Human well-being remains an urgent topic for discussion around the whole globe. Millions of people develop their ideas on how to improve human health, what services to be offered, how to increase the staff, and when to promote training. Many other questions deserve attention, and one of the leading worldwide programs is known as the Healthy People Initiative. The first goal of Healthy People has introduced about 40 years ago. Experts call it “the leading disease prevention and health promotion roadmap for the nation” (Pahigiannis et al., 2019, p. 1957). Some people still question the worthiness of the Healthy People Initiative, and their doubts are usually based on the lack of knowledge or the absence of necessary information. This paper aims to discuss the main historical aspects of the program, its objectives, and lessons that have been obtained during the last several decades of its existence. Being one of the best achievements by the American Government, Healthy People Initiative 2020 continues to ensure people’s healthy living through the establishment of clear goals and missions and disease prevention and control in different areas.
History
Healthy People 2020 is a program with a 4-decade history. At this moment, there are five legally approved editions of the initiative within a regular 10-year period. Each time, certain improvements were discovered to strengthen the chosen positions and make sure the system works. The first attempt to introduce a national public health agenda was made in 1979 (Healthy People, n.d.a). It included five main goals and more than 200 supportive purposes in such fields as childhood infectious diseases or injury prevention. By the end of the decade, not all objectives were successfully met, and another program was developed in 1990. The decision to focus on particular groups of patients, roles of citizens, and stages of diseases was made. American society is known for its controversial issues and debates in the fields of racial and social relations. Therefore, the development of healthcare services and the promotion of health also depend on the same factors, and Healthy People is one of the best examples of their implementation. Every new period of the program introduced additional ideas on how to promote American well-being based on available human and physical resources.
A similar task was properly set for the year 2000. At the beginning of the 21st century, Healthy People gained better recognition, and its contributions were recognized around the globe. There were three initial objectives, including the increase in the span of a healthy life, the reduction of health disparities, the achievement of access to preventive services among Americans (Centers for Disease Control and Prevention, 2001). To make sure the goals were SMART (specific, measurable, assignable, relevant, and time-based), specific monitoring programs were established. For example, life expectancy at birth or the expected years of healthy/unhealthy life was statistically reported by professional organizations (Centers for Disease Control and Prevention, 2001). Besides, it was not enough to identify or control disparities but find the sources and decrease them considerably. Finally, attention to health insurance and required sources of health care was paid. State and local efforts were taken into consideration to gather reports, publish annual reviews, and conduct primary research to evaluate the achieved progress. The promotion of new technologies and software products facilitated the process of gathering information.
In 2010, the time to introduce another addition to the already developed agenda came. Its distinctive feature was the presence of two new goals, the increase in quality and years of healthy life and the elimination of health disparities. This time, the developers were ready to use their experience and indicate the factors to eradicate race/ethnicity/education/sex/income/geographic location/sexual orientation-related inequalities among Americans (Centers for Disease Control and Prevention, 2012). Along with the development of the population and the growth of social debates and concerns, Healthy People found it obligatory to improve its agenda and introduce new topic areas (28 compared to 22 in 2000) and more than 1000 supplementary goals. The task was to involve ordinary people and analyze their opinions about the word done by Healthy People at the moment and the contributions the initiative could have on the life of modern Americans. In addition to governmental organizations that participated in the creation of goals and their scanning, many non-governmental facilities were involved in achieving the desired progress. The recognition of new areas and diseases within the frames of the program helped Americans understand major threats and available preventive measures.
Lessons
One of the most evident false beliefs about a variety of Healthy People editions is the presence of some mistakes made by their development. It is wrong to believe the Healthy People Initiative (either 2000 or 2010) poorly identified goals and chose the wrong methods for the improvement of American well-being. The core idea of all these editions is the possibility to get several important lessons and use obtained knowledge and practice within a new attempt. At this moment, Healthy People Initiatives of 2000 and 2010 have three extremely important lessons to introduce its fifth edition in 2020.
One of the critical lessons of the initiative created in 2000 was the necessity to establish measurements and follow the system. It will help to identify even small changes and compare the results in different areas. There were some cases when targets were not met, and the way of how organizations were able to measure their baselines and results played a significant role (Centers for Disease Control and Prevention, 2001). The strength of the program lies in the possibility to not only set the goals and explain why the U.S. society needs them. The experts should know how to improve the situation, what next steps to be taken, and when evident outcomes to be recognized either by the population or healthcare practitioner.
