With 2010 nearly over, the Department of Health and Human Services (HHS) has updated its Healthy People program to reduce health risk factors and disparities, providing new topics and objectives for 2020.
The Healthy People initiative began in 1979 with a Surgeon General's report, which set public health targets to be reached by 1990. It has been revised in 10 year increments ever since.
The 2020 version identifies nearly 600 objectives, ranging from homicides to smoking cessation attempts, in 42 topic areas.
In announcing the update, HHS called the new targets and objectives "ambitious yet achievable."
For example, the department set a national goal for new-onset diabetes of 7.2 cases per 1,000 adults in 2020, compared with the current baseline of 8.0.
The goal setters noted that a wide range of interventions and services are available to meet the goal, such as community-based programs to promote physical activity and healthy diets.
But much of the Healthy People track record fails to support HHS' optimism.
In announcing the new update, the department claimed that "the country has either progressed toward or met" 71% of the Healthy People 2010 targets.
However, a 51˶ review of data posted on the Healthy People 2010 website indicated that most of this progress was minimal and few of the objectives were met completely.
Among the successes: significant increases in pediatric pneumococcal vaccination rates and reductions in the number of emergency department visits for asthma among children and adults.
Perhaps the most important achievement was in reducing coronary heart disease deaths. The Healthy People 2010 target was 162 per 100,000 population, starting from 203 when that goal was set in 2000.
By 2004, the CHD death rate had already fallen below the target to 160 per 100,000, and it has continued to decrease.
Reductions in stroke deaths have also exceeded the target.
But for most of the targets, progress was minimal or nonexistent.
Adult smoking rates, for example, declined from 23% in 2000 to 21% in 2008 (the most recent year with data reported by HHS), falling well short of the goal of 12%.
The record for diabetes was even worse. Healthy People 2010 set a target of 3.8 new-onset diabetes cases per 1,000 adults for this year, a reduction from the 2000 rate of 5.7 cases per 1,000.
Instead, the rate increased by 40% to the current level of 8.0 per 1,000.
The new version sets more modest targets in many cases.
For instance, whereas Healthy People 2010 had sought a 33% cut in new-onset diabetes rates, the 2020 update is targeting only a 10% reduction.
On the other hand, Healthy People 2020 still sets a goal of 12% for adult smoking rates.
Agency officials said the nation needs goals as a framework both for policy and for individual behavior change.
"Healthy People is the nation's road map and compass for better health, providing our society a vision for improving both the quantity and quality of life for all Americans," said Howard Koh, MD, MPH, the department's assistant secretary for health, in a press release.
The American Heart Association issued a statement endorsing the plan's goals for cardiovascular health.
"The obesity epidemic has taken a toll on the health and vitality of communities across the country due to sedentary behaviors and lack of access to healthy foods, areas that promote physical activity, and weight management services," said the group's CEO, Nancy Brown, in the statement.
"We support initiatives that will educate more Americans about recommended levels for sodium consumption, added sugars, saturated fat, and other ingredients that are found in many processed foods and restaurant meals."
She also praised the goals for smoking cessation, although she noted that "work lies ahead to boost funding" for programs that will cut smoking significantly.