W DEPARTMENTS

Debra Hardy Havens, BS, RN, FNP Washington Representative for NAPNAP

Capitol Associates, Inc. Washington, DC

l Year 2000 Health Objectives q

L>ebra Hardy Havens dnd lames Peterson

0 n September 6th and 7th of this year, the Public Health S&ice (PHS) of the U. S. ‘Department of Health and Human Services (DHHS) released the report, Healthy People 2000: National Health Pro- motion and Diseme Prevention Objectives. The draft of the report is a collection of general and specific goals for the level of health in the United States by the year 2000. Specifically, the report contains five major topics: general goals for the nation, health promotion priorities, health protection priorities, preventive scr- vices priorities, and system improvement priorities. Although it contains no breakthrough statements. the report makes clear the goals of public health. Some skepticism, however, accompanies the Year 2000 Objectives because a similarly styled report was published in 1980 but received only extremely lim- ited and diffuse backing. Hence, it sparked little ac- tivity and received little praise. Year 2000 advocates are, therefore, aware of the implications of not on11 setting goals for the nation’s health, but of following those ideas with persistent support.

m HISTORY OF HEALTH OBJECTIVES REPORTS

As mentioned previously, HHS published the first of the Objectives for a Nation reports in 1980. The first report served as an attempt to both quantify what the standard of U. S. health should be in 1990 and to manage and plan priorities in health by objectives set forth in the report. The comprehensive study fi)r the Year 2000 report is simply an affirmation of this “management-by-objectives” approach begun in 1980. As in the 1990 report, scvcral high prioritI\. goals for the levels of infant and child health arc included in the Year 2000 report.

n FORMATION OF THE REPORT

Since September of 1988, work groups formed b!, the PHS have been developing a consensus on an

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updated set ofgoals for the report. Input was received from over 300 national membership organizations and all state and territorial health departments. The PHS also joined with the Institute of Medicine and the National Academy of Sciences to convene a num- ber of regional hearings across the country. Through these sources, the PHS steering committee received the expert input of over 7000 individuals and groups in drafting its Year 2000 objectives. The result is a document much broader in scope and participation than its Year 1990 predecessor.

m CONTENTS

Both the “agenda for action” and the overall strateg) to improve the health of the nation are goal-oriented and are defined in quantitative terms. The Year 2000 priority areas primarily expand and revise the 1990 objectives, with the addition of areas focused on top- ics such as HIV infection and cancer.

The report has five broad health goals including:

q Reducing the infant mortality rate to no more than seven deaths per 1000 live births;

9 Increasing the life expectancy to at least 78 vcars. . 7

n Reducing disabilities caused by chronic condi- tions to a prevalence of no more than 6% of all people;

’ Increasing the years of healthy life to at least 65 years;

. Decreasing disparity in life expectancy between white and minority populations to no more than 4 years.

The most recently released draft defines 2 1 prioritv issues and places them into one of four areas: heal& promotion priorities, health protection priorities, preventive services priorities, and system improve- ment priorities. Each of the four categories quanti- tativclv describes the present health status, risk re- duction goals, public awareness goals, professional education and awareness goals, and services and pro- tection goals set forth by the draft report.

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Among the many issues addressed in the Year 2000 report are many NAJ?NAP concerns including the following:

. Nutrition n Physical activity and fitness . Unintentional injuries . Maternal and infant health n Immunization and infectious diseases l Health education and preventive services 8 AIDS

n NUTRITION

Because dietary factors are associated with five of the ten leading causes of death in the United States, the framers of the Year 2000 report have emphasized greatly the importance of nutrition and its role in health promotion and disease prevention. Several items are listed as goals for the year 2000. These include: reduction of consumption of foods high in fats; reductions in growth retardation in children aged 5 years and younger to less than 10% (compared with today’s 19.4%); the lowering of iron deficien- cies among children ages 1 through 4 years; and an increase in the proportion of mothers who exclusively or partially breast-feed their babies from birth through 5 to 6 months of age. In terms of service goals, the report is aimed at increasing the proportion of primary care providers who provide nutrition counseling and/or referral and requiring all states to provide nutrition education through grade 12.

n PHYSICAL ACTIVITY AND FITNESS

The report also recommends increases in physical activity and fitness. An increase in the proportion of people aged 6 years and older who participate in moderate, vigorous, or muscular strength physical activities three or more days a week would contribute to risk reduction. In the arena of public awareness, the report is aimed at increasing the number of peo- ple who know the benefits of regular exercise for disease prevention, cardiovascular fitness, and flexi- bility.

n UNINTENTIONAL INJURIES

The report also studies the problems and solutions associated with unintentional injuries. Among the goals of the report is the reduction of motor vehicle crash injuries and fatalities, drowning deaths, and residential fire deaths. To combat these problems, the report urges increases in the use of state-of-the- art motor vehicle occupant protection systems from 42% to 85% and increased instruction in injury pre- vention in primary and secondary schools. The report

also states that trauma care services and organized, coordinate emergency medical services should be ex- tended to reach at least 80% of the U. S. population.