Another lesson that was learned from the previous initiatives is connected with the cooperation of people with different backgrounds. Americans, as a nation, have enough resources and abilities to improve their health in a short period in case the same goals are achieved, and similar interventions are enhanced. The example of Healthy People 2010 shows that national childhood vaccination does not need serious efforts to be organized and supported, and its benefits are essentials for the population (Centers for Disease Control and Prevention, 2012). As soon as families pay attention to the improvement of health among children at an early age, there are good chances to reduce early mortality, heart diseases, and the development of harmful habits (alcohol, drug, or tobacco use).
Finally, the last two decades have considerably improved an understanding of human health in the United States. It is hard to choose one or two areas and make sure healthcare services are directed to their improvement. The system should integrate opinions, resources, and the contributions of other organizations to make sure a program like Healthy People works effectively. As a result, the identification of priorities increased public awareness, and the support of critical research becomes possible (Centers for Disease Control and Prevention, 2019). Cooperation between state and national facilities is the key to success in the implementation of ideas, control of vital indicators, and the assessment of health in different groups.
At the same time, although Healthy People was directed to the improvement of the quality of life in the United States, its impact could be perfectly observed in other countries. For example, Abu-Saad, Avni, and Kalter-Leibovici (2018) underlined the worth of the U.S. initiatives in the intention to remove health disparities and improve the quality of monitoring services. This study identified a variety of spheres where health disparities could play an integral role, including political commitment, demographic data gaps, and the application of digital tools (Abu-Saad et al., 2018). All these lessons and recommendations play a significant role in the creation of the recent Healthy People 2020 Initiative that should determine the quality of today’s population in the United States.
Summary
As soon as the nation enters a new decade, the 2020s, the time to introduce a new Healthy People program will come. Its implementation is based on the lessons obtained during the last decades, and its goals contribute to the national health and well-being of every American. The major goal of the Healthy People 2020 Initiative is to identify and reduce preventable threats to human health (Centers for Disease Control and Prevention, 2014). Following the same important vision, this decade focuses on promoting the conditions under which American society can live its long, healthy lives. For the current decade, it is important to achieve health equity, promote high-quality living with eliminated disparities, and improve health in all groups (Centers for Disease Control and Prevention, 2014). At the same, this program includes some improvements in social and physical environments and the discussion of the conditions under which people understand their responsibilities.
The analysis of Healthy People 2020 is hard to present on ten or twenty pages because its outcomes vary, depending on the offered topics and objectives. Many researchers and writers share their opinion about the program through the prism of one or several broad areas. For example, Greenberg-Worisek et al. (2019) underlined that recent changes in health information technologies were remarkable during the last several years, and the evaluation of health indicators could be considerably improved. In case the implementation of all the details succeeds, this new program would influence an understanding of positive health outcomes, promote the creation of new opportunities for improvement, and encourage different communities and organizations to collaborate and meet the goals set. Evaluation of health data is a serious task because it helps to monitor changes, control well-being, and prevent the conditions when health care cannot stay effective anymore.
Implementation
The development of a clear implementation plan is one of the integral steps for any initiative or intervention. Therefore, the authors of Healthy People work thoroughly to think about every detail, step, and potential outcome. This year, the decision to follow the MAP-IT path was made. This acronym stands for mobilizing, assessing, planning, implementing, and tracing (Healthy People, n.d.c). This approach aims at mobilizing partners and assessing the needs of American communities. Health data becomes available to all interested parties, including states, governments, healthcare facilities, and individuals. After health objectives are established at the national level, it becomes possible to create a plan and track changes. Each step has its characteristics, and the visitors of the official site with the Healthy People 2020 Initiative could follow recommendations. The first step is to mobilize resources and understand if partners are interested in the chosen vision and mission. They identify roles, discuss responsibilities, and investigate what assistance may be required. The assessment stage is taken to analyze the material and consider such issues as feasibility or measurability (Healthy People, n.d.c). Baseline data has to be formulated at this particular moment.
The next point of the implementation plan is the establishment of goals and the discussion of how they can be achieved, which is known as planning. The implementation step is one of the most critical points because it is the period when all written-on-paper ideas have to become real. Sometimes, it becomes difficult to follow all the goals, and some adjustments are necessary. However, Healthy People is a collaboration of many people with their ideas and abilities. The fact that goals are improved and achieved regularly is the best evidence of its success. Finally, Healthy People should track its progress and demonstrate what has been achieved, what improvements are necessary, and why some failures occur.
Each state is free to develop its plans and agendas according to its resources, main health problems, and the number of partners interested in these activities. In this paper, the work of the New York State Department of Health (2019) will be evaluated in terms of its objectives and implementation. As well as the supporters of the Healthy People 2020 Initiative, the representatives of the New York program promote health equity in all populations and implement various well-being approaches. To increase the interest of communities, the developers find it necessary to address various social determinants, introduce evidence-based interventions and practices, and share professional guides with recommendations (New York State Department of Health, 2019). There are five main areas on the agenda of the chosen state, and more than 100 organizations that are eager to participate in the program.
