The US is not making progress on public health

Aaron recently called our attention to the Healthy People 2020 report on progress in public health. The high-level goals are fundamental contributors to human well-being:

  • Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death;
  • Achieve health equity, eliminate disparities, and improve the health of all groups;
  • Create social and physical environments that promote good health for all; and
  • Promote quality of life, healthy development, and healthy behaviors across all life stages.

To make progress on these high-level goals, public health experts chose 26 specific and measurable goals, for example, to reduce the number of persons with diagnosed diabetes whose A1c value is greater than 9%.

The point of setting goals is to track whether we are getting anywhere. Are we?

Dr. Howard Koh is the Assistant Secretary for Health for the U.S. Department of Health and Human Services. In JAMA, he reports on recent progress (or lack thereof) toward the Healthy People 2020 goals.

The data demonstrate areas of both improvement and continued need. On the positive side, 14 of the 26 Leading Health Indicators (54%) have documented improvement, and 4 have met or exceeded their Healthy People 2020 targets… The new data also document no improvement for 11 of the 26 indicators (42%) and, of those, 3 show worsening health outcomes.

We aren’t making meaningful progress on public health. For example, there was little improvement in the percent of persons with high levels of A1C. There was progress in maternal and child health: Infant deaths per 1,000 live births decreased from 6.7 in 2006 to 6.1 in 2010 and total preterm live births declined from 12.7% in 2007 to 11.5% in 2012.

But we lost ground on both of our national mental health goals: The age-adjusted suicide rate increased from 11.3/100,000 in 2007 to 12.1 in 2010 and the percent of adolescents with major depressive episodes increased from 8.3% in 2008 to 9.1% in 2011.

Fourteen successes on 25 goals is not statistically better than a 50% success rate (change could not be measured for one of the goals).

Why aren’t we doing better? One reason is that we don’t pay enough attention to public health data. Every month, the economics wonks wait anxiously for reports on employment, economic growth, and so on. Twitter buzzes about relatively small improvements or declines. Those indicators matter, a lot. But are they more important than longer lives free of preventable disease, disability, injury, and premature death?


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