Healthy People 2000 Consortium Meeting November 7, 1997

Summary of Breakout Group Discussion Concerning Priority Area 17: Diabetes and Chronic Disabling Conditions

The following is a summary of the comments and concerns shared at the Diabetes and Chronic Disease workgroup meeting during the November 7, 1997 Healthy People 2000 Consortium Meeting. Facilitating the discussion was Dr. Frank Vinicor, CDC. Introductions were done around the table.

I. General 2010 Structure

The general consensus of the group was that the fan was the first draft at developing the Healthy People 2010 structure and now needed to be modified. Two of the proposed focus areas public health infrastructure and the educational and communities based programs were both recommended to be reposition from proposed focus areas to more foundation areas. (Graphically two separate bands on the bottom, illustrating the importance of public health infrastructure and educational and community based programs to the proposed focus areas.)

The group supported the idea that in Healthy People 2010, there would be no duplicate objectives but rather a sharing of objectives. Discussed and agreed upon was that as objectives are identified as having relevancy to different focus areas, they would be incorporated in those other focus areas. The concern did arise for those objectives being shared, of how the decision would be made of where their official home would be. Some members in the group also felt that if an objective is shared in too many areas such as an overweight or obesity objective, that the objective may be extended and perhaps at risk of loosing its particular attention to its principal focus area.

It was communicated that the Healthy People 2010 framework should clearly recognize the importance of developing partnership and encouraging implementation at the local level. For that reason, the title "Healthy People in Healthy Communities" received unanimous support.

II. Beyond Health

The group members also discussed that the concept of Healthy People in Healthy Communities was larger than the biological characteristics that affect a person's health. Some examples that were provided that are interrelated to the health of the individual were education, housing, and employment.

III. Overarching Goals

The group agreed that the second overarching goal of "Eliminate (original reducing) Health Disparities" included a change in language that communicated a greater sense of social justice and fairness. Also restated was the position of the racial and ethnic advocacy groups at other Healthy People 2000 meetings that they wanted to see same targets for all populations in Healthy People 2010. The advocacy groups recognize the greater disparity some of the racial and ethnic populations have in comparison to the total population, but they do not want to be held at a different standard. Nor do these advocacy groups support the idea of proportional change in targeting setting.

The group also expressed concern that the two overarching goals were not equally weighed. They felt that the first goal of "Increasing years of healthy life" has been and will continue to be a manageable and reachable goal while the second goal, "Eliminating Health Disparities" was significantly a more difficult one.

Some concerns were also voiced about the second goal had produced very little progress in Healthy People 2000. While a different participant, expressed that identifying wide disparities creates unrealistic targets, but at the same time draws attention to populations with greater needs.

Some in the group felt that because of the particular attention to higher at risk populations, that some groups, who are in need would be at a disadvantage to the higher at risk group. Therefore creating a sense of some groups will loose in order for others to gain. Yet, others expressed that with the modified second goal and having the same targets that this would still allow for healthy populations to continue to improve on their health.

IV. Enabling Goals

The group felt that the enabling goals were segmented and with the current graphic not illustrating an associating with all the focus areas. The current visual represented a limited association of each of the four enabling goals to their prospective, next to focus area. The agreed upon recommendation was that these four enabling goals were accurate but that they relate to more than the currently shown focus areas. The four enabling goals are important to all the proposed focus areas and the visual should communicate this.

V. Data Collection and Presentation

The general consensus was that data surveillance is critical to analyzing and identifying the public health needs of the population of the U.S. It was also agreed that higher at risk populations are still lagging on available data.

Although, the entire group agreed upon the importance of data systems and surveillance mechanisms, there was also thoughts that we should not allow data systems to necessarily consume all resources.

Members of the groups agreed that in the stages of writing draft objectives that one should not be constrained by lack of data. The group agreed of the importance of having two kinds of objectives, measurable and developmental. Some members felt that these draft objectives subject matter would be of importance, that national recognition as objectives would generate interest in developing surveillance systems. Many in the group were comfortable with the 2005 deadline for developmental objectives identifying baseline data. The group did agree that there should be a limit to the number of objectives included as developmental. Some in the group felt that for those objectives without data that they should be properly marked as having "no data" in the Healthy People 2010 document.

A member of the group felt that we should be careful of not creating an unrealistic document in which many of the objectives do not have available data sources.

The group agreed that largely aggregated data on specific racial and ethnic population mask the disparities among these groups. A concern was also expressed of when we, as a national initiative stop requesting the specificity on data? Anyone population could be broken down to as many as 500 different groups. The question was also posed as what the national utility of such specificity would provide. We don't want to create an unmanageable project with too much process and very little usefulness. The group agreed that on the local level there was tremendous need for particular specific data but on the national level we don't need that amount of depth.

VI. Chronic Diseases

Some members of the group questioned why chronic diseases were all lumped together. They preferred to see each chronic condition as a separate focus area. The group also questioned the reasoning of why physical impairment was included with mental disability.

The group felt that blindness and impairment conditions should be included in diabetes. Some in the group also felt that health issues related to vision were not appropriately included in the proposed 2010 plan. It was also identified that there is no lead agency discussing the issues of vision. Some areas of concern brought up were that eyes should be examined for hemoglobin taxacoma.

Stated was that arthritis health management programs want to be included in focus area of chronic diseases. It was also expressed that arthritis needs to stand now even if don't have data sources

Some in the group wanted to see of a connection to mental health.

VII. Special Populations

Some in the group felt that if special populations' specific or unique health concerns were not appropriately represented in the focus areas for Healthy People 2010 that separate focus areas be created for these race, ethnic, gender, age, social economic status, and disability populations be developed.

A new population that members in the group felt was not included or discussed is refugees and immigrants.

VIII. Behavioral Risk Factors

The group also felt that behavioral risk factors were also segmented in the current visual.

The group discussed that an identified health disparity, economic cost, the burden of disease, the impact on morbidity and mortality were all good characteristics of objectives to be considered for inclusion into Healthy People 2010. It was stated that by having objectives it would communicate a functional status of something should be done. While others brought up the concern that what if a particular illness is not treatable or we as a nation can't realistically do anything to improve the situation should we still include it as an objective? What are the ethics of drawing national attention to a situation where there may be no or minimal opportunity for change?

IX. Visual Representation

There was also a concern that reading the graphic from bottom up was difficult and perhaps confusing to the reader. Therefore, the suggestion of the repositioning the visual so it read from top to bottom was suggested.

The numerical figures identifying the proposed focus areas were also confusing to the members of the group. The number system implied a false sense of priority and some felt was a connection to the future printed document but of no utility in the visual. The group agreed that displaying the focus areas in alphabetical order would eliminate any indication of prioritization. It was also suggested that there be an index in the printed and electronic versions of Healthy People 2010.

Some discussion was spent on the colors of the visual. The group agreed that the current colors are just too arbitrary. The various colors also split and limit the association among the enabling goals and the focus areas. It was also communicated that it would be essential to have the color copy of the visual, when reproduced in black and white, be able to represent as close as possible the relationships in the color copy, as the group anticipates that the graphic will be photocopied an uncountable number of times. It was also commented that the visual needs to illustrate more fluidity. It was suggested to use arrows in the graphic. Another suggestion was to expand the fan to a complete circle.

Participants

Frank Vinicor, Facilitator, Centers for Disease Control and Prevention
Miryam Granthon, Recorder, Office of Disease Prevention and Health Promotion
J. O'Neal Adams
Patricia Brugliera, Arthritis Foundation
Sharon Hipkins, Asthma and Allergy Foundation of America
John Shoemaker, Prevent Blindness America

Breakout Session List