![](media/image1.png){width="1.40625in" height="0.6875in"}

**Request for Proposals**

**Time Line for Project: July 1, 2009 -**

> **June 30, 2010**

**Proposal Forms and Instructions Available March 12, 2009**

**Proposals Due April 27, 2009**

> **by 5:00pm MST**
>
> ***Postmarks not accepted***

**Notification of Intent to Fund or Decline June 1, 2009**

######### Agree On Project Plan, Budget and Sign Contract June 1- 26, 2009

**Funds disbursed June 1-26, 2009**

**Completion of Funded Project Activities June 30, 2010**

***Proposal forms and additional information are also available at***

[***www.healthypeople.gov/stateaction***](../www.healthypeople.gov/stateaction)

**For help with this proposal:**

[]{.mark}

**e-mail: state_action@jsi.com**

**or phone: 1.800.839.0934**

**BACKGROUND**

For three decades, Healthy People has served as an evidence-based
foundation for public health agencies and organizations to reach goals
related to improving health status in the U.S. As Healthy People has
evolved, its use has become more widespread. Public health activities
from national to local levels are increasingly aligned with Healthy
People goals and objectives.

Coordinated by the U.S. Department of Health and Human Services (HHS),
Office of Disease Prevention and Health Promotion (ODPHP), Healthy
People 2020 is being developed in 2 phases. Phase 1 includes the
framework---vision, mission, and overarching goals. The framework
provides a foundation for Healthy People 2020 objectives that will be
developed. While general in nature, the framework offers specific,
important areas of emphasis where action must be taken if the United
States is to achieve better health by the year 2020. In partnership with
the many national, federal, state and local stakeholders of the Healthy
People initiative, HHS is now in Phase 2, developing specific
objectives, targets and considering effective strategies for addressing
Healthy People 2020. The full Healthy People 2020 initiative is
anticipated to be released in 2010.

The Healthy People 2020 framework was developed by a federal workgroup
with advice and consultation from a fully public member expert advisory
committee and has included numerous opportunities for public comment.
The result is a framework for improving the nation's health which
recognizes the multiple and integrated factors that impact health. These
factors include social and physical environments as well as disease
prevention, health promotion and health care. This change from Healthy
People 2010 to Healthy People 2020 is intended to move-away from a
"silo" approach to health and promote the notion that health is not the
responsibility of the health sector alone; but also includes personal,
social, economic, and environmental determinants. In addition, new and
emerging issues and influences on health (health equity; health
information technology; all hazards preparedness) are highlighted for
their significance in promoting and ensuring the nation's health.

**PURPOSE**

The purpose of this evaluation program is to have state, territory, and
tribal governments propose and conduct innovative and participatory
strategic planning activities and processes, with an emphasis on
multi-sector collaboration, using the Healthy People 2020 framework and
population health improvement concepts (i.e., Healthy People 2020
mission and overarching goals; social, physical, and environmental
determinants of health; and health equity) to improve the health of
their communities. ODPHP is interested in evaluating the utility of the
Healthy People 2020 framework in guiding program and policy for eligible
entities in addition to their state, regional and community partners and
stakeholders. ODPHP is also interested in entities' responses to the
revised Healthy People initiative to a more integrated approach to
address health determinants and diseases/conditions.

Awardees will receive funding to support activities that create a
dynamic and flexible approach to operationalizing the Healthy People
2020 framework to address their specific population health contexts and
needs. Since draft Healthy People 2020 objectives are expected during
the implementation of projects, awardees should plan to incorporate them
into their project design to address state disease prevention and health
promotion priorities and needs.

Funding from this evaluation program is intended to enhance existing or
planned state, territorial, and tribal activities to develop a Healthy
People plan based on the national Healthy People 2020 framework and
objectives.

**FUNDING INFORMATION**

-   A maximum of \$37,000 will be awarded per project.

-   Up to 12 projects will be funded.

-   Multiple submissions representing a single eligible entity will not
    be reviewed (see below for eligibility criteria).

-   Awardees will be chosen to represent geographic diversity as well as
    a variety of themes and activities.

-   Projects will cover the period July 1, 2009 to June 30, 2010.

-   This is a one-time funding opportunity.

**WHO CAN APPLY**

Eligible applicants that can apply for this funding opportunity are
listed below:

-   State and territory health departments (this includes the District
    of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands,
    the Commonwealth of the Northern Marianna Islands, American Samoa,
    Guam, the National Government of the Federated States of Micronesia,
    the Republic of the Marshall Islands, and the Republic of Palau).

-   Federally recognized Indian tribes, tribal organizations, tribal
    epidemiology centers and urban Indian organizations.

Preference will be given to projects that demonstrate collaboration with
and inclusion of other relevant groups. Preference will also be given to
proposals that demonstrate a broad and diverse target audience,
particularly underserved populations (e.g. low-income, minority, etc.).
State Health Departments that have tribal entities within their borders
are encouraged to seek the participation of those tribal entities in
planning and implementing their project.

