Healthy People 2000 Midcourse Review and 1995 Revisions
Joanne F. Guthrie
When the Dietary Guidelines for Americans was first published in 1980 as a statement of Federal nutrition policy and a summary of the best knowledge of how diet can promote health, the Federal Government was also considering new ways of directing and monitoring its health promotion and disease prevention activities in order to increase their effectiveness.
In Promoting Health/Preventing Disease: Objectives for the Nation, published in 1980, the U.S. Department of Health and Human Services adopted a management-by-objectives planning process borrowed from the business world: to set measurable objectives for improvements in health status and risk reduction for Americans. These objectives were broad in scope, encompassing such areas as nutrition, substance abuse, cardiovascular risk factor reduction, and many others. Several of the nutrition objectives were consistent with the recommendations or goals of the Dietary Guidelines for Americans. Measurable levels of improvement (target outcomes) in each area were established for achievement in 1990.
In 1990, Healthy People 2000: National Health Promotion and Disease Prevention Objectives was published. The Year 2000 objectives built upon those established in 1980, with some modification and expansion. For example, such health problems as HIV infection and cancer were added as priority areas.
As in 1990, a key aspect of the project was the development of measurable objectives for monitoring improvement. Again, the nutrition objectives frequently paralleled the Dietary Guidelines for Americans. For example, Year 2000 nutrition objectives include decreased consumption of total fat, saturated fat, and sodium; increased consumption of fruits, vegetables, and grains; and reduction in the prevalence of overweight, all recommendations of the Dietary Guidelines for Americans.
The Healthy People 2000 Midcourse Review and 1995 Revisions provides a mid-decade report on progress on these objectives. The midcourse review also prompted development of new objectives in response to changes in health knowledge and health concerns. The box on pp. 24-25 presents nutrition objectives for the year 2000 plus six objectives from other priority areas that have been added to the Nutrition priority area in 1995.
The findings presented here are a summary of those reported in the Healthy People 2000 Midcourse Review and 1995 Revisions. The data reported are taken from the review itself, although the original data used to evaluate progress toward objectives were obtained from a wide range of public and private sources and compiled for the review.
Three overarching goals have been established for the Healthy People 2000 initiative. These are to: (1) increase the span of healthy life for Americans, (2) reduce health disparities among Americans, and (3) achieve access to preventive services for all Americans. Priority areas for health improvements that would lead to the achievement of these goals have also been established. There are 22 priority areas, which fall into three broad categories–health promotion, health protection, and preventive health services.
Within each priority area, objectives have been set for improvement. The objectives are designed to achieve three major types of outcomes–changes in health status, changes in risk reduction factors, and changes in health care service and protection. Health status objectives assess progress toward reduction of death, disease, and disability and enhancement of functional status, including physical, mental, and social functioning. Risk reduction objectives target the reduction of physical, environmental, social, or behavioral risks to health (e.g., cigarette smoking, use of safety belts). Services and protection objectives are aimed at increasing the comprehensiveness, accessibility, and/ or quality of preventive services and protective interventions (e.g., blood pressure and cholesterol screening, testing for lead-based paint in older homes).
For each objective, baseline data have been obtained whenever possible and measurable target figures established for accomplishment of the objective. In addition to objectives that address the total population, more than 200 objectives or subobjectives address needs of special population groups. In all, there are more than 500 specific objectives and subobjectives for which targets have been established.
Summary of Progress
Halfway to the year 2000, a review of the available data indicates that progress is being made in accomplishing many but not all of the Healthy People 2000 goals and objectives. Since 1990, average life expectancy has increased by about three-quarters of a year, reaching a new high of almost 76 years. The infant mortality rate declined to a new low of 8.5 per 1,000 live births in 1992. However, international data indicate that there is still room for improvement: compared with other industrialized nations, the United States ranks 24th in infant mortality rates.
Progress toward meeting established targets has been made on about 50 percent of the objectives. For 18 percent, however, the situation has worsened, with available data indicating movement further away from the target; 3 percent show no change from the baseline; and for the remaining 29 percent, evaluation data are not yet available.
To provide a broad perspective on the overall progress of the initiative, 47 “sentinel” objectives were selected for particular examination (see table). There are sentinel objectives for each of the 22 priority areas, allowing assessment of progress in each area.
