Healthy People is a set of recurring 10 year objectives, established by the U.S. government, to set goals and track performance on over 1200 objectives in 42 public health areas. The overall goal? To improve the nation’s health, both by setting incremental objectives and monitoring research-based information over each 10 year period. There are 26 Leading Health Indicators (LHIs) that comprise the highest-priority objectives in various target areas (e.g., mental health, access to clinical care, physical well-being) and these represent an overall snapshot of whether Americans are improving, staying stagnant, or getting worse at health objectives. The latest March 2014 data showcase both exciting and disappointing trends:
1. Access to health care services (as measured by assessing the number of Americans with health insurance and the number of Americans with a primary care provider) has stayed the same and is not meeting the goal. The impact of the individual mandate for health insurance and other reforms contained within the 2010 Patient Protection and Affordable Care Act (known as Obamacare) have likely not yet shown up in these data, so it is too soon to tell whether this sweeping reform act will benefit access as it was designed to do. Conclusion? Cannot yet be determined.
2. In general, more adults and children are receiving beneficial preventive care services such as cancer screenings, blood pressure assessment and treatment, and immunizations. However, we are still far below the target goals set for these services by 10-20 percentage points in each category, and the number of adults with uncontrolled diabetes is increasing. Conclusion? Promising progress, but we need to continue to expand preventive services.
3. Mental health measurements are not improving, as the number of suicides are increasing and more adolescents are being treated for major depressive episodes. This is discouraging, as mental and physical health are irrevocably intertwined. Both life itself and our ways of living it are critical to well-being. Conclusion? Mental health services and research into these trends should be expanded.
4. Obesity has remained relatively stable among children and adults, with 16.9% of children and 35.3% of adults classified as obese. Our vegetable consumption (a powerful indicator of an overall healthy diet) has remained stagnant, below goal. Interestingly, the number of adults meeting guidelines for aerobic and strength-based physical activity is at goal– with 20% of adults meeting federal guidelines! It’s hard to cheer on this goal given that the target seems so abysmally low. Conclusion? We could do a lot better.
Data also show beneficial (but relatively small) improvements in that fewer adults are smoking, fewer children are exposed to secondhand smoke, and fewer adolescents are using drugs and alcohol. Overall, it’s promising to see incremental progress. However, of the 26 LHIs published in the March 2014 progress report, 10 are improving, 8 have shown little change, and 3 are getting worse, demonstrating that public health change of this nature happens at a relatively glacial pace. And, for many of the targets (especially those aimed at diet, obesity and physical activity), it’s hard not to be discouraged by the unambitious targets set in Healthy People 2020. We can do better, and we should.