DEPARTMENT OF HEALTH AND HUMAN SERVICES
Meeting of: Secretary's Council on Health Promotion and Disease Prevention Objectives for
2010
April 23, 1999, Proceedings
I am going to open it up now for public comment. Again, I have tried to run an open meeting, which is sort of my style. So we have had a lot of comments from people beyond the table, but are there other people who did not feel comfortable speaking earlier?
MS. FOX: Actually, I felt comfortable speaking, but I am going to feel even more comfortable speaking again.
[Laughter.]
I am Tracy Fox with the American Dietetic Association. I just kind of want to commend certainly the Council, as well as the workgroup that we have been working with in some of the objectives. Really, the openness and the inclusion of outside organizations, I do not think, has ever been more evident than in this iteration. Although I did not work actively in it the last time, clearly this time it has been, through the Internet site and through the really clear emphasis on trying to get public input.
Just a couple of specific points about some of the issues regarding nutrition-to kind of go on record that we do advocate the need for a separate chapter on obesity. We think the way it exists now really does weaken the importance of nutrition as well as obesity. So if you did not hear it the first time, hear it this time.
Also, just in terms of the some of the recent evidence regarding the link between nutrition services and cost effectiveness, there is some good evidence coming out on the need to provide nutrition services and the impact it has on cost effectiveness. There is some recent research that was just done for the Department of Defense that found that nutrition coverage for the TRICARE population would produce a net savings of $3.1 million annually beginning in the first year, and I think that is significant. The data is out there. It is not in publishable form yet, but I think that is important, and we would be glad to provide more specifics to the Council on that.
Another example of specific cost effectiveness when nutrition services are covered is a health plan that extended nutrition care to beneficiaries; for each dollar spent, there is a ten-to-one savings. I think, again, that points to the need for nutrition services to be covered by insurance and to be an integral part of the entire health system as well as the community. Congress has also in the Balanced Budget Act initiated a study with the National Academy of Sciences to look at the provision of nutrition care and cost effectiveness. So I think the work that we have done and a lot of the information that we have provided to the Healthy People workgroup and our official comments really point to the need for nutrition services to be integral. We think that the draft document as it stands now really does take a step forward in recognizing it as a preventive benefit, not just a fringe benefit, and steps are taken to sort of map that out.
Also in terms of the objectives, we have heard a lot about numbers and cutting them down. In the nutrition section, I think-I do not know what the number of objectives was and is now, but in terms of nutrition services, there actually has been a reduction in the objectives in that area because of the need to streamline looking at the data sources. So, again, to just kind of reiterate the openness that has been in the process, we hope to be able to provide more information as we get it to the committee to look for data sources, to make sure that the objectives as they exist now are strong.
DR. SATCHER: Thank you.
Other comments?
DR. SONDIK: I had a question. On the diagram, it occurred to me when it was presented this morning that while the feedback is shown, there is nothing on there specifically about data, and I wondered whether-it was obvious to me, but I wondered, given that it is important to Healthy People, whether this is something we should be showing more explicitly.
DR. SATCHER: So it is certainly implied.
DR. SONDIK: I thought it was.
DR. SATCHER: Mark, do you want to comment on that?
DR. SMOLINSKI: Well, I think the whole thing is data. Basically, this is a framework for how we describe health, and you cannot really describe health unless you have data to describe it. I do not know exactly what you are getting at as far as-
DR. SONDIK: I was getting at, actually that in the feedback loop that goes from the top to the bottom, that top is really the assessment as I see it. It is assessment all along the way, and then one assesses it and then that drives policy down here. But when you presented it actually, I drew a little diagram off to the side and sort of the data requirements, and it is a very good way of thinking about the data requirements at each of these various stages.
DR. SATCHER: We would like to see that diagram.
DR. SONDIK: So this is, I think, a useful template.
DR. SMOLINSKI: It is something that would be good text to add into Volume I, as well.
DR. SATCHER: Yes?
MS. MOORE: I was interested in the process for finalizing health indicators. I understand that there will be these focus groups. How will that information then be used to help-
MS. BAILEY: There really is a tremendous amount of work to do over the next 2 months. We have, I think, 11 or 12 areas. We would like to go ahead and focus group all 12 of those and see how they communicate with the public, to see if everybody understands them as important health issues. We also would like to talk with some professional groups and make sure that the stakeholders, the partners, that we need to bring in over the next 10 years see a role for themselves and actions that they can take to contribute to the goals. So that needs to go on over the next 6 weeks.
We will be working with members of this Council, with the Healthy People Steering Committee, with the workgroups, on finalizing that, and the HHS workgroup on Leading Health Indicators, who will also be talking with the IOM and doing some data consultations on the actual measures for each of the indicators.
DR. LURIE: I think we are also interested-at the same time that we do that, if we can-in sort of testing the framework and maybe an alternative translation for different kinds of audiences so that we can understand again most effectively how we communicate with what sectors.
DR. SATCHER: Those two things should go very well together.
DR. LURIE: They should go really well together.
DR. SATCHER: Charlene?
DR. IRVIN: I just want to make a plea that, when you do the focus group on the evaluation of Leading Health Indicators, that you would do some cost benefit analysis, because I think, when you get down to the State level and they are given only a specific list of indicators, it would be nice to at least gauge them or rank them in terms of the biggest bang for your buck kind of thing.