Healthy People 2000: Progress on 47 sentinel objectives
Objective Baseline(a) Update(g)
Health promotion
1. Physical activity
– more people exercising regularly 22%(c) 24%(j)
– fewer people never exercising 24%(c) 24%(j)
2. Nutrition
– fewer people overweight 26%(b) 34%(h)
– lower fat diets 36%(b) 34%(h)
3. Tobacco
– fewer people smoking cigarettes 29% 25%
– fewer youth beginning to smoke 30% 27%
4. Alcohol and other drugs
– fewer alcohol-related automobile
deaths (per 100,000) 9.8 6.8
– less alcohol use among 25.2%(e) 18.0%
youth age 12-17 years
– less marijuana use among 6.4%(e) 4.9%
youth age 12-17 years
5. Family planning
– fewer teen pregnancies (per 1,000) 71.1(c,r) 74.3(i,r)
– fewer unintended pregnancies 56%(e) NA
6. Mental health and mental disorders
– fewer suicides (per 100,000) 11.7 11.2
– fewer people reporting 44.2%(c) 39.2%
stress-related problems
7. Violent and abusive behavior
– fewer homicides (per 100,000) 8.5 10.3(k)
– fewer assault injuries 9.7(d) 9.9(k)
(per 100,000)
8. Educational and community-based programs
– more schools with comprehensive school
– health education NA NA
– more workplaces with health 65%(c) 81%(k)
promotion programs
Health protection
9. Unintentional injuries
– fewer unintentional injury 34.7 29.6
deaths (per 100,000)
– more people using automobile 42%(e) 67%(l)
safety restraints
10. Occupational safety and health
– fewer work-related deaths 6(m) 5
(per 100,000)
– fewer work-related injuries 7.7(m) 7.9
(per 100,000)
11. Environmental health
– no children with blood lead 25 gg/dl 234,000(n) 93,000(h)
– more people with clear 49.7%(e) 76.5%
air in their communities
– more people in radon-tested houses 5%(f) 11.4%
12. Food and drug safety
– fewer salmonella outbreaks 77(f) 63
13. Oral health
– fewer children with dental caries 54% 52%
– fewer older people without teeth 36%(d) 30%
Preventive services
14. Maternal and infant health
– fewer newborns with low weight 6.9% 7.1%(k)
– more mothers with first 76.0% 77.7%(k)
trimester care
15. Heart disease and stroke
– fewer coronary heart disease
deaths (per 100,000) 135 114(k)
– fewer stroke deaths 30.4% 26.4%
(per 100,000)
– better control of high blood 11%(b) 21%(h)
pressure
– lower cholesterol levels 213 mg/dl(b) 205mg/dl(h)
16. Cancer
– decrease cancer deaths 134 133
(per 100,000)
– increase screening for breast 25% 55%
cancer (age>50)
– increase screening for cervical 88% 95%
cancer (age>18)
– increase fecal occult blood 27% 30%(k)
testing (age>50)
17. Diabetes and chronic disabling
conditions
– fewer people disabled by 9.4% 10.6%
chronic conditions
– fewer diabetes-related deaths 38(d) 38(k)
(per 100,000)
18. HIV infection
– slower increase in HIV 400(f) NA
infection (per 100,000)
19. Sexually transmitted diseases
– fewer gonorrhea infections 300(f) 172
(per 100,000)
– fewer syphilis infections 18.1(f) 10.4
(per 100,000)
20. Immunization and infectious
diseases
– no measles cases 3058(e, q) 312(q)
– fewer pneumonia and influenza 19.9(o) 23.1(p)
deaths (per 100,000)
– higher immunization levels 54-64% 67%
(age 19-35 months)
21. Clinical preventive services
– financial barriers to
recommended preventive services 16%(f) 17%
Surveillance and data systems
22. Surveillance and data systems
– common and comparable health
status indicators in use across 0 States 48 States
States
Total
Year
2000 Right
Objective targets direction
Health promotion
1. Physical activity
– more people exercising regularly 30% X
– fewer people never exercising 15%
2. Nutrition
– fewer people overweight 20%
– lower fat diets 30% X
3. Tobacco
– fewer people smoking cigarettes 15% X
– fewer youth beginning to smoke 15% X
4. Alcohol and other drugs
– fewer alcohol-related automobile
deaths (per 100,000) 8.5 X
– less alcohol use among 12.6% X
youth age 12-17 years
– less marijuana use among 3.2% X
youth age 12-17 years
5. Family planning
– fewer teen pregnancies (per 1,000) 50.0(r)
– fewer unintended pregnancies 30%
6. Mental health and mental disorders
– fewer suicides (per 100,000) 10.5 X
– fewer people reporting 35% X
stress-related problems
