Healthy People: The Role for
Measurement, Data, and
Evaluation to Inform Policies
Aimed at Improving Health
and Equity in Communities
Angela McGowan, JD, MPH
Project Director, Office of Disease Prevention and Health
Promotion, U.S. Department of Health and Human Services
Twitter: @angiemcgowan
February 11, 2020
| Law and Health Policy
Healthy People Initiative and
Developing Healthy People 2030
Law and Health Policy |
What Is Healthy People?
• Provides a strategic framework for a
national prevention agenda that
communicates a vision for improving
health and achieving health equity
• Identifies science-based, measurable
objectives with targets to be achieved
by the end of the decade
• Requires tracking of data-driven
outcomes to monitor progress and to
motivate, guide, and focus action
• Offers a model for international, state,
and local program planning
Law and Health Policy |
3
Evolution of Healthy People and Health Equity Across the
Decades
Target Year
Overarching Goals
1990
•
•
Decrease
•
mortality:
infants–adults •
Increase
independence •
among older
adults
2000
Increase span •
of healthy life
Reduce health
disparities
•
Achieve access
to preventive
services for all
2010
2030
2020
Increase quality •
and years of
healthy life
Eliminate
•
health
disparities
•
•
Attain high-quality, longer
lives free of preventable
disease
Achieve health equity;
eliminate disparities
Create social and physical
environments that
promote good health
Promote quality of life,
healthy development,
healthy behaviors across
life stages
•
•
•
•
•
Leading Health
Indicators
10 topics
22 indicators
Attain healthy, thriving lives and wellbeing, free of preventable disease,
disability, injury and premature death.
Eliminate health disparities, achieve
health equity, and attain health literacy
to improve the health and well-being of
all.
Create social, physical, and economic
environments that promote attaining
full potential for health and well-being
for all.
Promote healthy development, healthy
behaviors and well-being across all life
stages.
Engage leadership, key constituents, and
the public across multiple sectors to take
action and design policies that improve
the health and well-being of all.
12 topics
26 indicators
TBD
Topic Areas
15
22
28
42
40
Objectives
226
319
~1,000
>1,200
355 *
Law and Health
4 Policy |
Streamlining Objectives
• Objective Selection Criteria
o Baseline data from 2016 or later
o Collection of at least 2 data points
in addition to the baseline by
2030
o Address health concerns of
national importance
o Identification of at least 1
evidence-based intervention
o Considerations related to health
disparities and health equity
Healthy People 2020:
~1,200
Stage I & II
Assessment: ~500
FIW
Review:
~400
355*
* Number of Objectives Submitted for Public Comment
Law and Health Policy |
5
Healthy People 2030 Objective Types
Core Objectives
•Must address all of the core inclusion criteria
•Targets will be set
Developmental Objectives
•Focus on need to develop data sources and data collection
•Represent high priority issues that do not have reliable baseline data,
but for which evidence-based interventions have been identified
Research Objectives
•Focus on need to advance research and develop evidence-base
interventions in an area
•Represent significant opportunities for advancement in areas with
limited research, a high degree of health or economic burden
(preventable or otherwise), or evidence of substantial disparities
between populations
Law and Health Policy |
6
Role for the Social Determinants of
Health and Health Equity
Law and7Health Policy |
Healthy People’s Social Determinants of Health
Framework and Key Issue Areas
Objectives should seek to reduce health disparities and increase health equity
as much as possible, including addressing social determinants of health




Poverty
Employment
Housing stability
Food insecurity
 High school
graduation rates
 Enrollment in
higher education
 Early childhood
education and
development
 Language and
literacy
 Access to health
services
 Access to
primary care
 Health literacy
 Quality of
housing
 Crime and
violence
 Environmental
conditions
 Access to healthy
foods
 Social cohesion
 Discrimination
 Civic
participation
 Incarceration
Law and Health Policy |
Health Equity Issue Brief
Health equity is “attainment of the highest level of health for all people”
• To achieve health equity, we must recognize that multiple determinants of
health and well-being interact with each other across the life span.
• The ability of Healthy People 2030 to measure its success in achieving health
equity will depend on ongoing surveillance of health inequalities between more
and less advantaged social groups.
Law and Health Policy |
Healthy People Data and Disparities Resources
Law and Health Policy |
Law and Policy in Healthy
People and Tools and
Resources to Identify and
Evaluate Evidence-Based
Laws and Policies
Law and Health Policy | 11
Why Use Law and Policy to Help Meet Healthy People Goals?