DR. SATCHER: Okay, thanks very much.
Let me ask, Dr. Brooks, would you like to make a comment before we close?
DR. BROOKS: I am just glad to be a part of this large experience and would ask you to, as mentioned, keep a focus on the actual implementation, which is different from the more conceptual and evaluative parts of the whole enterprise, as to how we are going to be able to prioritize with limited State budgets what comes down. Certainly what the Secretary is able to get into the congressional budget next year often will give us direction at the State level, as was mentioned, as to which programs are to get the most attention.
DR. SATCHER: Great. Well, let me say it has been really delightful to have you with us today, and we really appreciate your taking this time to work with us in this very important area. It means a lot.
Okay, let's hear from the former Assistant Secretaries for Health. I guess we have lost our phone partners, but Bob, do you want to start?
DR. WINDOM: Yes, looking back 10 years ago and today comparing the changes, it's remarkable how things are improving, and that is what the process is supposed to do. I certainly hope that it will go forward from this meeting on, with the faith we have in the staff and the agency people here who have done so well, that we will see a document here in a few months that will actually reflect what we want the nation to see.
But one thing I am concerned about, I think what we need to really focus upon, again, as I mentioned before, is the provider, the physician who sees the patients. I am a little disappointed again that neither the AMA or the NMA or the osteopathic organizations are here in the audience even today. We are talking about bringing public health and medicine together. That is one of the goals that the IOM has told everybody we want to work toward, but still we are not reaching them, and we hear about the medical students who do not even know about 2000. So I think that there ought to be plans somehow made to bring these people together to form a continuing communication to their constituency and make them aware of what needs to be done and how they can play that role.
Earl mentioned, and I thought it was so interesting, that rather than wait for the midterm review for the data to come out, that maybe what can be done from Ed's work, on an annual basis focus on certain issues so that then you could say, we are making progress, to get those people to want to really jump on a bandwagon and focus on those and not have to wait so long to hear what is coming out of this hard work. So it really boils down to that cooperation and the effort that we need to make from the public health side as well as the provider/practitioner side. So I hope that will go forward in some way.
DR. SATCHER: Good point. I am glad you said that. I think we can do that. One venue, of course, is a quarterly meeting of public health and medicine that we are having. We could prepare a concise presentation to at least make sure that they were aware of where we are in this process and to try to get them engaged going forward. But I think you are right; they need to know where we are right now and sort of how we have gotten here. We will figure out a way to do that, definitely. It is very important.
Monte?
DR. DUVAL: David, I think I would only hold my comments to two. First, I would like to assure Mary Jo that I not only still have my tee shirt but I wear it proudly twice a week.
[Laughter.]
Then, secondly, I would like to thank you personally as well as your staff for the arrangements that made it possible for us to be here and participate with you today. I think it was a great compliment that I am still invited to a meeting of this kind, and if I can contribute then that makes me feel even better. It was a lot of thought, and I thank you for inviting me.
DR. SATCHER: Thank you for being here, and your great contributions really helped.
Julie?
DR. RICHMOND: Yes, I too want to add my words of appreciation to you, David, for all of the leadership you have shown in this and the seriousness with which you have taken this as a major effort to improve the health of our people. I guess what impresses me, having launched this from its inception, is the level of sophistication that has developed in the agencies and the depth of involvement. It is very clear that this is kind of an intrinsic process in the Public Health Service, and what we have seen I think reflects that.
I would also just like to comment that, in my interactions with the staff, they emphasized something that I was not really fully acquainted with in my own thinking and that is the whole issue of improving systems for personal and public health. That has to sort of permeate all of this if we are really going to function effectively. So I keep being impressed that the National Center for Health Statistics, which I call the directional compass for all of this, is so involved and how much it influences the improvement and the development of better systems for personal and public health.
I think that the other point that I would make is the significance of-even within our 10, if we can get this down to the 10 indicators-the real importance of articulating some overarching themes that are very readily communicated. I think you have been doing that in a very significant way as Surgeon General, and that is the emphasis on disparities. Disparities, as Ed was indicating earlier, come in various forms. There are all kinds of them, disparities, but closing the gap on disparities is kind of an overarching goal that can be stated and grasped by both the public and the professional community. One does not have to get one message to the public and another message to the professional community. It seems to me we are kind of Unitarians on that. The nation by and large embraces that as a concept. So I think, every way we can, we can sort of indicate that, sure, we have these more specific issues, but if we could keep narrowing the gap between what is optimal and where we are that that is a very significant way to go.
So again, I really appreciate the opportunity to be here, and I certainly appreciate the extraordinary amount of effort that has gone into formulating these documents thus far.
DR. SATCHER: Thank you for being here and for your continuing vision and support.
DR. WINDOM: On behalf of the three of us, I wanted to mention that we offer our willingness to come back in 10 years and plan for 2020.
[Laughter.]
So put that down on your calendar.
DR. SATCHER: We certainly will. I hope we have it on tape.
DR. MEYERS: First of all, you have to help launch 2010.
DR. SATCHER: That is right.
Okay, Linda did you-do we need to do something of a summary statement?