n MATERNAL AND INFANT HEALTH

The report states that “improving the health status of mothers and infants remains a national challenge.” The authors of the report consider the infant mor- tality rate one of the best overall indicators of a na- tion’s health. Goals for the year 2000 include de- creasing the infant, neonatal, and postneonatal mor- tality rates, increasing the number of infants who receive primary care services, reducing total cesarean deliveries, increasing the numbers of women who at least partially breast-feed, and reducing the number of severe complications of pregnancy. Public aware- ness and education play an important role in meeting these goals. This awareness includes increasing pre- natal care; offering screening and information about fetal abnormalities, handicaps, and genetic disorders; and also educating women about the dangers asso- ciated with alcohol, smoking, and other drug use during pregnancy.

n IMMUNIZATION AND INFECTIOUS DISEASES

The report also discusses immunization and infec- tious diseases. Goals in these areas include reducing cases of vaccine-preventable diseases, reducing the number of food-born and water-born pathogens, and reducing the number of cases of infectious diarrhea. To reduce these risks, the study recommends in- creases in:

n Basic immunization series among children un- der age 2 years.

. Basic immunization series among children in licensed child-care facilities and in kindergarten through grade 12.

To meet these goals, the study recommends that comprehensive health insurance coverage for im- munization be expanded to all and that the insurance pay for immunizations.

n AIDS

Finally, the report discusses the AIDS epidemic. By 1988, as many as 1.5 million people in the United States were infected with HIV; most of these persons will develop or become symptomatic of AIDS. The objectives aim to reverse the rising trend in the incidence of AIDS cases and reduce the annual incidence of the disease to no more than the projected number of 80,000 new cases in 1992, compared with 32,971 new cases in 1988. Specific to children, by the year 2000, the report wants to see no more than

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1 per 1000 women giving birth to live-born infants who are HIV infected. Public awareness plays a large role in slowing the spread of the disease. In that respect, the number of people who are aware of ho\\ the disease is and is not transmitted and how to prevent transmission, must increase to 95% of people aged 13 years and older. To carry out this agenda for AIDS education, the report outlines many pro- grams, including HIV education curricula for stu- dents in grades 7 to 12. Additionally, services for both testing and treatment of those infected must bc increased.

n LEGISLATION

Currently, the programs listed in the Year 2000 rc- port receive federal funding from a number of dif- ferent agencies and departments. A bill currently working its way rhrough Congress would alter the present system by attempting to bring more order and control into the funding process. “The National Health Objectives Act” (S. 2056), sponsored by Sen- ator Harkin (D-IA) passed unanimously out of the Labor and Human Resources Committee. There is no companion bill in the House of Representatives. However, Representative Louis Stokes (D-OH) has expressed some interest in introducing legislation.

The following are the goals of the Senate bill:

. To obtain funding for states to implement the Year 2000 goals program.

. To achieve the Year 2000 health objectives and mandate a permanent committee to revise these objectives.

. To create and develop a partnership of federal, state, and local health agencies and other groups whose aim is to develop initiatives in disease prevention.

n To assess the health status of the population. n To require states to draft and annually revise

state health objectives (that must incorporate the five primary national health objectives) and to submit these objectives to the Department of HHS for approval.

If passed, the funding for this bill will begin with an initial investment of $300 million in fiscal veal 1991 and increase by $25 million per year through fiscal year 1995. The bill requires that 90% of the

funds, through a prearranged formula, wiil go to the states. The remaining 10% will be allocated to the Department of HHS for administration, personnel training, and demonstration projects. NAPNAP sub- mitted comments to Senator Tom Harkin to endorse the concept of the Health Objectives 2000 Act. Thr: American Academy of Pediatrics i,eL\P) also sub- mitted comments about the report. AAP’s suggcs- tions convinced the Year 2000 work group that chil.- dren’s issues merit enough concern to have a scparatc category on that subject for the final report.

a SUMMARY

The potential rffkcts of the report reach ti;lr into the health cart community. This report could mark the beginning of an era of increased preventive health care. How the report is followed-up, however, is the key to the Year 2000 equation. Countless hours of study and countless dollars have, in the past, pro-

duced valuable reports similar to the Year 2000 rc- port. Yet, the results of these other reports. because of lack of follow-up, arc less than impressive. If the contributions of more than 7000 individuals are to translate to better health for the nation in the vcar 2000, follow-up measures must be enacted. Th’is is an opportunig; for action on the part of NAPNAP and all pediatric nurse practitioners.

For a copy of the report, Healthy People 2000: hia- tional Health Promotion and Disease Prevention Objectives, write to:

ODPHP National Health Information Center P.O. Box 1133 Washington, D.C. 20013-l 1 3