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Sunday, September 03, 2006

Healthy People 2000 Objectives

Healthy People 2000
Healthy People 2000 was adopted by the U.S. Department of Health and Human Services in 1990 in order to:
1. Increase the span of healthy life for Americans.
2. Reduce health disparities among Americans.
3. Achieve access to preventive services for all Americans. (CDC, 1997).
To achieve these goals, 22 priority areas were identified with 300 specific objectives set. The Healthy People 2000 Consortium is composed of 330 member organizations. Each priority area is overseen by a Lead Public Health Service (PHS) agency. (Appendix A).
Priority area 22:
Year 2000 Objectives:
· Develop and implement common health status indicators
· Create national data sources to track the year 2000 objectives
· Develop and disseminate among Federal/State/local agencies procedures for collecting comparable data for the year 2000 objectives.
· Improve related data for blacks, Hispanics, American Indians and Alaska Natives, Asian Americans, people with disabilities and with low incomes.
· Expand state-based activity to track progress toward year 2000 objectives.
· Improve information transfer capabilities among Federal/State/local agencies.
· Provide more timely processing of survey and surveillance data. (CDC, 1998).
The Lead PHS is the Centers for Disease Control and Prevention (CDC).
· The CDC Prevention Strategy as related to data includes;
· Secure networks for the transmission of sensitive information.
· Automatic and direct reporting from physicians offices, hospitals, and private and public laboratories.
· Computer based patient record technology.
· Strategies to integrate existing and planned information systems.
· Field applications of computer technology.
· Geographic information systems (GISs) and satellite imagery.
· New statistical and mathematical modeling methods.
In addition, an international database is being developed to improve data collection, surveillance, and dissemination of information globally.

Priority 22 Challenges
On February 18, 1997, the Department of Health and Human Services held a review on surveillance and data systems progress toward Healthy People 2000 objectives. When the first national health promotion and disease prevention objectives were published, 35% of the 226 objectives had no baseline data. (HP 2000, 1998). Despite major progress in obtaining baseline data, several areas of concern still exist.
· Infectious diseases and conditions designated as notifiable at the national level may not be notifiable at the state level (Appendix B).
· There is no unified statistical program implemented across states.
· Variations in Case Definitions for infectious conditions impede tracking of data.
· Local budget limitations may not provide technology capable of disseminating timely information.
· The use of passive surveillance reporting (provider-based) remains incomplete even when used in conjunction with laboratory-based reporting.

Current status of priority 22
Surveillance and data system objectives are supported primarily through the National Electronic Telecommunications Systems for Surveillance (NETSS). The NETSS is a computerized public health surveillance system that provides data on all cases of notifiable disease.
The Development of NETSS
The CDC in cooperation with the Council of State and Territorial Epidemiologist (CSTE) developed NETSS in 1984. In 1985 the system was deemed operable and by 1989 all 50 states had begun to participate in the reporting system, however, participation in NETSS is not mandated. Currently the CDC Division of Public Health Surveillance and Informatics (DPHSI) supports the NETSS. All information must be reported in ASCII format, however, there is no requirement as to the specific statistical/other software to be utilized. Reporting must be made by designated staff of local health departments or other authorized persons.
In addition to the use of telecommunications for the collection and dissemination of data, other suggestions are proposed in order to reach target goals. These include (but are not limited to…) the implementation of active surveillance, the use of a Unified Medical Language System (UMLS), and CDC Health Information and Surveillance Systems Board Proposed Standards.

Active Surveillance
One method of improving the completeness of reporting is to implement active surveillance. Active surveillance refers to the practice of making contact with all providers and institutions responsible for reporting on a regular basis to solicit reports rather than relying solely on passive reporting. Studies demonstrate increased reporting of measles, rebella, salmonellosis, and hepatitis when active surveillance is used.
Unified Medical Language System
The Unified Medical Language System is an “offshoot” of the numerical medical coding we have all become acquainted with. In 1986 the National Library of Medicine began a long-term research project to build a Unified Medical Language System (UMLS) to retrieve and integrate electronic biomedical information. These machine-readable “knowledge sources” assist in retrieval problems brought about by differences in terminology, coding, and the “scattering” on information across several databases.
There are four UMLS “knowledge sources”;
1. UMLS Methathesaurus
2. SPECIALIST ™ Lexicon
3. UMLS Semantic Network
4. UMLS Information Sources Map
The Methathesaurus is the most commonly used. It provides “a uniform, integrated distribution format for more than 30 biomedical vocabularies and classifications, …and links to many different names for the same concept”. The Lexicon contains “syntactic information for many Metathesaurus terms component words, and English words that do not appear in the Metathesarus”. The Semantic Network contains “information about the types of categories to which all Metathesaurus concepts have been assigned and the relationship between the types”, and finally, the Information Sources Map contains “both human readable and machine processable information about the scope, location, vocabulary, syntax rules, and access conditions of biomedical databases”. (NLM, 1998).
Proposed CDC Health Data Standards
The CDC often requires grant recipients to use CDC developed software for data transmission or develop software in compliance with CDC standards…which are complex (Example for DATE: Appendix D). Standards for Health Information and Surveillance Systems have been proposed but not yet mandated. A major barrier is the CDC developed software itself. As states integrate surveillance data into one system to be accessed by various routes and integrated with other software, the CDC developed software appears inflexible as it does not promote the exchange/integration of information with other systems. As a result, data is unavailable to different state organizations or entities.
Traditional Resources
For General Information on Healthy People 2000:
Office of Disease Prevention and Health Promotion
U.S. Public Health Services, 330 C Street, SW, Room 2132
Washington, DC 20201