7. Violent and abusive behavior
– fewer homicides (per 100,000) 7.2
– fewer assault injuries 8.7
(per 100,000)
8. Educational and community-based programs
– more schools with comprehensive school
– health education 75%
– more workplaces with health 85% X
promotion programs
Health protection
9. Unintentional injuries
– fewer unintentional injury 29.3 X
deaths (per 100,000)
– more people using automobile 85% X
safety restraints
10. Occupational safety and health
– fewer work-related deaths 4 X
(per 100,000)
– fewer work-related injuries 6.0
(per 100,000)
11. Environmental health
– no children with blood lead 25 gg/dl 0 X
– more people with clear 85% X
air in their communities
– more people in radon-tested houses 40% X
12. Food and drug safety
– fewer salmonella outbreaks 25 X
13. Oral health
– fewer children with dental caries 35% X
– fewer older people without teeth 20% X
Preventive services
14. Maternal and infant health
– fewer newborns with low weight 5%
– more mothers with first 90% X
trimester care
15. Heart disease and stroke
– fewer coronary heart disease
deaths (per 100,000) 100 X
– fewer stroke deaths 20.0% X
(per 100,000)
– better control of high blood 50% X
pressure
– lower cholesterol levels 200 mg% X
16. Cancer
– decrease cancer deaths 130 X
(per 100,000)
– increase screening for breast 60% X
cancer (age>50)
– increase screening for cervical 95% X
cancer (age>18)
– increase fecal occult blood 50% X
testing (age>50)
17. Diabetes and chronic disabling
conditions
– fewer people disabled by 8%
chronic conditions
– fewer diabetes-related deaths 34
(per 100,000)
18. HIV infection
– slower increase in HIV 400
infection (per 100,000)
19. Sexually transmitted diseases
– fewer gonorrhea infections 225 X
(per 100,000)
– fewer syphilis infections 10.0 X
(per 100,000)
20. Immunization and infectious
diseases
– no measles cases 0 X
– fewer pneumonia and influenza 7.3
deaths (per 100,000)
– higher immunization levels 90% X
(age 19-35 months)
21. Clinical preventive services
– financial barriers to
recommended preventive services 0
Surveillance and data systems
22. Surveillance and data systems
– common and comparable health
status indicators in use across 40 States X
States
Total 33
Wrong No No
Objective direction change data
Health promotion
1. Physical activity
– more people
exercising regularly
– fewer people
never exercising X
2. Nutrition
– fewer people overweight X
– lower fat diets
3. Tobacco
– fewer people
smoking cigarettes
– fewer youth
beginning to smoke
4. Alcohol and other drugs
– fewer alcohol-related
automobile deaths
(per 100,000)
– less alcohol use among
youth age 12-17 years
– less marijuana use among
youth age 12-17 years
5. Family planning
– fewer teen pregnancies
(per 1,000) X
– fewer unintended
pregnancies X
6. Mental health and
mental disorders
– fewer suicides
(per 100,000)
– fewer people reporting
stress-related problems
7. Violent and abusive behavior
– fewer homicides
(per 100,000) X
– fewer assault injuries X
(per 100,000)
8. Educational and
community-based programs
– more schools with
comprehensive school X
– health education
– more workplaces with
health promotion programs
Health protection
9. Unintentional injuries
– fewer unintentional injury
deaths (per 100,000)
– more people using
automobile safety restraints
10. Occupational safety and health
– fewer work-related deaths
(per 100,000)
– fewer work-related injuries X
(per 100,000)
11. Environmental health
– no children with
blood lead 25 gg/dl
– more people with clear
air in their communities
– more people in
radon-tested houses
12. Food and drug safety
– fewer salmonella outbreaks
13. Oral health
– fewer children with
dental caries
– fewer older people
without teeth
Preventive services
14. Maternal and infant health
– fewer newborns with low weight X
– more mothers with first
trimester care
15. Heart disease and stroke
– fewer coronary heart disease
deaths (per 100,000)
– fewer stroke deaths
(per 100,000)
– better control of high blood
pressure
– lower cholesterol levels
16. Cancer
– decrease cancer deaths
