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Flourishing After a Pandemic: Healthy People 2030

Koh, Howard K. MD, MPH; Blakey, Carter BS; Ochiai, Emmeline MPH

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Journal of Public Health Management and Practice: November/December 2021 - Volume 27 - Issue - p S215-S217
doi: 10.1097/PHH.0000000000001415
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As communities everywhere struggle to recover from an earth-shattering pandemic, an exhausted nation is yearning for well-being more than ever. COVID-19—a preventable fast pandemic fueled by an equally preventable slow pandemic of chronic conditions such as obesity, heart disease, diabetes, and lung disease—has dramatically confirmed the inextricable link between the health of individuals and that of society as a whole. COVID-19 has strained every social determinant of health; it has closed schools, shuttered businesses, unemployed millions, and ravaged communities. For a brighter future, the Healthy People initiative stands poised to yet again serve as the public health roadmap and compass for the country.1,2

For each decennial iteration since 1979, Healthy People has leveraged the evolving science and art of public health through a federally coordinated, user-driven process to help communities become fully alive. It recognizes that “further improvements in the health of the American people...will be achieved—not alone through increased medical care and greater health expenditures but through a renewed national commitment to efforts designed to prevent disease and to promote health.”3 In each of its 4 previous iterations, Healthy People set overarching national goals, issued science-based objectives regarding key actionable health challenges, longitudinally assessed trends, and offered evidence-based resources. Healthy People 2030 now arrives to shape a future vision for a nation experiencing unprecedented need.4

Healthy People 2030 comes on the heels of a final Healthy People 2020 outcomes assessment that documented not only notable advances but also substantial unfinished business. Of the 985 Healthy People 2020 trackable objectives (those with a target, a baseline value, and at least one follow-up data point), more than half exceeded, met, or progressed toward targets, with major improvement in areas such as air quality, childhood secondhand smoke exposure, and infant mortality.5 However, about a third changed little or not at all and 14% actually worsened, receding in critical areas such as obesity, injury deaths, suicide, and adolescent major depressive episodes.5

Together these challenges threaten many key outcomes, starting with life expectancy at birth. After rising steadily during the 1970s, this measure slowed and stagnated in the 1980s, peaked in 2014 (78.9 years), and then declined for 3 consecutive years before rebounding slightly (from 78.6 years [2017]6 to 78.8 years [2019]7). When COVID-19 became a leading cause—and at times the leading cause—of death in 2020,8 US life expectancy in the first half of 2020 dropped a full year overall, by 2.7 years for the non-Hispanic Black population and by 1.9 years for the Hispanic population.9

Pandemic recovery depends on a Healthy People 2030 vision coming alive to inspire communities to thrive, not merely survive. Historically, public health monitoring has generally employed a framework that tracks disease outcomes and risk factor burden; while useful, this deficit-based perspective can prompt some to incorrectly equate “the absence of disease or infirmity” with “health.”10 In a paradigm shift, Healthy People 2030 has begun to pivot toward an asset-based approach that emphasizes population well-being (initially measured by “life satisfaction”).11 Doing so can help monitor post-COVID-19 recovery, especially for groups disproportionately impacted by the pandemic, and also track “human flourishing” that reimagines health to include concepts of happiness, meaning and purpose, close social relationships, and being a “good person.”10

Healthy People 2030 also brings urgent attention to the social determinants of health “upstream factors”—unnatural causes of disease and death—stemming from places where people are born, live, learn, work, play, worship, and age over a life course. Since the social determinants of health represent the ultimate12—not just merely important—measures of health burdened by the pandemic, Healthy People 2030 embraces a social determinants of health lens for each of its 23 Leading Health Indicators across 5 domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.13 Moreover, in a world where people are paradoxically awash in health information that they are unable to use, Healthy People 2030 extends the arc of responsibility for health literacy beyond individuals to include institutions. Doing so creates norms and standards for many more to realize improved shared decision-making through a better understanding of health-related information as the foundation for patient-centered care.14 Healthy People 2030 also advances health equity, critical for an increasingly diverse nation projected to become majority-minority by 2045.15 Its provision of demographic tools can help federal, state, local, and tribal partners track and narrow health disparities in the wake of the pandemic's devastation on communities of color.

Furthermore, Healthy People 2030 provides adaptable, evidence-based resources for a host of partners. For example, states seeking accreditation for their public health departments can align their State Health Improvement Plans with Healthy People 2030's framework involving local targets, health literacy efforts, and equity goals.16 Moreover, Healthy People 2030 links rigorous, evidence-based interventions, recommendations, and resources from leading independent review panels—including the US Preventive Services Task Force, Community Preventive Services Task Force, and the Cochrane Collaborative—that can be flexibly scaled for use by community organizations, businesses, health care organizations, or schools. Similarly, US Department of Health and Human Services grantees are encouraged to include project objectives and approaches that specifically align with Healthy People 2030 objectives as part of goal setting and evaluation.