Objectives
The Healthy People 2020 Initiative is characterized by an impressive list of objectives within a variety of health indicators that determine the quality of human life and American well-being. The current program is improved by the creation of new topic areas like adolescent health, older adults, global health, healthcare-associated infections, preparedness, etc. Such results mean that certain positive results have already been reported, and it is high time to introduce new options for the U.S. population to be healthy. Each area has several objectives that are directed to the reduction of particular problems, an increase of services, or control of information.
The New York City Department of Health and Mental Hygiene follows the initiative in different ways. It aims at protecting and promoting the health of more than 8 million New Yorkers (New York State Department of Health, 2019). For example, the area of oral health is perfectly discussed in both sources. The national goal is to prevent and control oral diseases and conditions by promoting effective preventive dental care. It is expected to reduce the number of pediatric and adult patients with untreated dental decay and introduce new school-based health centers where children can learn oral health as a part of the program (Healthy People, n.d.b). The oral health initiative in New York does not have such a serious scope of problems, but its recommendations contribute to the fulfillment of the national goals. Such educative steps like the importance of brushing teeth twice a day, eating healthy, and drinking tap water help to prevent tooth decay. Within the frame of this New York initiative, people also promote the limitation of alcohol and tobacco use to control the risks of other dental complications.
Feedback
Taking into consideration the goals and impact of the Healthy People 2020 Initiative, there are many supporters and opponents of this intervention. On the one hand, Bachert (2017) admits that the current program shows little or no improvement in several health indicators and even regression in some areas. These results may question the need for such huge funding in the healthcare strategy. Many urgent problems still exist like tobacco smoking, childhood obesity, or alcohol-related problems. Therefore, ordinary people want to know more about how the idea of Healthy People could change their lives or if it is reasonable to use governmental resources on planning.
At the same time, there are many positive attitudes toward this initiative because it remains one of the brightest examples of how health and human well-being must be promoted. Many representatives of developing countries define Healthy People as an integral aspect of population health at the national level (Abu-Saad et al., 2018). It is also a great opportunity for people to understand how to prevent such a serious area as cardiovascular health by removing disparities and addressing target goals (Pahigiannis et al., 2019). According to Greenberg-Worisek et al. (2019), the management of personal health information has also considerably been improved with Healthy People. Americans learn what areas need special attention, the government makes specific contributions, and healthcare facilities indicate their roles and resources. Therefore, despite the presence of certain failures and possible mistakes, and overall attitude toward Healy People remains positive because the intentions prove the readiness of society to improve human health.
Conclusion
In general, the discussion of the history of the Healthy People initiative starting from its first edition and ending with its 2020 version proves the worthiness of the work done by governmental and non-governmental organizations. Each decade introduces several lessons that help to improve the already made achievements, indicate new goals, and enhance new implementation strategies and opportunities. The Healthy People 2020 Initiative was organized according to the MAP-IT approach that helped to identify the goals, vision, and mission of the program, as well as available resources, expectations, and potential partners. Among the existing variety of goals, the work of the New York State’s department proves itself as urgent, coherent, and connected with the national program. There will always be some negative critics about the work done, but the presence of positive outcomes and improvements also plays a critical role in understanding the Healthy People 2020 Initiative with all its history, goals, and contributions to human well-being.
References
Abu-Saad, K., Avni, S., & Kalter-Leibovici, O. (2018). Health disparities monitoring in the US: Lessons for monitoring efforts in Israel and other countries. Israel Journal of Health Policy Research, 7(1). Web.
Bachert, A. (2017).CDC: U.S. 40% of the way toward Healthy People 2020. Web.
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Greenberg-Worisek, A. J., Kurani, S., Finney Rutten, L. J., Blake, K. D., Moser, R. P., & Hesse, B. W. (2019). Assessing electronic personal health information use: An update on progress toward Healthy People 2020 objectives. Health Policy and Technology, 8, 211-220. Web.
Healthy People. (n.d.a). History & Development of Healthy People. Web.
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The New York City Department of Health and Mental Hygiene. (n.d.). Oral health.Web.
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Pahigiannis, K., Thompson-Paul, A. M., Barfield, W., Ochiai, E., Loustalot, F., Shero, S., & Hong, Y. (2019). Progress toward improved cardiovascular health in the United States: Healthy People 2020 heart disease and stroke objectives. Circulation, 139(16), 1957-1973.