(per 100,000)
– increase screening for breast
cancer (age>50)
– increase screening for cervical
cancer (age>18)
– increase fecal occult blood
testing (age>50)
17. Diabetes and chronic disabling
conditions
– fewer people disabled by X
chronic conditions
– fewer diabetes-related deaths X
(per 100,000)
18. HIV infection
– slower increase in HIV X
infection (per 100,000)
19. Sexually transmitted diseases
– fewer gonorrhea infections
(per 100,000)
– fewer syphilis infections
(per 100,000)
20. Immunization and infectious
diseases
– no measles cases
– fewer pneumonia and influenza X
deaths (per 100,000)
– higher immunization levels
(age 19-35 months)
21. Clinical preventive services
– financial barriers to
recommended preventive services X
Surveillance and data systems
22. Surveillance and data systems
– common and comparable health
status indicators in use across
States
Total 9 2 3
(a) 1987 unless otherwise noted
(b) 1976-80
(c) 1985
(d) 1986
(e) 1988
(f) 1989
(g) 1993 unless otherwise noted
(h) 1989-91
(i) 1990
(j) 1991
(k) 1992
(1) 1994
(m) 1983-1987
(n) 1984
(o) 1979-80 through 1986-87 influenza seasons
(p) 1987-88 through 1989-90 influenza seasons
(q) Data are expressed as measles cases
(r) Rate per 1,000
NA = not available
Physical Activity and Fitness. Progress on physical activity and fitness objectives appears to be mixed. Objectives monitoring prevalence of regular moderate and vigorous physical activity among adults have shown a slight increase. However, there has been no change in the percentage of adults who state that they never exercise. Unfortunately, little information is available on the physical activity levels of children. Two objectives for which there are data, the percentage of students in grades 9 to 12 engaged in daily school physical education and the proportion of time that students spend being physically active, show declines, however.
Nutrition. Data indicate that the prevalence of overweight among adults 20-74 years of age has increased from 26 percent in 1976-80 to 34 percent in 1988-91. Over the same period, the prevalence of overweight among adolescents increased from 15 to 21 percent. This substantial movement away from the Year 2000 target indicates that action is needed both to improve diets and to promote physical activity.
The average intake of dietary fat has declined from 36 percent of calories in 1976-80 to 34 percent in 1988-91. Numerous changes have taken place that may promote further dietary improvement. Since implementation of the Nutrition Labeling and Education Act in 1994, more understandable and useful food labels appear on most packaged foods. More lowfat foods are now available to consumers, a Healthy People objective for which the original target has now been surpassed. An increasing number of worksites now offer nutrition education, weight management, and/or physical fitness programs for employees.
Tobacco. Progress continues to be made in reducing cigarette smoking. The prevalence of cigarette smoking among the general adult population dropped to 25 percent in 1993. It continues to be considerably higher among some special population groups, including American Indians/Alaska Natives, blue-collar workers, and military personnel, however, indicating that special attention needs to be paid to these groups. The prevalence of smoking among adults 20-24 years of age, a proxy measure of youth initiation to smoking, dropped from 30 percent in 1987 to 27 percent in 1993. One objective in which there was movement in a negative direction was the percentage of female cigarette smokers who quit during pregnancy. Compared with 39 percent who quit in 1985, only 31 percent quit in 1991.
Alcohol and Other Drugs. One of the most dramatic areas of improvement is the reduction of alcohol-related automobile deaths. The reduction by 1993 to 6.8 deaths per 100,000 people exceeded the Year 2000 target of 8.5 deaths per 100,000. Major factors in achieving this success have been the passage and enforcement of stricter laws regulating alcohol-related driving issues by many States.
