process will inform the development of objectives, and will direct how the new plan will be presented in 2010. If you would like to review the current draft, and comment on any issues that you think are important, visit http://www.healthypeople.gov/hp2020/.