**TYPES OF ACTIVITIES TO BE FUNDED**

Proposed projects should include innovative planning activities---using
the Healthy People 2020 framework components and population health
improvement concepts--that build upon the organization's existing
planning processes and structure. They should also include evidence of
collaboration with diverse users and audiences to implement Healthy
People 2020 (health professionals, consumers, business, community
leaders, and stakeholders from multiple sectors). Examples of possible
activities include:

-   Facilitated meetings for multi-sectoral decision makers to engender
    buy-in and support

-   Technical assistance in identifying measures around social
    determinants of health

-   Development of products and information media regarding Healthy
    People 2020 activities

-   Web-based applications to support Healthy People 2020 plans

Please note that ongoing operations will not be funded through this
project. Funded activities must be completed by June 30, 2010.

**REVIEW PROCESS**

Proposals will be reviewed by an objective committee comprised of public
health experts including Regional Health Administrators with final
funding approvals guided by the Office of Disease Prevention and Health
Promotion.

Successful proposals will be selected based on their proposed plans and
activities, scored based on the qualities described below.

Total available points: 150.

Submitters' abilities to carry out the project and complete deliverables
(30 points total)

> 1\. Experience in terms of strength/knowledge of proposed project
> team; demonstrated project involvement and support of submitting
> organization's leadership; understanding of state population
> demographics and health status/needs of the state; and experience in
> working across sectors (20 points)
>
> 2\. Readiness for carrying out the project (10 points)

Project description (100 points total)

> 1\. Relevance of the proposed project to the stated purpose of this
> program (25 points)
>
> 2\. The degree to which the proposed work plan is robust and
> reasonable to accomplish the goal(s) and meet deliverables (25 points)
>
> 3\. Demonstration of innovation and creativity in the project approach
> (20 points)
>
> 4\. Evidence of collaborations and partnerships with a diverse group
> of stakeholders, including federally recognized Indian tribes and
> other relevant tribal entities (15 points)
>
> 5\. Relevance of activities to addressing racial and ethnic health
> disparities and minority and underserved populations (15 points)

Budget (20 points total)

1.  Budget showing each item and its cost (10 points)

2.  Justification for each item listed in the budget (10 points)

In addition to meeting the selection criteria, the mix of proposals
awarded will be geographically diverse and represent a variety of themes
and activities.

The submitter must agree to participate in a national evaluation of this
project. The national evaluation will include participation in three
teleconferences and/or webcasts in addition to completion of an on-line
evaluation tool. Please note that 10 percent of awarded funds will be
withheld until final completion of the evaluation activities.

**EVALUATION**

As a condition of the final funds disbursement, funded projects must
participate in a national evaluation of the State Action: Evaluating the
Healthy People 2020 Disease Prevention and Health Promotion Agenda
project. They must indicate their commitment to participating in the
evaluation by signing the "Agreement to Complete Evaluation" on Form C.
The purpose of the evaluation is to report on how funds were used and
what was accomplished with the funds.

The evaluation will consist of a survey, three tele- and/or
web-conferences, and submission of project products (based on proposal
and finalized in contract agreement). The survey will be available
on-line. Surveys via postal mail will also be provided if on-line access
is limited. Technical assistance will be available from John Snow Inc.
for the evaluation component on an as needed basis. Evaluation reports
must be submitted during the last month of the project period and no
later than June 15, 2010. Ten percent of the project funds will be
withheld until the evaluation report is submitted.

**PROPOSAL INSTRUCTIONS**

Completed proposals should include:

-   Cover Page (included as Form A)

-   Applicant Description (included as Form B) (maximum number of pages
    5)

-   Project Description (included as Form C) (maximum number of pages 5)

-   Partnerships Description (included as Form D)

-   Project Work Plan (included as Form E) (maximum number of pages 5)

-   Budget Form (included as Form F)

-   Budget Information (included as Form G)

Proposals that are illegible, that use a font size less than 11 point,
or are inconsistent with the format provided will not be reviewed.

The submitter is advised prior to developing your proposal to read the
following materials:

-   DHHS Healthy People 2020 Framework - attached as Healthy People 2020
    Framework and Background (Attachment A)

-   Background - Excerpts from Healthy People 2010 (determinants of
    health) (Attachment B)

-   Secretary's Advisory Committee Phase 1 Report: Recommendations for
    the Framework and Format of Healthy People 2020 -- available online
    at <http://www.healthypeople.gov/hp2020/advisory/PhaseI/>

-   Healthy People 2010 Toolkit -- available online at
    <http://www.healthypeople.gov/state/toolkit/>

-   Healthy People in Healthy Communities: A Community Planning Guide
    Using Healthy People 2010 -- available online at
    <http://www.healthypeople.gov/Publications/HealthyCommunities2001/>

-   Healthy People 2020 Web site -
    [www.healthypeople.gov/hp2020](http://www.healthypeople.gov/hp2020)

If you are unable to access these materials, please email
<state_action@jsi.com> or call 1.800.839.0934 for assistance.