In general, alcohol use appears to be on the decline. Annual per capita alcohol consumption in the United States dropped from 2.54 gallons in 1987 to 2.31 gallons in 1991. Alcohol and marijuana use declined by 29 and 23 percent respectively between 1988 and 1993 among adolescents ages 12-17 years, based on data from the National Household Survey of Drug Abuse.
Family Planning. No recent data are available on the reduction of unintended pregnancies in the general female population. Among adolescents, a high-risk group identified for special attention, the movement appears to be away from Year 2000 targets. Despite prevention efforts such as sex education, abstinence education, life skills education, and contraceptive services programs, adolescent pregnancies continue to increase, rising from 71.1 per 1,000 females in 1985 to 74.3 per 1,000 in 1990. Sexual activity among young teens also continues to increase. Among 15-year-old females, 36 percent reported being sexually active in 1991 compared with 27 percent in 1988, based on data from the Youth Risk Behavior Surveillance System.
Mental Health and Mental Disorders. Suicide rates have declined from 11.7 per 100,000 people in 1987 to 11.2 per 100,000 in 1993. One contributing factor may be the increase in persons seeking treatment for depression (one of the strongest risk factors for suicide) and other mental problems. More employers are offering worksite programs to reduce employees’ stress. The percentage of adults who report experiencing adverse health effects from stress has declined from 44.2 percent in 1985 to 39.2 percent in 1993.
Violent and Abusive Behavior. The United States ranks first among industrialized nations in violent death rates, and unfortunately, recent data indicate that the trend to increasing mortality and morbidity resulting from violent behavior is continuing. Deaths from homicide have increased from 8.5 persons per 100,000 in 1987 to 10.3 per 100,000 in 1992. The Centers for Disease Control have predicted that if current mortality trends continue, the death rate from firearms will surpass that from motor vehicle crashes in the United States by the year 2003. Injuries from assault have also increased from 9.7 persons per 100,000 in 1986 to 9.9 per 100,000 in 1992.
Educational and Community-Based Programs. A major area of success has been the rise in workplaces offering health promotion programs on such topics as physical fitness, stress management, and nutrition and weight management. The proportion of workplaces offering programs has risen from 65 percent in 1985 to 81 percent in 1992, almost reaching the Year 2000 target of 85 percent. For schools, another potential site for health promotion, there are currently no data on the number offering comprehensive health education.
Unintentional Injuries. Deaths from unintentional injuries have dropped from 34.7 per 100,000 in 1987 to 29.6 per 100,000 in 1993, approaching the Year 2000 target. One major factor in this decline has been the decrease in motor vehicle traffic fatalities, which may, in turn, be partly attributable to increased use of automobile safety restraints. Currently, two-thirds of Americans use automobile safety restraints, and one State, Hawaii, has met the Year 2000 target of 85 percent of individuals using safety restraints.
Occupational Safety and Health. While work-related injury deaths have been reduced to 5 per 100,000 workers in 1993, nonfatal injuries at work have increased slightly. In particular, repetitive trauma injuries, such as carpal tunnel syndrome, have increased. This increase may reflect the changing nature of the workplace–a rise in automation–as well as heightened awareness and improved reporting.
Environmental Health. One of the most important improvements in environmental health has been the reduction in the number of children with elevated blood lead levels from 234,000 in 1984 to 93,000 in 1989. Factors contributing to this improvement include increased use of unleaded gasoline, virtual elimination of U.S. manufactured food and drink cans containing lead solder, a ban on leaded paint and lead-containing solder for residential use, and the implementation of lead poisoning prevention programs by several States and cities.
Implementation of the Clean Air Act of 1990 has helped increase the proportion of people living in counties that meet EPA standards for air pollution from 49.7 percent in 1988 to 76.5 percent in 1993. Some progress has been made on reducing exposure to radon, with the percentage of people whose homes have been tested for radon increasing from less than 5 percent in 1989 to 11.4 percent in 1993.
Food and Drug Safety. Progress has been made in reducing Salmonella outbreaks from 77 during 1989 to 63 in 1993. National data for tracking infections caused by E. coli O157:H7, the bacteria responsible for a multi-State outbreak of food poisoning in 1993, are not currently available. The 1992-93 Food and Drug Administration Food Safety Survey found improvements in household practices such as promptly refrigerating perishable foods.
