Healthier Americans: Translating the broad strokes into clear objectives

For each of the last three decades, the federal government has issued a litany of goals for improving Americans’ health -- a sort of decadal list of resolutions to guide government programs, mobilize public health workers and the medical community, and remind Americans where we need to step up our efforts to get healthier.

The latest, “Healthy People 2020,” calls for progress in a total of 42 areas of health.

The Department of Health and Human Services, which issues the “Healthy People” reports, calls them the “master plan” for boosting the nation’s health. But if their lofty objectives are meant to be reached, master plans need to have concrete objectives, to set priorities, and to ensure there are means in place to measure progress.

So, they call in the National Academies of Science’s Institute of Medicine to do that. The resulting IOM report, released Tuesday, issued 24 objectives that “warrant priority attention in the plan’s implementation.”

Many of this decade’s priority objectives clearly verge into hotly political territory, particularly in the midst of a partisan tug-of-war over the Patient Protection and Affordable Care Act signed into law last March. Others lead directly to more intimately familiar places, such as our beds (reduce the number of Americans who don’t get enough sleep), our refrigerators (reduce consumption of calories from solid fats and added sugars) and our minds (reduce the proportion of people who experience major depressive episodes).

Here’s the list:

• Increase educational achievement of adolescents and young adults.
• Increase the proportion of people with health insurance.
• Increase the proportion of people with a usual primary care provider.
• Increase the proportion of people who receive appropriate evidence-based clinical preventive services.
• Reduce the overall cancer death rate.
• Reduce the number of days the Air Quality Index exceeds 100.
• Increase the proportion of children who are ready for school in all five domains of healthy development: physical development, social-emotional development, language, cognitive development, and approaches to learning.
• Reduce pregnancy rates among adolescents.
• Reduce central-line-associated bloodstream infections.
• Improve the health literacy of the population.
• Reduce coronary heart disease deaths.
• Reduce the proportion of people with hypertension.
• Increase the proportion of sexually active people who use condoms.
• Reduce fatal and nonfatal injuries.
• Reduce the proportion of people who experience major depressive episodes.
• Reduce low birth weight and very low birth weight.
• Reduce the proportion of obese children and adolescents.
• Reduce consumption of calories from solid fats and added sugars by people age 2 and older.
• Increase the proportion of adults who meet current federal guidelines for aerobic physical activity and for muscle-strengthening activity.
• Reduce the proportion of people engaging in binge drinking of alcoholic beverages.
• Reduce past-month use of illicit substances.
• Increase the proportion of adults who get sufficient sleep.
• Reduce tobacco use by adults.
• Reduce the initiation of tobacco use among children, adolescents, and young adults.