**IMPORTANT INFORMATION ABOUT FUNDING MECHANISM**

The State Action: Evaluating the Healthy People 2020 Disease Prevention
and Health Promotion Agenda Project will fund organizations to provide a
framework for disease prevention and health promotion services in their
respective states. The lead contractor for the administration and
national evaluation of this project is John Snow, Inc. (JSI).

Awardees will become subcontractors of JSI. The proposed activities will
serve as deliverables required from the subcontractors and will include
completion of required evaluation activities.

**DATA DISCLAIMER**

The Office of Disease Prevention and Health Promotion (ODPHP) and the
Regional Health Administrators, Office of Public Health and Science,
Department of Health and Human Services (HHS) has contracted with John
Snow, Inc. to administer the State Action: Evaluating the Healthy People
2020 Disease Prevention and Health Promotion Agenda project.

All material submitted regarding this project announcement becomes the
property of the U.S. Department of Health and Human Services (HHS). HHS
has the right to use any or all information/material presented in your
proposal, subject to limitations for proprietary or confidential
information. Disqualifications or denial of the proposal does not
eliminate this right.

It is the responsibility of the applicant to identify proprietary
information and request that the information be treated as such. Any
additional restrictions on the use or inspection of material contained
within the proposal shall be clearly stated in the proposal itself. The
privacy policy for John Snow, Inc is available at
[[http://www.jsi.com/JSIInternet/privacy.cfm]{.underline}](http://www.jsi.com/JSIInternet/privacy.cfm).
The HHS privacy policy is available at
<http://www.hhs.gov/privacy.html>.

The contents of the proposal will become contractual obligations if the
project is funded. ODPHP and the Regional Health Administrators, Office
of Public Health and Science, and HHS reserve the right to request
revisions to the budget and/or scope of work of any applicant.

**INSTRUCTIONS FOR SUBMITTING THE PROPOSAL**

Completed proposals must be received in the JSI office before 5pm MST on
April 27, 2009. Please note that postmarks will not be accepted. Email
is strongly encouraged. Please email one completed copy of the proposal
to: <state_action@jsi.com>.

*If email is **[not an option]{.underline}**, please mail one copy to:*

> John Snow, Inc.
>
> ATTN: Ann Loeffler
>
> 1860 Blake Street, Suite 320
>
> Denver, Colorado 80202

***If you email your proposal, please do not mail a hard copy. Hard copy
submissions are strongly discouraged.***

> **FORM A**

**COVER PAGE**

+---------------------------+------------------------------------------+
| Applicant Agency Name:    |                                          |
+---------------------------+------------------------------------------+
| Eligible Entity Category  |                                          |
| (please select only one): |                                          |
|                           |                                          |
| 1.  State Health          |                                          |
|     Department            |                                          |
|                           |                                          |
| 2.  U.S. Territory Health |                                          |
|     Department            |                                          |
|                           |                                          |
| 3.  Federally recognized  |                                          |
|     Indian Tribe, Tribal  |                                          |
|     Organization, Tribal  |                                          |
|     epidemiology center,  |                                          |
|     and/or Urban Indian   |                                          |
|     Organization. *Please |                                          |
|     specify which type(s) |                                          |
|     in the space below:*  |                                          |
|                           |                                          |
| > \_\_\_\_\_\_\_\_\_      |                                          |
| \_\_\_\_\_\_\_\_\_\_\_\_\ |                                          |
| _\_\_\_\_\_\_\_\_\_\_\_\_ |                                          |
| \_\_\_\_\_\_\_\_\_\_\_\_\ |                                          |
| _\_\_\_\_\_\_\_\_\_\_\_\_ |                                          |
+---------------------------+------------------------------------------+
| Address:                  |                                          |
+---------------------------+------------------------------------------+
|                           |                                          |
+---------------------------+------------------------------------------+
| City, State:              |                                          |
+---------------------------+------------------------------------------+
| Zip Code:                 |                                          |
+---------------------------+------------------------------------------+

+--------------------------+-------------------------------------------+
| ##### Proposal Contact:  | #####                                     |
+--------------------------+-------------------------------------------+
| ##### Title of Contact : | #####                                     |
+--------------------------+-------------------------------------------+
| ##### Email:             | #####                                     |
+--------------------------+-------------------------------------------+
| ##### Phone Number:      | #####                                     |
+--------------------------+-------------------------------------------+
| ##### Fax:               | #####                                     |
+--------------------------+-------------------------------------------+
| ####                     | #####                                     |
| # TotalAmount Requested: |                                           |
|                          | ##### \$                                  |
| ##### (max. \$37,000)    |                                           |
+--------------------------+-------------------------------------------+

Briefly provide a project proposal abstract in the space below:

> **FORM B**

**APPLICANT DESCRIPTION PAGE**

**APPLICANT AGENCY NAME
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

*[Please limit your response to this form to **5 pages**.]{.underline}*

1.  Briefly provide an overview of population health in your state. When
    appropriate, please include demographics, priority public health and
    health care statistics and health disparities.

