Government Proposes Sweeping Health Goals : Master plan: Bush Administration official hopes for dramatic results by the year 2000. But experts caution that more money is needed.

The Bush Administration Thursday proposed a master plan to dramatically increase the nation’s health by the year 2000, describing the report as “a call to healthier lives for all Americans.”

The health blueprint, released by Health and Human Services Secretary Louis W. Sullivan at a two-day health conference, identified 298 specific objectives in 22 priority areas. They range from fitness, nutrition and tobacco use to maternal and infant health, cancer and heart disease prevention, AIDS, immunization against illness and the health of minority members.

“We must assume more responsibility for our own good health and the health of others,” Sullivan told conference participants. “Good health can preserve dignity and choice. It can enhance empowerment. Poor health can lead to dependence, loss of dignity and premature death.”

The vast majority of Americans, he said, “do have a choice--we can exercise our freedom to preserve our health or to diminish it.”

Sullivan noted that Americans spent $600 billion on health care last year and said his department has estimated that, “unless changes are forthcoming, our nation’s health care costs will reach $1.5 trillion by the year 2000.”

He said that he is particularly distressed by the health status of low-income minority members, saying that the death rate among black infants is twice that of whites. Further, he said, this health disparity “continues throughout life.”

In proposing its overall health objectives, the department outlined specific ways to achieve them, such as increasing exercise, cutting down on dietary fat and giving up cigarettes and alcohol. Sullivan urged the numerous organizations and agencies that contributed to the report to “take the message to the people.”

“We need your active participation to inform your family, friends, neighbors, co-workers and community,” he said. “And we need more than words--we need a clear, serious and constant acceptance of personal responsibility--from each and every American . . . from you as our nation’s health care and community leaders, and from me as the nation’s top health officer.”

Although many experts agree that the goals are laudable, some voiced doubts about whether they can be achieved without new federal programs and spending increases. The report itself proposed no new programs, but critics said they are necessary to meet at least some of the major objectives.

“When you don’t put money into programs, you don’t get the results,” said Rae K. Grad, executive director of the National Commission to Prevent Infant Mortality. “We need these objectives to translate into dollars, including federal dollars.”

Rep. Henry A. Waxman (D-Los Angeles), chairman of the House Energy and Commerce subcommittee on health, agreed.

“From one side of its mouth, the Bush Administration issues goals for better health for Americans,” he said. “But, from the other side of its mouth, the same Bush Administration opposes paying for the health programs that would make these goals real. That’s not health policy. That’s kinder and gentler hypocrisy.”

Sen. Edward M. Kennedy (D-Mass.), chairman of the Senate Labor and Human Resources Committee, used the report’s release to call again for a national health insurance program. Enacting such a program, he said, is the “best way and perhaps the only realistic way” to achieve the goals.

But federal health officials insisted that many of the goals are “within our personal grasp,” pointing out that 40% to 70% of premature deaths in this country are the result of lifestyle choices, such as smoking, diet and the consumption of alcohol and drugs.

“Personal behaviors represent a sizable contribution to premature mortality,” said Dr. J. Michael McGinnis, deputy assistant secretary for health and director of the office of disease prevention.

Further, he said in an interview, meeting the goals requires a collaborative effort, not just action by the federal government.

For example, he said, the Administration has proposed changes in the poverty definition under Medicaid that would make more poor women eligible for the program, which includes such services as prenatal care, considered critical to lowering the infant mortality rate.

However, he said, “the problem has been in getting the states to agree to it and pick up their share of the tab.” This kind of initial investment ultimately would be “recouped by a reduction in the treatment side of things,” he said.

He added: “The major purpose of this report is to indicate that there is a substantial measure of better health that can be accomplished by the American people. There really are important national opportunities here.”

The overall objectives include:

* A reduction in the death rate from coronary heart disease to no more than 100 per 100,000 people. In 1987, the figure was 135 per 100,000. The goals listed blacks as a special population target, aiming for a reduction to 115 from the 1987 rate of 163.

* A reduction in the rise in cancer deaths to achieve a rate of no more than 130 per 100,000 people, which was the 1970 level. In 1987, the figure was 133.

* Limiting the annual incidence of diagnosed AIDS cases to no more than 98,000. An estimated 44,000 to 50,000 cases were diagnosed in 1989, but the number of new cases has been increasing steadily every year. Experts believe, however, that these cases have occurred for the most part among individuals who were infected many years earlier and that future cases can be curbed by reducing the number of new infections. AIDS can have a long incubation period--up to 10 years or more--before the onset of symptoms.

* A reduction in the infant mortality rate to no more than seven deaths per 100,000 live births. Preliminary data released last week reported the 1989 rate at 9.7.

The report was developed during the last three years by the Public Health Service, working with 272 national voluntary and health organizations and state and territorial health officials.

A similar health plan was released in 1980, with goals aimed at 1990. A midcourse review of these goals in 1987 showed that about half of the goals had been achieved, or were “well on their way” toward achievement by 1990; about one-quarter appeared unlikely to be achieved, and the status of the remainder was unclear because statistics were unavailable for tracking their progress, the latest report said.