Oral Health. The oral health of Americans continues to improve. The percentage of children with dental caries declined from 54 percent in 1987 to 52 percent in 1993. The proportion of people 65 years and over with complete tooth loss declined from 36 percent in 1986 to 30 percent in 1993.
Maternal and Infant Health. Although infant mortality rates have improved, the prevalence of low birthweight has increased, with 7.1 percent of babies born weighing less than 5.5 pounds in 1992. The number of babies born with Fetal Alcohol Syndrome has also increased, from 0.22 per 1,000 live births in 1987 to 0.67 per 1,000 in 1993, although this may be at least partly a function of changes in reporting.
More mothers are receiving prenatal care in the first trimester, although Black, Native American, and Hispanic mothers are less likely than other mothers to receive care in the first trimester. The percent of mothers breastfeeding has increased–56 percent in 1993, compared with 54 percent in 1988.
Heart Disease and Stroke. Over the past 25 years, death rates from coronary heart disease and stroke have declined by 49 percent and 58 percent, respectively, and current data indicate that the decline in mortality is continuing. Improvements in control of cardiovascular risk factors have accompanied this decline. Blood cholesterol levels have dropped and control of high blood pressure has improved. These changes seem to be attributable, at least partly, to dietary and lifestyle change, as well as earlier screening, detection, and treatment.
Cancer. Cancer deaths have declined slightly from 134 per 100,000 people in 1987 to 133 per 100,000 in 1993. One major area of improvement has been increased screening for detection of such common types of cancer as breast cancer, cervical cancer, and colon cancer (fecal occult blood testing).
Diabetes and Chronic Disabling Conditions. The proportion of people disabled by such chronic conditions as back problems, asthma, and hearing or visual impairment has increased from 9.4 percent in 1987 to 10.6 percent in 1993. There has been no change in the prevalence of diabetes-related deaths or of most diabetes-related complications, although there has been a reduction in lower extremity amputations among people with diabetes.
HIV Infection. Data are not currently available to evaluate progress on the Year 2000 target of slowing the increase in HIV infection. In general, the nature of the HIV disease–with its relatively long incubation period between infection and symptoms–creates problems for tracking the progress of AIDS prevention efforts: most of the people who will be diagnosed as having AIDS between now and the year 2000 already have been infected. Some prevention-oriented objectives show progress, including increased condom use by sexually active unmarried people, the increased percentage of injecting drug users in drug abuse treatment or using uncontaminated drug paraphernalia, and the increased safety of blood supply.
Sexually Transmitted Diseases. Rates of nearly all sexually transmitted diseases are declining. Both gonorrhea and syphilis are declining in prevalence, with syphilis rates almost meeting the Year 2000 target. The rate of decline, however, is not as great among minorities.
Immunization and Infectious Diseases. The number of reported measles cases declined from 3,058 in 1988 to 312 in 1993. The prevalence of numerous other infectious diseases, including mumps, rubella, diphtheria, and poliomyelitis, has declined, and the proportion of young children who have received age-appropriate immunizations has increased. The introduction of a new vaccine reduced the incidence of Haemophilus influenza meningitis by 95 percent. Deaths from pneumonia and influenza among adults 65 years and over have increased from 19.9 per 100,000 people in 1979-87 to 23.1 per 100,000 in 1987-90, despite increased immunization levels for these illnesses among older adults. Another area of concern is the rise in the prevalence of tuberculosis, especially among minorities, as well as the decline in the proportion of tuberculosis patients who complete therapy to prevent further spread of the disease.
Clinical Preventive Services. This area encompasses such services as immunizations, screening tests for early detection of disease, and patient education and counseling. In addition to being clinically effective and having a positive impact on quality of life, preventive services have a strong probability of being cost-effective. Therefore, the increase in the percentage of people under 65 years old without health care coverage–from 16 percent in 1989 to 17 percent in 1993–is a concern.
Surveillance and Data Systems. One problem in assessing the health status of Americans and progress toward improvement has been shortcomings in available data and the lack of comparable data across States. In 1991, CDC/ NCHS released a consensus set of 18 health status indicators. Forty-eight States were using the indicators in 1993, thus allowing comparability of information across States.