For Healthy People 2000 Publications:

ODPHP National Health Information Center
POB 1133
Washington, DC 20013

For information on Surveillance and Data Systems:

Centers for Disease Control and Prevention
National Center for Health Statistics
(Note: Diane Wagener or Richard Klein)
6525 Belcrest Road
Room 630
Hyattsville, MD 20782
301. 436.3572 (FAX)

Division of Public Health Surveillance and Informatics
EPO, Mailstop C-08
Centers for Disease Control and Prevention
1600 Clifton Road, NE
Atlanta, GA 30333
404. 639.3761
404.639.1546 (FAXA)

To register to use CDC WONDER/PC contact customer support @ 404.332.4569 (phone) or 404. 488.7593 (FAX). The software and users guide is available for $50.00 or FREE if you work for a local or state health dept..

Healthy People 2000 Surveillance and Data Systems
1600 Clifton Road, NE
Mailstop A23
Atlanta GA 30333
404.639.1537 (FAX)

National Institute of Health
National Library of Medicine
MEDLARS Management
8600 Rockville Pike
Bethesda, MD 20894
301.496.4450 (FAX)

National Sources

Association of State and Territorial Health Officials
415 2nd St. NE
Suite 200
Washington DC 20002
202.544.9349 (FAX)

National Academy of Sciences
Institute of Medicine
2101 Constitution Av NW
Washington DC 20418
202.334.2158 (Fax)

Public Health Foundation
1220 L St. NW
Suite 350
Washington DC 20005
202.898.5609 (FAX)

Appendix A
Healthy People 2000 Priority Areas and Lead PHS Agencies
Physical Activity and Fitness
Presidents Council on Physical Fitness and Sports 202. 272.3421

National Institutes of Health 301.594.8822
Food and Drug Administration 202.205.5483

Centers for Disease Control and Prevention 770.488.5709

Substance Abuse: AOD
Substance Abuse and Mental Health Services Administration 301.443.7790

Family Planning
Office of Population Affairs 301.594.4000

Mental Health and Mental Disorders
Substance Abuse and Mental Health Services Administration 301.443.4111
National Institutes of Health 301.443.4513

Violent and Abusive Behavior
Centers for Disease Control and Prevention 770.488.4276

Educational and Community Based Programs
Centers for Disease Control and Prevention 770.488.5080
Health Resources and Services Administration 301.443.2460

Unintentional Injuries
Centers for Disease Control and Prevention 770.488.4652

Occupational Safety and Health
National Institutes of Health 919.541.5723

Food and Drug Safety
Food and Drug Administration 301.443.1382

Oral Health
National Institutes of Health 301.594.5579
Centers for Disease Control and Prevention 770.488.5080

Maternal and Infant Health
Health Resources and Services Administration 301.443.2170

Heart Disease and Stroke
National Institute of Health 301.496.1051

National Institutes of Health 301.496.9569

Diabetes and Chronic Disabling Conditions
National Institutes of Health 301.654.3327
Centers for Disease Control and Prevention 770.488.5080

HIV Infection
Office of HIV/AIDS Policy 202.690.5560

Sexually Transmitted Diseases
Centers for Disease Control and Prevention 1.800.27.8922

Immunization and Infectious Diseases
Centers for Disease Control and Prevention 404.639.8200

Clinical Prevention Services
Health Resources and Services Administration 301.443.5277
Centers for Disease Control and Prevention 404.637.7075

Surveillance and Data Systems
Centers for Disease Control and Prevention 301.436.3548

Appendix B

Infectious Diseases and Conditions Designated as Notifiable at the National Level 1997

2. Acute Pesticide Poisoning
3. Anthrax
4. Botulism
5. Brucellosis
6. Chancroid
7. Chlamydia trachomatis
8. Cholera
9. Coccidiodomycosis
10. Diphtheria
11. Elevated Blood levels (adult)
12. Elevated Blood levels (child)
13. Encephalitis (western equine)
14. Encephalitis (California serogroup)
15. Encephalitis (St. Louis)
16. Encephalitis (eastern equine)
17. Escherichia coli 0157:H7
18. Gonorrhea
19. Haemophilus influenza
20. Hansen disease (leprosy)
21. Hantavirus
22. Hemolytic uremic syndrome
23. Hepatitis A
24. Hepatitis B
25. Hepatitis C/non A, non B
26. HIV infection, adult
27. HIV infection, child
28. Legionellosis
29. Lyme disease
30. Malaria
31. Measles
32. Meningococcal disease
33. Mumps
34. Pertussis
35. Plague
36. Poliomyelitis
37. Prevalence of tobacco use
38. Psittacosis
39. Rabies, animal
40. Rabies, human
41. Rocky Mountain spotted fever
42. Rubella
43. Rubella, congenital syndrome
44. Salmonellosis
45. Shigellosis
46. Silicosis
47. Streptococcal disease, invasive, group A


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