Skip to main content

A Perspective on the Development of the Healthy People 2020 Framework for Improving U.S. Population Health

Abstract

Since the late 1970s, the federal Healthy People Initiative has been a visible component of the United States’ approach to improving population health. In each decade, a new version of Healthy People is issued, featuring updated goals and identifying topic areas and quantifiable objectives for health improvement during the succeeding ten years, with assessment at that point of progress or lack thereof. Progress has been limited for many objectives, leading to concerns about the effectiveness of Healthy People in shaping outcomes in the context of a decentralized and uncoordinated US health system. This article describes development of Healthy People 2020, launched in December of 2010, from the perspectives of three members of a public advisory committee appointed to guide the process: The Secretary’s Advisory Committee on Health Promotion and Disease Prevention Objectives for 2020 (SAC). The SAC made recommendations, almost all of which were adopted in some form, based on extensive assessments of strengths and weaknesses of the program and deliberations about critical areas to update. As a result, compared to prior versions, Healthy People 2020 gives more prominence to health promotion and preventive approaches, and adds a substantive focus on the importance of addressing societal determinants of health. A new expanded digital interface facilitates use and dissemination rather than bulky printed books as produced in the past. The impact of these changes to Healthy People will be determined in the coming years.

References

  1. U.S. Department of Health and Human Services. History and development of Healthy People. Washington (DC): DHHS; updated 15 November 2011. Available from URL: http://www.healthypeople.gov/2020/about/history.aspx (Accessed 23 April 2013).

    Google Scholar 

  2. Robert Wood Johnson Foundation and Wisconsin Population Health Institute. County health rankings and roadmaps. Available from URL: http://www.countyhealthrankings.org/ (Accessed 17 December 2013).

  3. Sondik EJ, Huang DT, Klein RJ, Satcher D. Progress toward the healthy people 2010 goals and objectives. Annu Rev Public Health. 2010;31:271–81, 4p following 281.

    Article  PubMed  Google Scholar 

  4. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Phase I Report: Recommendations for the Framework and Format of Healthy People 2020. Washington (DC): U.S. Department of Health and Human Services; 28 October 2008. Available from URL: http://healthypeople.gov/2020/about/advisory/Reports.aspx (Accessed 23 April 2013).

    Google Scholar 

  5. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Healthy People 2010 Final Review. Hyattsville (MD): NCHS; 2012. Available from URL: http://www.cdc.gov/nchs/healthy_people/hp2010/hp2010_final_review.htm (Accessed 17 December 2013).

    Google Scholar 

  6. Green LW, Fielding JE. The U.S. healthy people initiative: its genesis and its sustainability. Annual Rev Public Health. 2011;32:451–70.

    Article  Google Scholar 

  7. National Conference of State Legislatures. The Affordable Care Act: a brief summary. Washington (DC): NCSL; March 2011. Available from URL: http://www.ncsl.org/portals/1/documents/health/hraca.pdf (Accessed 23 April 2013).

    Google Scholar 

  8. National Prevention Council. National Prevention Strategy: America’s plan for better health and wellness. Washington (DC): U.S. Department of Health and Human Services, Office of the Surgeon General; June 2011.

    Google Scholar 

  9. National Opinion Research Center at the University of Chicago. NORC Final Report: Healthy People User Study. Bethesda (MD): U.S. Department of Health and Human Services; 18 November 2009, revised 28 March 2010. Available from URL: http://aspe.hhs.gov/health/reports/09/userstudy/report.shtml (Accessed 23 April 2013).

    Google Scholar 

  10. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Washington (DC): U.S. Department of Health and Human Services; updated 8 September 2011. Available from URL: http://healthypeople.gov/2020/about/advisory/default.aspx (Accessed 23 April 2013).

  11. U.S. Department of Health and Human Services. About Healthy People. Washington (DC): DHHS; updated 17 December 2012. Available from URL: http://www.healthypeople.gov/2020/about/default.aspx (Accessed 23 April 2013).

    Google Scholar 

  12. Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services. Healthy People 2020. Washington (DC): DHHS; November 2010. Available from URL: http://www.healthypeople.gov/2020/topicsobjectives2020/pdfs/hp2020_brochure.pdf (Accessed 17 December 2013).

    Google Scholar 

  13. Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm. A New Health System for the 21st Century. Washington (DC): National Academy Press; 2001

    Google Scholar 

  14. Marmot M. Closing the health gap in a generation: the work of the Commission on Social Determinants of Health and its recommendations. Glob Health Promot. 2009;Suppl 1:23–7.

