NCHStats

STATCAST, APRIL 2021: DISCUSSION WITH DAVID HUANG, CHIEF, STATISTICIAN, ABOUT HEALTHY PEOPLE INITIATIVE.

HOST:  David Huang is the chief of the health promotion statistics branch at NCHS, and serves as the center’s primary statistical advisor on the Healthy People initiative. Healthy People for decades now has been identifying science-based objectives with targets to monitor progress and motivate and focus action aimed at improving the health of the nation.  David joined us to discuss the history of the program, what is going on presently, and what the future directions are.

HOST:  So we can expect more products coming in the future – in the days, weeks, months ahead – from “Healthy People 2020.”  What about any differences between “Healthy People 2030” and “2020” – what are some of the more distinctive differences?

DAVID HUANG:  I think the main difference is that there was really a concerted effort by the Department and its stakeholders to reduce the size of “Healthy People.” “2020” was becoming very large and in some ways unwieldy, and it was felt that the initiative had grown too large to be really useful for its stakeholders.  So as part of these efforts, we went through a process over the past several years where we reduced the size of the initiative itself.  We went from about 1100 objectives with data in “2020” to 355 for “2030.”  In addition to that, there was also an effort to maintain a better balance and structure across the initiative.  So during the development of “2030,” after all of the objectives went through the approval process with the interagency steering committee – the federal interagency work group -there was actually another group that reviewed the objectives, the slate of objectives as a whole, and looked for balance.  And there were actually some objectives that were removed, I think one or two that were added, and that was something that was not part of the “2020” process in terms of looking at the balance of objectives as a whole.  As I mentioned earlier, we made sure that the objectives themselves were aligned with the latest science and that included aligning with the latest recommendations, the latest evidence, and also the latest issues that are important in the field of public health, specifically disease prevention and health promotion.

HOST:  Any other future directions that you like to talk about as far as the Healthy People program?

DAVID HUANG: Well of course we’re wrapping up “Healthy People 2020” with the release of a couple of more components that will comprise the rest of the “Healthy People 2020 Final Review.”  As part of that work, we’re also working on a Statistical Note on the elimination of health disparities, specifically among racial and ethnic groups, as well as a more formal archive site for both “Healthy People 2020” and “Data 2020,” which is the Healthy People 2020 database.  Now for “Healthy People 2030,” of course there is a lot to do over the next decade.  And we’re working on a variety of interactive tools, infographics, and products, working with our federal partners including ODPHP.  And this will start with the launch of our database, “Data 2030,” later this year.  Of note also, our webinars that are related to the leading health indicators and overall health and well-being measures.  And finally I’ll note that we are working on a “Healthy People 2030” disparities tool in collaboration with the HHS Office of Minority Health and ODPHP.

HOST:  One question that comes to mind – for “Healthy People 2030” are there any specific objectives dealing with the pandemic?

DAVID HUANG:  So we don’t have anything that is necessarily directly related to COVID, but certainly as many listeners will be aware there are many risk factors and diseases that are tied to COVID-19, and there’s actually a customized list that the Department has created that has all of the “Healthy People 2030” objectives directly related to COVID and this list is actually available to the public from the “Healthy People 2030” website.

HOST:  Anything else at all that we haven’t covered here that you like to mention?

DAVID HUANG:   Sure.  I actually wanted to mention that in terms of the new decade the branch is actually looking forward to expanding outreach and dissemination efforts throughout the decade, and this is actually possible because we do have a more focused and parsimonious set of objectives in Healthy People 2030.

HOST:  Very good – well, thank you David for joining us.

DAVID HUANG:  You’re welcome.

MUSIC BRIDGE:

HOST:  Our thanks to David Huang for joining us on this edition of “Statcast.”

HOST:  This week NCHS released a new report examining the prevalence of underlying chronic conditions among U.S. adults in the years leading into the pandemic. The analysis helps us understand how many people were at high risk for severe COVID-19 illness going into the pandemic.  Seven risk factors were examined: obesity – in particular severe obesity, diabetes, chronic obstructive pulmonary disease or COPD, serious heart conditions including heart failure, coronary artery disease, and cardiomyopathies, chronic kidney disease or CKD, and smoking.  The data come from the 2015-2018 National Health and Nutrition Examination Survey, and showed that 3/4 of all adults in the U.S. had at least one of these chronic conditions or risk factors that put them at high risk for severe COVID-19 illness, and over 86% of non-Hispanic black adults had one or more of these conditions.

STATCAST, APRIL 2021: DISCUSSION WITH DAVID HUANG, CHIEF, STATISTICIAN, ABOUT HEALTHY PEOPLE INITIATIVE.