Private
Entities
Federal
Tribal
Businesses
Local
NonProfits
Religious
Groups
State
Regulations
Statutes &
Ordinances
Case Law
Licensure
Law and Policy Actions
Handbooks
Contract
Language
Budgets
Accreditation
Guidance
Documents
Law and Health Policy |
12
Law and Policy in Healthy People, 1990–2020
Decade
Healthy People
1990
Objectives
Related to
Law and Policy
4 of 226
objectives
Topic Areas
with Law
and Policy
Objectives
Relevant Topic Areas
3 of 15
topic areas
Toxic Agent and Radiation Control, Smoking and Health, Nutrition
Healthy People
2000
27 of 319
objectives*
10 of 22
topic areas
Tobacco, Substance Abuse: Alcohol and Other Drugs, Violent and
Abusive Behavior, Unintentional Injuries, Occupational Safety and
Health, Environmental Health, Food and Drug Safety, Cancer,
Diabetes and Chronic Disabling Conditions, Immunization and
Infectious Diseases
Healthy People
2010
23 of ~1,000
objectives^
6 of 28
topic areas
Environmental Health, Injury and Violence Prevention, Physical
Activity and Fitness, Public Health Infrastructure, Substance Abuse,
Tobacco Use
10 of 42
topic areas
Adolescent Health, Early and Middle Childhood, Environmental
Health, Injury and Violence Prevention, Maternal, Infant, and Child
Health, Nutrition and Weight Status, Physical Activity,
Preparedness, Substance Abuse, Tobacco Use
Healthy People
2020
59 of >1,200
objectives^
• In HP2000, some objectives were included under more than one topic area. These duplicate objectives were given more than one
objective number (e.g., 3.11 and 10.18) . For this exercise, these objectives are counted twice to reflect they are in both topic areas.
˄ In HP2010 and HP2020, some objectives are grouped under a main objective "header." The sub-objectives are the measurable
objectives. The number of relevant objectives reflects all measurable objectives that are related to law and policy.
Law and Health Policy |
13
Law and Health Policy Project
Reports and Related Products
• Reports and community “Bright Spots”
Webinar Series
• Focused on specific Healthy People 2020 topics
• Shares community examples of innovative uses of law
and policy to improve health outcomes
Supporting the Development of Healthy People 2030
(HP2030)
• HP2030 Listening Session: 2018 Public Health Law
Conference
For more information: www.healthypeople.gov/2020/lawand-health-policy
Law and Health Policy |
14
Law and Policy effectively
serve as the nation’s primary
structural engineer,
responsible for its foundation,
its most important design
features, and its resiliency.
~Healthy People 2030 Law and
Policy Subcommittee
Law and Health Policy |
Law and Policy Issue Brief:
Law and Policy as Determinants of Health
Can be direct responses to health-harming social conditions
and deficiencies
Law and Legal
Policy Are
Critical
Determinants
of Health
Perpetuate social conditions that can be harmful to
health and well-being
Sometimes applied selectively based on biases that
affect distributions of health and well-being
Are hollow without regulations, funding, and effective
enforcement
Can affect health and well-being based on how they are
interpreted by the courts
Law and Health Policy |
16
Evaluation of Laws and Policies
Law and Health
17 Policy |
What Works: Evidence-Based Interventions to Protect and
Promote Public Health
Law and Health Policy |
18
What Works: The Role of Evidence-based Law and Policy
in Evidence-Based
• Laws and policies as public health
interventions
• Laws and policies that support
public health interventions and
practices
Law and Health Policy |
19
Leading Health Indicator: Injury Deaths
Approaches to Prevent
Fatal Injuries
Evidence-Based Legal and Policy Strategies
IVP 1-1: Injury Deaths
Motor vehicle injury
prevention
Helmet laws, seatbelt laws, laws and ordinances to promote complete streets and
holistic safe transit systems, policies to reduce drunk and impaired driving, and
graduated driver licensing systems
School-based violence
prevention
Anti-bullying legislation and policies, dating abuse policies
Law and20Health Policy |
Tools to Measure and Evaluate Public Health Laws and
Policies
• Legal epidemiology * is defined as the scientific study and deployment of law as a factor in the cause,
distribution, and prevention of disease and injury in a population. The field, which has been developing
during the past decade, broadens the idea of public health law to a transdisciplinary understanding that
laws, legal systems, practices, and approaches have a measurable impact on public health outcomes.
Legal practice applies the law, and legal epidemiology measures it.
o CDC’s Public Health Law Program: https://www.cdc.gov/phlp/index.html
o Temple’s Center for Public Health Law Research: http://phlr.org/
• Policy Surveillance ^ is the systematic collection, analysis, and dissemination of laws and policies
across jurisdictions or institutions, and over time. Examples of reources:
o
o
o
o
Alcohol Policy Information System (APIS): https://alcoholpolicy.niaaa.nih.gov/
Chronic Disease State Policy Tracking System (CDC): http://nccd.cdc.gov/CDPHPPolicySearch//Default.aspx
CityHealth: https://www.cityhealth.org/
LawAtlas: The Policy Surveillance Portal (Social Determinants of Health, Housing, Health Services:
http://lawatlas.org/welcome
o National Conference of State Legislatures (NCSL): http://www.ncsl.org/research/health.aspx
o WORLD Policy Analysis Center: https://ph.ucla.edu/research/centers/world-policy-analysis-center
• * Public Health Law Academy resources: https://www.changelabsolutions.org/good-governance/phla/legal-epidemiology
• ^ Burris S, Hitchcock L, Ibrahim J, Penn M, Ramanathan T. Policy Surveillance: A Vital Public Health Practice Comes of Age. J Health Polit Policy Law 2016
Dec;41(6):1151-1173. https://www.ncbi.nlm.nih.gov/pubmed/27531941
Law and Health Policy |
21
Conclusions
• Laws and policies should be measured and evaluated like other interventions to
determine impact on health and equity.
o Data and targets can be helpful tools
o Surveillance of laws and policies critical
• Law and policy can be important tools to promote health equity and to address
barriers to good health.