New Objectives
As a part of the midcourse review process, new objectives that reflect scientific developments, changes in health concerns, or new strategies for health promotion have been added to the existing Healthy People 2000 objectives. Some of these changes reflect advances in knowledge that make it possible to prevent or control health problems that previously were less amenable to treatment.
Several major studies published since 1990 have demonstrated that adequate intake of folic acid by women of childbearing age was associated with reduced risk of giving birth to a child with neural tube defects (e.g., spina bifida or anencephaly). Therefore, the Public Health Service published a recommendation in 1992 that all women capable of becoming pregnant consume 400 micrograms of folic acid daily. Because of this new information on how neural tube defects may be reduced, a new Maternal and Infant Health objective to reduce the incidence of spina bifida and other neural tube defects has been added.
Two new objectives reflecting new scientific knowledge have been added to the Diabetes and Chronic Disabling Conditions priority area. With the identification of the bacterium Helicobacter pylori as a cause of recurrent and chronic peptic ulcer disease, effective therapies have been developed to eradicate the bacteria and prevent the recurrence of peptic ulcer disease. Consequently, a new objective to reduce the prevalence of peptic ulcer disease by preventing its recurrence has been added. Other recent studies indicate that about 90 percent of diabetes-caused blindness could have been avoided through improved detection and treatment. Therefore, a new objective to increase the number of people with diabetes receiving annual eye exams that would detect treatable retinopathy has been added.
The growth of homicide as a leading cause of fatal injury to workers has prompted the addition of an objective to reduce deaths from work-related homicides to the Occupational Safety and Health Priority Area. In the area of Violent and Abusive Behavior, an objective calling for all States to enact laws requiting proper storage of firearms has been added.
Several new objectives seek to employ new strategies to control health problems. In the Tobacco Priority Area, new objectives have been added that advocate increasing taxes on tobacco products to discourage smoking and increasing the proportion of health plans that offer treatment for nicotine addiction. In the Unintentional Injuries priority area, one new objective calls for extending, to all States, laws requiting helmets for bicycle riders; and a second objective aims to increase the number of States having a graduated driver licensing system for drivers and motorcycle riders under the age of 18. In the area of controlling HIV Infection, a new objective has been added to increase the proportion of businesses offering an HIV/AIDS workplace program.
In the area of Food and Drug Safety, a new objective has been added that takes advantage of MedWatch, the FDA Medical Products Reporting Program developed in 1993. It seeks to increase the proportion of adverse event reports voluntarily sent to FDA by health professionals via this program. A second drug safety objective would increase the proportion of people receiving information on new prescriptions from prescribers or dispensers.
In addition to these completely new objectives, several pre-existing objectives have been modified to include a new emphasis on population subgroups of particular concern. These changes reflect both the ongoing concern about health disparities in America and the growth of more detailed information on health characteristics of specific population subgroups.
Continuing Progress
At the mid-point of the Healthy People 2000 initiative, appropriate strategies for continuing progress toward the Year 2000 goals and objectives must also be considered. The initiative has employed a broad-based approach toward accomplishment of its aims, with State and local communities, as well as private organizations, playing important roles in the development and implementation of intervention programs and strategies. Today, most States have developed their own disease prevention and health promotion objectives as a means of setting public health priorities and as a framework for developing and supporting legislation. To continue making progress toward the Year 2000 targets, this broad-based approach–with interventions at the family, school, worksite, and community levels–must be continued.
Nutrition Objectives
Health Status
* Reduce coronary heart disease deaths to no more than 100 per 100,000 people.
* Reverse the rise in cancer deaths to achieve a rate of no more than 130 per 100,000 people.
* Reduce overweight to a prevalence of no more than 20 percent among people aged 20 and older and no more than 15 percent among adolescents aged 12-19.
* Reduce growth retardation among low-income children aged 5 and younger to less than 10 percent.
Risk Reduction
* Reduce dietary fat intake to an average of 30 percent of calories or less and average saturated fat intake to less than 10 percent of calories among people aged 2 and older. In addition, increase to at least 50 percent the proportion of people aged 2 and older who meet the Dietary Guidelines’ average daily goal of no more than 30 percent of calories from fat, and increase to at least 50 percent the proportion of people aged 2 and older who meet the average daily goal of less than 10 percent of calories from saturated fat.