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20210416/20210416.htm

HOST:  David Huang is the chief of the health promotion statistics branch at NCHS, and serves as the center’s primary statistical advisor on the Healthy People initiative. Healthy People for decades now has been identifying science-based objectives with targets to monitor progress and motivate and focus action aimed at improving the health of the nation.

HOST:  So there are obviously – since the beginning of the program – there’ve been hundreds and hundreds of objectives set.  Do you have any sort of gauge of how many objectives or what percent of the objectives of we’ve met over the years or exceeded?

DAVID HUANG:  Sure – so we look at these really decade by decade.  And for Healthy People 2020, which we’re closing out now, there were 985 trackable objectives, which were those with at least a baseline and one or more follow up data points.  And of these 985, 334 of these – which is about a third – had met or exceeded their targets at the end of the decade.  This compares with Healthy People 2010, where 172 of 733 – or about 1/4 of trackable objectives – met or exceeded their targets.  Note that over the decades, the balance and composition of objectives as well as target setting methods themselves do vary, so any of these sorts of comparisons across decades should be taken with a grain of salt.

HOST:  Right, so it’s not a direct apples to apples comparison but your goal is always to increase the proportion that are met?

DAVID HUANG:  Yes and no.  I mean I think certainly we do want to say that we’ve met more and more of our targets, but on the flip side you know some of that is directly related to how the targets are set as well as I mentioned kind of the balance and composition of the objectives themselves, so again not an apples to apples comparison.  It’s certainly something that the Department and Healthy People stakeholders are paying attention to.

HOST:  Now you alluded to COVID-19 – what happens when new health challenges appear on the scene, such as COVID-19?

DAVID HUANG:  One of the hallmarks of the Healthy People initiative is its ability to incorporate new science and innovation as well as emerging health priorities.  For example, Healthy People 2030 includes science-based objectives related to opioids and social determinants of health, which are top priorities for HHS and for the nation.  The initiative itself does allow the flexibility for new objectives to be added or even dropped as the decade progresses.  The new Healthy People 2030 website actually features a resource for building customizable lists of objectives that can be used to curate objectives that are relevant to specific goals.  So even though there isn’t anything necessarily specific on COVID-19 in Healthy People 2030, HHS has used this tool to develop a custom list of 2030 objectives that are directly related to COVID-19 and that list is actually available to the public on the Healthy People website.

HOST:  Before we get into some specifics as far as progress made in these objectives, in looking at the new tables I noticed that in some cases there’s more recent data then what you’re referring to as far as the end point. I’ll use some of the cancer death measures – I think 2017 was used and even though there was great progress made on that there’s obviously more recent data than 2017.  So we’re just curious why you don’t use the latest year of data?

DAVID HUANG:  So what you’re referring to is the set of progress tables that we developed for the Healthy People 2020 final review, which is our end of decade assessment of progress.  And because we were dealing with so many objectives and data sources we had to choose a data cutoff and for the Healthy People 2020 final review, that cutoff was January of 2020.  So yes, we certainly acknowledge we don’t necessarily have the latest available data for this report, but the intention is really to be looking across all objectives which is a broad range of objectives.  And certainly we would encourage folks to look to other sources, such as Healthy People 2030 as well as other indicator projects and programs to find the actual latest available data for each individual indicator.

HOST: Our thanks to David Huang for joining us on this edition of “Statcast.”

MUSIC BRIDGE:

HOST:  This week the country reached a grim milestone in the fight against drug abuse. NCHS released the latest monthly provisional numbers showing more than 90,000 Americans lost their lives due to drug overdoses in the one-year period ending in September 2020.  This figure was nearly 29% higher than the total observed the year before.  Over 2/3 of those deaths – or nearly 67,000 – involved an opioid of some kind.  As has been the case for the last several years, fentanyl and other synthetic opioids are the drugs driving this increase.  Among the 50 U.S. states and DC, only South Dakota saw a decline in overdose deaths from the previous year.

NCHS also released a new report this week on flu vaccination among U.S. children.  Using data from the 2019 National Health Interview Survey, NCHS determined that just over half of children six months of age up to age 17 received a flu vaccine in the past year, and that older children were less likely to receive a flu vaccine than younger children.

STATCAST, APRIL 2021: DISCUSSION WITH DAVID HUANG, CHIEF, STATISTICIAN, ABOUT HEALTHY PEOPLE INITIATIVE.

HOST:  David Huang is the chief of the health promotion statistics branch at NCHS, and serves as the center’s primary statistical advisor on the Healthy People initiative. Healthy People for decades now has been identifying science-based objectives with targets to monitor progress and motivate and focus action aimed at improving the health of the nation.

David joined us to discuss the history of the program, what is going on presently, and what the future directions are.

