Public Health Assessment in the 1990s

In 1990, the Secretary of Health and Human Services unveiled Healthy People 2000: National Health Promotion and Disease Prevention Objectives (46), which is a milestone in public health. Healthy People 2000 identifies three national health goals: increase the span of healthy life, reduce health disparities among Americans, and achieve access to preventive services for all Americans. The report also details 300 specific objectives for health promo­ tion and disease prevention programs with quantitative targets to be achieved by the year 2000. Meeting these objectives requires agreement by public health statisticians on measures of individual and community health status to guide public health policy development and priorities, especially for state and .local areas, and improvement in the methods, for tracking these measures. Healthy People 2000 challenges public health practitioners to develop surveillance systems that are both meaningful in a public health sense and statistically sound. To clarify this challenge and outline some possible re­ sponses, I begin with some background on the public health assessment activities on which the year 2000 health objectives build and considerations that should guide public health assessment efforts. The next section presents general statistical issues in formulating measurable and meaningful objec­ tives. Other sections are devoted to two specific issues: the development of a small set of health status indicators that is both meaningful and feasible to monitor and special issues associated with setting objectives and determining appropriate targets for state and local areas.