Under the Biden Administration, laws and policies, yet another area of social determinants of health emphasis in Healthy People 2030, are taking hold. Presidential executive orders have already emphasized racial equity, environmental justice, and LGBTQ+ rights, for example. A new $1.9 trillion American Rescue Plan now offers opportunities to address critical social determinants of health challenges laid bare by the pandemic such as child poverty, housing insecurity, and lack of broadband infrastructure.17 Additional proposals before Congress could potentially bring even more resources to communities.

Nonhealth sectors are increasingly facilitating the Healthy People 2030 vision. From the pandemic's early days, private businesses creatively contributed in ways that included repurposing facilities such that garment companies could produce face masks and alcohol distilleries could make more hand sanitizer.18 Meanwhile, automobile industry efforts have begun to prioritize electric vehicle production in recognizing the need to address climate change. Faith-based organizations, major partners in COVID-19 vaccination, can serve as places of social connection and well-being; regular weekly religious service attendance has been strongly linked to lower all-cause mortality rates and reduced depression and suicide risk, possibly through enhanced social integration and supports.19 Federal government, through its Center for Faith-based and Neighborhood Partnerships, can continue this integration.19

By unifying national dialogue and encouraging new directions after a devastating pandemic, Healthy People 2030 can turn hurt into healing and hope. Its vision can once again remind a nation, through yet another decade, that we are all interdependent, interconnected, and have promises to keep.20

References

1. Koh HK. A 2020 vision for healthy people. N Engl J Med. 2010;362(18):1653–1656.
2. Koh HK, Blakey CR, Roper AY. Healthy People 2020: a report card on the health of the nation. JAMA. 2014;311(24):2475.
3. Office of the Assistant Secretary for Health, US Public Health Service. Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention. Washington, DC: US Public Health Service; 1979:262. https://profiles.nlm.nih.gov/spotlight/nn/catalog/nlm:nlmuid-101584932X92-doc. Accessed June 24, 2021.
4. Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. Healthy People 2030. health.gov. https://health.gov/healthypeople. Accessed June 30, 2021.
5. Office of the Assistant Secretary for Health. Healthy People 2020: An End of Decade Snapshot. Washington, DC: US Department of Health and Human Services; 2021:39. https://health.gov/sites/default/files/2021-03/21%20HP2020EndofDecadeSnapshot2.pdf. Accessed June 24, 2021.
6. Bastian B, Tejada Vera B, Arias E. Mortality Trends in the United States, 1900-2018. Hyattsville, MD: National Center for Health Statistics; 2020. https://www.cdc.gov/nchs/data-visualization/mortality-trends/index.htm. Accessed June 30, 2021.
7. Kochanek KD, Xu J, Arias E. Mortality in the United States, 2019. Hyattsville, MD: National Center for Health Statistics; 2021. https://www.cdc.gov/nchs/products/databriefs/db395.htm. Accessed June 30, 2021.
8. Koh HK, Geller AC, VanderWeele TJ. Deaths from COVID-19. JAMA. 2021;325(2):133–134.
9. Arias E, Tejada-Vera B, Ahmad F. Provisional Life Expectancy Estimates for January Through June, 2020. Hyattsville, MD: National Center for Health Statistics; 2021:8. https://www.cdc.gov/nchs/data/vsrr/VSRR10-508.pdf. Accessed June 24, 2021.
10. VanderWeele TJ, McNeely E, Koh HK. Reimagining health—flourishing. JAMA. 2019;321(17):1667.
11. Pronk N, Kleinman DV, Goekler SF, Ochiai E, Blakey C, Brewer KH. Promoting health and well-being in Healthy People 2030. J Public Health Manag Pract. 2020. doi:10.1097/PHH.0000000000001254.
12. Koh HK. The ultimate measures of health. Public Health Rep. 2011;126(suppl 3):14–15.
13. Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. Leading Health Indicators—Healthy People 2030. health.gov. https://health.gov/healthypeople/objectives-and-data/leading-health-indicators. Accessed June 30, 2021.
14. Koh HK, Rudd RE. The arc of health literacy. JAMA. 2015;314(12):1225–1226.
15. Frey WH. The US Will Become “Minority White” in 2045, Census Projects. Washington, DC: The Brookings Institution; 2018. https://www.brookings.edu/blog/the-avenue/2018/03/14/the-us-will-become-minority-white-in-2045-census-projects. Accessed June 30, 2021.
16. Fromknecht CQ, Hallman VA, Heffernan M. Developing state health improvement plans: exploring states' use of Healthy People. J Public Health Manag Pract. 2021;27(6 Suppl):S274–S279.
17. The White House. Fact sheet: the American jobs plan. The White House Briefing Room. https://www.whitehouse.gov/briefing-room/statements-releases/2021/03/31/fact-sheet-the-american-jobs-plan/. Published March 31, 2021. Accessed June 30, 2021.
18. Serafeim G, Rischbieth AM, Koh HK. Sustainability, business, and health. JAMA. 2020;324(2):147.
19. VanderWeele TJ, Balboni TA, Koh HK. Health and spirituality. JAMA. 2017;318(6):519.
20. Wallack L, Lawrence R. Talking about public health: developing America's “second language.” Am J Public Health. 2005;95(4):567–570.
© 2021 The Authors. Published by Wolters Kluwer Health, Inc.