32 Laying the foundation for public health priorities: Healthy People 2030

Natalie DiPietro Mager, PharmD, PhD, MPH

Leslie Ochs, PharmD, PhD, MSPH

Introduction

Healthy People is a framework that provides direction regarding the nation’s most pressing public health challenges. This health initiative, coordinated by the Office of Disease Prevention and Health Promotion within the United States Department of Health and Human Services, is a future-oriented approach to promote health and prevent disease. At the start of each decade, measurable objectives are released with the intent to work toward their achievement over the next 10 years. The most recent edition is Healthy People 2030.¹

Table 1 lists the vision, mission, foundational principles, and overarching goals of Healthy People 2030. While most of the overarching goals are similar to Healthy People 2020, there are two notable changes. This iteration maintains an emphasis on health equity and social determinants of health (SDH/SDOH), but for the first time, explicitly states attaining health literacy as an area of focus. Additionally, as there is growing recognition of factors outside of the healthcare system that influence health, a new overarching goal was added to collaborate across public, private, and not-for-profit sectors to improve health and well-being.¹

There are 355 measurable objectives included in Healthy People 2030; this represents a decrease from Healthy People 2020, which had over 1,000 objectives. The number of objectives were intentionally reduced to bring attention to the highest-priority public health issues, diminish overlap, and use higher data standards than in previous decades. There is an online crosswalk available that shows how objectives have changed from 2020 to 2030. Users of Healthy People 2030 are encouraged to utilize the website to identify the needs and priority populations in their own communities and to take national data to set local targets for their programs. In this way, Healthy People helps guide the work of both public health and clinical health professionals.¹ Pharmacists have embraced their role in public health by providing services such as chronic disease management, counseling for smoking cessation, immunizations, emergency preparedness and response, and health education. Working with public health officials to solve health problems and using Healthy People 2030 objectives to identify priority areas of intervention justifies the essential role that pharmacists play in public health and improving the health of our communities and nation.

Table 1. Healthy People 2030 Framework ¹

Case and Questions

You have been asked to serve on a public health advisory committee at the local health department. The committee has been tasked to create a roadmap to achieve public health goals for the local community. Your committee has decided to use Healthy People 2030 as a framework to understand the most pressing public health challenges. By using the findings from Healthy People, local health department activities will be more aligned with state and national public health priorities. You have also been asked to discuss the role of the pharmacist in helping to achieve Healthy People objective targets.

To begin your work, navigate to: https://health.gov/healthypeople. Review the “Home” and “About” tabs to become more familiar with Healthy People 2030 and why this document is important.

Select one of the leading health indicators (across the life spans) listed below:

• Adults who receive a colorectal screening based on the most recent guidelines
• Adults with hypertension whose blood pressure is under control
• Cigarette smoking in adults
• New cases of diagnosed diabetes in the population
• Current use of any tobacco products among adolescents
• Maternal deaths
• Drug overdose deaths
• Persons who are vaccinated annually against seasonal flu
• Adolescents with major depressive episodes (MDE) who receive treatment
• Persons who know their HIV status

Click on the arrow next to “Objectives and Data.” Once in the drop-down menu you see two tabs: “Leading Health Indicators” and “Social Determinants of Health.” Work through these sections to complete the questions for your selected indicator.

1. What is the overall purpose of Healthy People 2030? Describe the purpose of the leading health indicators (LHIs). What is the focus of the indicators and what do they address?

2. Review the leading health indicator you selected, and health behaviors associated with the indicator. Click on the indicator highlighted in blue in this section. This will take you to an objective overview page. On the top of the page you will see the objective for your leading health indicator and status for this objective. Below the baseline status is a summary and topic (health behavior) the objective. What was the objective for your leading health indicator? What was the baseline for your leading health indicator objective? What is the target for 2030? In the “Data methodology and measurement” section on this page, what were the changes for this objective from Healthy People 2020 to Healthy People 2030? Do you think these changes will impact the measurement of this objective? If so, how?

3. After reviewing the status of your leading health indicator objective and reading the summary, click on the topic (health behavior) in blue. Select 2-3 objectives from this page that you may be interested in and review. What is the current status of each of the objectives you selected? What is the target for 2030? Do you think we will be on target to achieve this objective(s)? Why or why not? What are the opportunities and challenges for pharmacists and student pharmacists in helping to achieve the objective targets?

4. Next go to the “Social Determinants” tab. What are the social determinants of health? Which determinants of health should be considered? How can pharmacists and student pharmacists help to address these determinants of health?

5. Why is it important for pharmacists and student pharmacists to use information from Healthy People 2030 in the planning of public health programs and interventions?

Author Commentary

Pharmacists have had long-standing roles in public health activities, and Healthy People provides direction for the profession’s continued efforts.^2-3 Pharmacists and student pharmacists can impact many of the objectives included in Healthy People 2030 directly or as members of interdisciplinary teams. Although pharmacists have made significant contributions to public health, gaps in services exist in our communities. The pharmacists’ role in public health must be broadened and include collaboration with other public health professionals to improve access to care and health equity. Increasingly, pharmacists have been incorporated into a wide range of public health initiatives, including disease surveillance, community outreach, chronic disease management, emergency preparedness, and vaccinations. Additional roles that would support community health and the public health infrastructure include participating in community needs assessments and monitoring health outcomes. Other roles may also include program planning and evaluation, policy development and analysis, and health informatics. To be most effective in these expanded roles, it will be important that pharmacists in all practice settings have greater access to data from public health and healthcare health information exchanges and surveillance systems.⁴

Student pharmacists must receive adequate education and training to deliver a full range of public health interventions that address health problems and support patients in understanding and navigating an increasingly complex healthcare system. To that end, the Healthy People Curriculum Task Force (HPCTF), a group of representatives from eight health professional education associations, including the American Association of Colleges of Pharmacy, have created the Clinical Prevention and Population Health Curriculum Framework as guidance on topic areas to be included in health professions education to prepare students to impact population health.⁵

Patient Approaches and Opportunities

Even if not an “official” part of their job title or description, by the very nature of their work, pharmacists impact public health every day. Similarly, student pharmacists who intern in pharmacies, administer immunizations, or perform outreach activities focused on areas including patient screening and community education are also engaged in public health activities. These interventions at the individual or local level are termed the “micro” level of public health and roll up to big changes at the population, or “macro” level.^2,3 The Healthy People objectives guide where these efforts should be focused to make the greatest impact. Additionally, the Healthy People website includes evidence-based resources that can be used or adapted when planning action on the topic areas.¹

Healthy People also has an emphasis on health equity, SDH/SDOH, and health literacy.¹ Health equity is key to ensuring that everyone has fair opportunity to attain their full health potential.⁶ SDH/SDOH are the non-medical factors that affect people’s health, well-being, and quality of life. Healthy People 2030 has an increased and overarching focus on social determinants of health as they are key to attaining better health and well-being. Healthy People 2030 now defines and differentiates personal health literacy and organizational health literacy. It is important for pharmacists to not only assess patients’ understanding and involve them in decision-making, but also to realize that pharmacies, pharmacy organizations, and healthcare systems have a responsibility to address health literacy.¹ Pharmacists’ recognition and action on these areas are key to improving the nation’s health.