• Health equity has an important role in both HP2020 and HP2030.
• Improving health often requires working closely with other sectors (e.g., housing or
transportation).
o Law and policy can be helpful tools to leverage.
o HP2030 advisory committee argues law is a determinant of health.
• Goal: evidence-based laws and policies with positive impacts on health and equity
Law and Health Policy | 22
Contact Information
• For more on the Healthy People initiative, including the
development of Healthy People 2030:
o www.healthypeople.gov
• For the Law and Health Policy project:
o https://www.healthypeople.gov/2020/law-and-healthpolicy/topic/nutrition-and-weight-status
• For any other questions, please contact:
o Angie McGowan, Project Director, ODPHP:
Angela.McGowan@hhs.gov
o Twitter: @angiemcgowan
Law and Health Policy | 23
EXTRA SLIDES
Law and24
Health Policy |
Law and Health Policy Project
Law and25
Health Policy |
Law and Health Policy Project Report: Increasing Fruit
and Vegetable Intake
• Report - “The Role of Law and Policy in Achieving the
Healthy People 2020 Nutrition and Weight Status Goals of
Increased Fruit and Vegetable Intake in the United States”
• Selected Objectives for this Report
o NWS-14: Increase the contribution of fruits to the diets of the
population aged 2 years and older
o NWS-15.1: Increase the contribution of total vegetables to
the diets of the population aged 2 years and older (LHI)
• Project landing page and materials available at:
https://www.healthypeople.gov/2020/law-and-health-policy
• Focuses on increasing fruit and vegetable intake through
increasing access, affordability, and demand
• Four “Bright Spots” are included:
o Minneapolis Staple Foods Ordinance, Navajo Nation’s:
Healthy Diné Nation Act, Georgia’s Growing Fit, and New
York City’s Green Carts Initiative
Law and Health Policy |
Developing Healthy People 2030
Phase I
Development of Framework
2019
2018
2017
Dec 2016
Phase II
Development of Objectives
Launch
March
31, 2020
Jan
2019
June 2017
Public Comment/Stakeholder Input
Secretary’s Advisory Committee on National Health
Promotion and Disease Prevention Objectives for 2030
develops recommendations for HHS Secretary
HP FIW develops
guidance and Agency
Leads develop
recommendations for
Healthy People 2030
framework and objectives
Law and10
Health Policy |
Healthy People 2030 Development - Next Steps
• Complete design of the new Healthy People 2030 website
• Launch of Healthy People 2030 anticipated for March 31, 2020
• HP2030 launch will include a new website (healthypeople.gov) that will be tailored to meet the
needs of Healthy People users
• Development of Foundation Health Measures for Healthy People 2030
• Development of the Leading Health Indicators for Healthy People 2030 (anticipated launch in
2020)
Law and Health Policy |
Sample HP2020 Data Template
Total
Sex
• Male
• Female
Age Group (continued)
• 65 years and over
– 65-74 years
– 75-84 years
– 85 years and over
Race/Ethnicity
Educational Attainment (25 years and over)
• American Indian or Alaska Native only
• < High school
• Asian only
• High school
• Native Hawaiian or Other Pacific Islander only • Some college
• Black or African American only
• Associates degree
• White only
• 4-year college degree
• 2 or more races
• Advanced degree
• Hispanic or Latino
• Not Hispanic or Latino
Family income (percent poverty threshold)
• Black or African American only, not Hispanic or • <100
Latino
• 100-199
• White only, not Hispanic or Latino
• 200-399
• 400-599
Age Group
• 600+
• <18 years
– 0-4 years
Family type
– 5-11 years
• Single
– 12-17 years
• Single parent with children
• 18-44 years
• Married couple or partners
– 18-24 years
• Two parent family with children
– 25-44 years
• Other
• 45-64 years
– 45-54 years
Country of birth
– 55-64 years
• US
• Outside US
Disability status (18 years and over)
• People with disabilities
• People without disabilities
Geographic location
• Metropolitan
• Non-metropolitan
Health insurance status (<65 years)
• Insured
– Private
– Public
• Uninsured
Sexual orientation
• Straight
– Straight, Male
– Straight, Female
• Gay/Lesbian
– Gay, Male
– Gay/Lesbian, Female
• Bisexual
– Bisexual, Male
– Bisexual, Female
Marital status (18 years and over)
• Married
• Cohabiting partner
• Divorced or separated
• Widowed
• Never married
29
30
30
State-Level Data and Maps
Selection of
state-level
data or maps
31
Uses of Healthy People
• Data tool for measuring program performance
• Framework for program planning and development
• Goal setting and agenda building
• Teaching public health courses
• Benchmarks to compare state and local data
• Way to develop nontraditional partnerships
• Model for other plans and countries
• Community health assessments
• Public health accreditation
32