    Google Scholar 

  15. Braveman PA, Kumanyika S, Fielding JE, Laveist T, Borrell LN, et al. Am J Public Health. 2011;101:S149–55.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dahlgren G, Whitehead M. Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute for Futures Studies; 1991.

    Google Scholar 

  17. Committee on Assuring the Health of the Public in the 21st Century, and Board on Health Promotion and Disease Prevention, Institute of Medicine. The Future of the Public’s Health in the 21st Century. Washington (DC): National Academies Press; 2002.

    Google Scholar 

  18. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Healthy People 2020: An opportunity to address societal determinants of health. U.S. Washington (DC): Department of Health and Human Services; 26 July 2010. Available from URL: http://healthypeople.gov/2020/about/advisory/SocietalDeterminantsHealth.pdf (Accessed 23 April 2013).

    Google Scholar 

  19. Koh HK, Piotrowski JJ, Kumanyika S, Fielding JE. Healthy people: a 2020 vision for the social determinants approach. Health Educ Behav. 2011;38:551–7.

    Article  PubMed  Google Scholar 

  20. United States Federal Bureau of Investigation. Ten years after: the FBI since 9/11. FBI. Available from URL: http://www.fbi.gov/about-us/ten-years-after-the-fbi-since-9-11 (Accessed 17 December 2013).

  21. United States Federal Bureau of Investigation. Amerithrax or Anthrax Investigation. FBI. Available from URL: http://www.fbi.gov/about-us/history/famous-cases/anthrax-amerithrax (Accessed 17 December 2013).

  22. Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services. National Health Security Strategy of the United States of America. Washington (DC): DHHS; December 2009. Available from URL: http://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Pages/default.aspx (Accessed 23 April 2013).

    Google Scholar 

  23. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Evidence-based clinical and public health: generating and applying the evidence. Washington (DC): U.S. Department of Health and Human Services; 26 July 2010. Available from URL: http://healthypeople.gov/2020/about/advisory/EvidenceBasedClinicalPH2010.pdf (Accessed 23 April 2013).

    Google Scholar 

  24. Chair and Vice-Chair, The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives 2020. Recommendations for implementing Healthy People 2020. Washington (DC): U.S. Department of Health and Human Services; August 2010. Available from URL: http://healthypeople.gov/2020/about/advisory/FACAImplementationRecommendations.pdf (Accessed 23 April 2013).

    Google Scholar 

  25. U.S. Department of Health and Human Services. Healthy People 2020. Leading Health Indicators. Washington (DC): DHHS; updated 18 April 2013. Available from URL: http://www.healthypeople.gov/2020/LHI/default.aspx (Accessed 23 April 2013).

    Google Scholar 

  26. Institute of Medicine. Leading Health Indicators for Healthy People 2020. Letter Report. Washington (DC): National Academies Press; 15 March 2011.

    Google Scholar 

  27. Berwick DM, Nolan TW Whittington J. The triple aim: care, health and cost. Health Aff. 2008;27:759–69. Available from URL: http://content.healthaffairs.org/content/27/3/759.full (Accessed 17 December 2013).

    Article  Google Scholar 

  28. Fielding JE, Teutsch SM. An opportunity map for societal investment in health. JAMA. 2011;305:2110–1.

    Article  CAS  PubMed  Google Scholar 

  29. Chair and Vice-Chair. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Recommendations on Action Steps and Evidence for Healthy People 2020. Washington (DC): U.S. Department of Health and Human Services; revised 26 October 2010. Available from URL: http://www.healthypeople.gov/2010/hp2020/advisory/ASERecommendations2010.htm (Accessed 16 December 2013).

    Google Scholar 

  30. Chair and Vice-Chair. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Recommendations for Leading Health Indicators for Healthy People 2020. Washington (DC): U.S. Department of Health and Human Services. Available from URL: http://www.healthypeople.gov/2020/about/advisory/LHI_Recommendations_Memo.pdf (Accessed 16 December 2013).

  31. Manderscheid R, Wukitsch K. Healthy People 2020: developing the potential of digital and mobile communication tools to touch the life of every American. In review.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jonathan E. Fielding MD, MPH, MA, MBA.

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article

Fielding, J.E., Kumanyika, S. & Manderscheid, R.W. A Perspective on the Development of the Healthy People 2020 Framework for Improving U.S. Population Health. Public Health Rev 35, 3 (2013). https://doi.org/10.1007/BF03391688

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/BF03391688

Key Words