HOST: David can you start by telling us a little bit about the history of the Healthy People program?

DAVID HUANG:  Sure.  Established in 1979, Healthy People is a science-based 10-year national initiative for improving the health of all Americans based on the latest available scientific evidence.  And at its core Healthy People provides a strategic framework for a national prevention agenda that communicates a vision for improving health and achieving health equity but at the heart of the initiative are the science-based measurable objectives with targets to be achieved by the end of each decade.  With the recent release of Healthy People 2030 last August, we’re actually now in our fifth decade of the initiative and while the Department of Health and Human Services or HHS leads the initiative through the Office of the Assistant Secretary for Health Office of Disease Prevention and Health Promotion or ODPHP, NCHS has served as the statistical advisor to the initiative since the first iteration of Healthy People.

HOST:  This program has been going on for quite a while – now how important is it in public health to have specific goals to work towards?

DAVID HUANG:  Well there are many federal health indicator projects, but the inclusion of a quantifiable target for each objective is a unique feature that distinguishes Healthy People from other broad federal prevention initiatives.  The use of targets was inspired by the “Management by Objectives” movement which emphasize setting of organizational goals and objectives and was outlined by Peter Drucker in his 1954 book called “The Practice of Management.”  Targets have been an integral part of Healthy People since its inception in 1979.  The examination of data relative to targets is considered critical to the usefulness of Healthy People as targets do communicate policy expectations and expert or evidence based recommendations to a wide range of stakeholders.  Moreover, targets offer a marker for assessing progress for each objective and for the initiative as a whole.

HOST:  How do you decide what the target is – is there any way of gauging whether it might be too lofty of a goal or too easy of a goal.  How is that process?

DAVID HUANG:  Targets are actually set by subject matter experts that are on topic area work groups and these are folks from across the Department.  Some from actually outside of HHS who provide subject matter expertise and at the end of the day these are the folks who are responsible for determining targets.  As policy constructs, NCHS does not advise one way or the other but we do provide statistical support as needed because there are certainly many cases where statistical methods are used to calculate targets.

HOST:  So there’s a lot of folks involved in this, is that correct?

DAVID HUANG:  Yes I would say probably hundreds from across the Department and certainly if you look at the stakeholder base of Healthy People, there are folks outside of government at the sub-national level, nonprofits… and really the intention is for Healthy People to reach the individual level.  In an ideal world that’s how I think the Department would like to see it.

HOST:  I wanted to then ask you what generally happens when you achieve one of these goals?  What happens to that health issue or condition as far as Healthy People goes?

DAVID HUANG:  Sure that’s definitely an interesting question and certainly one that has come up historically, particularly when targets are met or exceeded early in the decade.  In the last decade, for example, there was an objective in the Immunization and Infectious Diseases topic area.  They reached out to us in 2014 and actually asked to increase the Healthy People 2020 target for a specific objective IID 14 – that was one that tracked that percentage of adults 60 years and older who are vaccinated against zoster or shingles.  Ultimately, we decided for consistency and simplicity not to officially set new in Healthy People when targets are met, but to continue tracking and reporting data throughout the decade.  The work groups that as I mentioned manage Healthy People objectives have also been given the option to set unofficial secondary targets if desired.  Sometimes targets are adjusted for other reasons.  For example, some targets are set to be aligned with national policies, programs or laws and if there is some sort of change to that underlying policy program or law we do have the flexibility to make the same change to the corresponding Healthy People target.  Another example is if an objective baseline changes due to a change in science or data collection.  In those cases, targets are generally adjusted using the same target-setting method if possible.  And finally I’ll just note that there are certainly opportunities for further progress even after targets have been met.  So for example we continued to track the further reduction in overall cancer death rates, which is objective C1 for Healthy People 2020, even though the target for that objective was met in the year 2014.   Moreover, most population-based objectives continue to have underlying health disparities by various sociodemographic factors such as race, ethnicity or family income whether they have met their targets or not.  One of the overarching goals for Healthy People is actually to eliminate health disparities and achieve health equity.  And of course this is a topic that has been further highlighted by COVID-19.

HOST:  So you’re saying the official policy is not to make any adjustments if you’ve already met an objective.  Is that also true on the flip side – if there’s no progress being made and it might become apparent that maybe the goal is a little too ambitious?  Is it the same sort of approach on that side?

DAVID HUANG:  Yeah it is a similar approach for… consistency and simplicity, not to change targets. I think in those situations where an objective is moving in the wrong direction… these certainly highlight opportunities for further work in disease prevention and health promotion.  In addition, this could be a consideration for the target-setting for the following decade if that objective happens to be carried over from one 10-year iteration to the next.

HOST:  Our thanks to David Huang for joining us on this edition of “Statcast.”