* Increase complex carbohydrate and fiber-containing foods in the diets of people aged 2 and older to an average of 5 or more daily servings for vegetables (including legumes) and fruits, and to an average of 6 or more daily servings for grain products. In addition, increase to at least 50 percent the proportion of people aged 2 and older who meet the Dietary Guidelines’ average daily goal of 5 or more servings of vegetables/fruits, and increase to at least 50 percent the proportion who meet the goal of 6 or more servings of grain products.
* Increase to at least 50 percent the proportion of overweight people aged 12 and older who have adopted sound dietary practices combined with regular physical activity to attain an appropriate body weight.
* Increase calcium intake so at least 50 percent of people aged 11-24 and 50 percent of pregnant and lactating women consume an average of 3 or more daily servings of foods rich in calcium, and at least 75 percent of children aged 2-10 and 50 percent of people aged 25 and older consume an average of 2 or more servings daily.
* Decrease salt and sodium intake so at least 65 percent of home meal preparers prepare foods without adding salt, at least 80 percent of people avoid using salt at the table, and at least 40 percent of adults regularly purchase foods modified or lower in sodium.
* Reduce iron deficiency to less than 3 percent among children aged 1-4 and among women of childbearing age.
* Increase to at least 75 percent the proportion of mothers who breastfeed their babies in the early postpartum period and to at least 50 percent the proportion who continue breastfeeding until their babies are 5-6 months old.
* Increase to at least 75 percent the proportion of parents and caregivers who use feeding practices that prevent baby bottle tooth decay.
* Increase to at least 85 percent the proportion of people aged 18 and older who use food labels to make nutritious food selections.
Services and Protection
* Achieve useful and informative nutrition labeling for virtually all processed foods and at least 40 percent of ready-to-eat carry-away foods. Achieve compliance by at least 90 percent of retailers with the voluntary labeling of fresh meats, poultry, seafood, fruits, and vegetables.
* Increase to at least 5,000 brand items the availability of processed food products that are reduced in fat and saturated fat.
* Increase to at least 90 percent the proportion of restaurants and institutional food service operations that offer identifiable low-fat, low-calorie food choices, consistent with the Dietary Guidelines for Americans.
* Increase to at least 90 percent the proportion of school lunch and breakfast services and child care food services with menus that are consistent with the nutrition principles in the Dietary Guidelines for Americans.
* Increase to at least 80 percent the receipt of home food services by people aged 65 and older who have difficulty in preparing their own meals or are otherwise in need of home-delivered meals.
* Increase to at least 75 percent the proportion of the Nation’s schools that provide nutrition education from preschool to 12th grade, preferably as part of comprehensive school health education.
* Increase to at least 50 percent the proportion of worksites with 50 or more employees that offer nutrition education and/or weight management programs for employees.
* Increase to at least 75 percent the proportion of primary care providers who provide nutrition assessment and counseling and/or referral to qualified nutritionists or dietitians.
In 1995, six objectives from other priority areas have been added to the Nutrition priority area, recognizing that diet can contribute to the prevention of these diseases.
Health Status
* Reduce stroke deaths to no more than 20 per 100,000 people.
* Reduce colorectal cancer deaths to no more than 13.2 per 100,000 people.
* Reduce diabetes to an incidence of no more than 2.5 per 1,000 people and a prevalence of 25 per 1,000 people.
Risk Reduction
* Reduce the prevalence of blood cholesterol levels of 240 mg/dL or greater to no more than 20 percent among adults.
* Increase to at least 50 percent the proportion of people with high blood
pressure whose blood pressure is under control.
* Reduce the mean serum cholesterol level among adults to no more than 200 mg/dL.
Source: U.S. Department of Health and Human Services, Public Health Service, Healthy People 2000 Midcourse Review and 1995 Revisions.
Summarized by Joanne F. Guthrie
Nutritionist Center for Nutrition Policy and Promotion
COPYRIGHT 1996 Superintendent Of Documents
COPYRIGHT 2004 Gale Group
