Grading the health of the nation

by The Incidental Economist on June 30, 2014 · 2 comments

Howard Koh, the Assistant Secretary for Health for the U.S. Department of Health and Human Services, has written a viewpoint (with colleagues) that was recently published in JAMA. In it, he details how the United States is moving toward achieving the health goals set forth in Health People 2020. What is Healthy People?

Healthy People provides science-based, national goals and objectives with 10-year targets designed to guide national health promotion and disease prevention efforts to improve the health of all people in the United States.  For three decades, Healthy People has established benchmarks and monitored progress over time…

Healthy People 2020 contains about 1,200 objectives in 42 Topic Areas designed to serve as this decades framework for improving the health of all people in the United States.

We have data for about a third of the decade, so it seems an appropriate time to check in and see how we’re doing. If you read the JAMA piece, and I encourage you to do so, you would likely come away feeling pretty good. After all, as Koh and colleagues report, 14 of the leading 26 indicators have shown improvement. This is surely a good thing. But even when we see improvement, there’s still a long way to go.

The percent of adults receiving screening for colorectal cancer went from 52% to 59%. But the goal is 75%. The percent of adults with hypertension under control went from 44% to 49%. But the goal is 61%.  the percent of kids receiving all their vaccines went from 44% to 69%. The goal is 80%. Injury deaths are down; preterm births are down. Adolescent drug use is down and adult cigarette smoking is down. Both have room to move, though.

Some goals have been met. The air is much cleaner, and fewer kids are exposed to secondhand smoke. The homicide rate is below projections. Adults are exercising, too. All this is good.

But a number of goals have seen little or no improvement. Obesity among both adults and children is steady to up. Vegetable consumption has not improved. Binge drinking remains a problem in adults, and smoking remains steady in adolescents. The percent of people insured and who had a primary care provider remains relatively unchanged. Diabetes is still poorly controlled.

And some things have gotten worse. Suicide is actually more common than it was before. So are adolescents reporting major depressive episodes. Fewer people are seeing the dentist than before, too.

I understand the administration’s desire to make things look good. I really do. But improving in 54% of metrics is barely more than half. In terms of a grade, I don’t see how that’s much better than an F. The things we’re failing on are of critical importance. We’re talking about obesity, nutrition, diabetes, alcohol, and cigarette use. We’re talking about depression and suicide. These are not minor issues. They are major problems.

An important aspect, and one often overlooked, is that we too often lack an evidence base for making things better. We know where we are, and we know where we want to be, but we’re not all in agreement as to how we should get there. More research needs to be performed. More data needs to be gathered. We need to study solutions, and to promote those that work. This is some of the critical work that health services research can do.

I’m glad to see that we’re holding ourselves accountable. I’m glad to see we’re getting feedback early and often. But we have a long way to go to make the nation healthier.