2.  What division or component within your agency will have lead
    responsibility for implementing this project? Describe this
    division's experience implementing similar projects.

3.  List each member of the project team, title, project role, education
    and experience implementing similar projects.

4.  Describe the role of your Healthy People state coordinator in this
    project, if one has been designated.

5.  What other divisions or components within your agency will be
    involved with this project? Describe their role. What other state,
    territory or tribal agencies or offices will be involved? Describe
    their role.

> 5\. Describe your organization's past experience in working across
> sectors to improve the health of your population and the results of
> this work.
>
> **FORM C**

**PROJECT DESCRIPTION PAGE**

**APPLICANT AGENCY NAME
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

*[Please limit your response to this form to **5 pages**.]{.underline}*

> 1\. Describe how your agency has used past (Healthy People 1990 and
> 2000) and is using the current (2010) Healthy People initiative.
> Please include the successes and challenges your agency has faced. If
> your agency has not used Healthy People before, please describe a
> similar strategic planning activity that your agency has engaged in.
>
> 2\. Using the Healthy People 2020 framework and supporting concepts
> for improving population health, please address the following in a
> narrative description:

-   Identify each framework component, population health improvement
    concept, existing Healthy People 2010 focus area topic(s), or topics
    that address the determinants of health (social and physical
    environment, biology and genetics, health services, or individual
    behavior) that your project will address. Explain why you have
    chosen each component, concept, and/or topic.

```{=html}
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-   Describe the activities you will implement under each (or multiple)
    framework component, concept or topic you have selected. Please
    support your choice of activities from the public health and/or
    science literature, planning tools, or based on past success with
    implementing this activity for strategic planning purposes.

-   If not directly tied to your activity (s), describe how you will
    involve multi-sectoral and interdisciplinary perspectives and
    contributions to your project.

-   What products (e.g. meeting summaries, organization strategic plan,
    timeline, logic model, webpage, community assessment results, agency
    policies/proposed legislation) will you provide as a deliverable (s)
    for each of your proposed activities?

-   Describe how this evaluation project will complement your agencies
    Healthy People 2020 state, territory or tribe(s) planning activities
    in progress or under consideration, or the use of the national
    Healthy People 2020 objectives (expected release in 2010)

**AGREEMENT TO COMPLETE EVALUATION (REQUIRED)**

I agree to participate in an evaluation of this project and complete a
report of how funds were spent by June 15, 2010.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_

Name of Responsible Party Date

Email Address of Responsible Party:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Phone Number of Responsible Party:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**FORM D**

**PARTNERSHIPS DESCRIPTION PAGE**

**APPLICANT AGENCY NAME
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

> If you are partnering with other external groups on this proposal,
> please complete this form and submit a signed letter of commitment for
> each partner organization listed.

  -------------- ---------------- ----------------- ----------------------- ---------------
  **Partner      **Length (years) **Partner's area  **Role/responsibility   **Description
  Organization   of relationship  of expertise**    in the planning and     of resources
  Name**         with applicant                     implementation of this  (financial and
                 organization**                     project**               in-kind) to be
                                                                            committed to
                                                                            this project**

                                                                            

                                                                            

                                                                            

                                                                            

                                                                            

                                                                            

                                                                            

                                                                            

                                                                            

                                                                            
  -------------- ---------------- ----------------- ----------------------- ---------------

> **FORM E**

**PROJECT WORK PLAN PAGE**

**APPLICANT AGENCY NAME
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

Please limit your response to this form to **5 pages**.

> **In the table below (or attach your own form), please describe your
> planned activities.**

**PROJECT GOAL/OBJECTIVE(S):**

  ---------------------------------------- --------- -------- ---------------
  **Activity**                             **Start   **End    **Person
                                           Date**    Date**   Responsible**

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              
  ---------------------------------------- --------- -------- ---------------

> **FORM F**

**BUDGET FORM**

**APPLICANT AGENCY NAME
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**List [each]{.underline} of your expected costs associated with your
proposed work plan in the table below (or attach your own form). Please
note that indirect costs are not allowable as a percent of total costs.
To include indirect costs, please list and justify them in this table.
If your project is relying on funds in addition to this award, please
also include them on this form.**

  ---------------------------- -------------- ------------------- ------------------
  **Item Description**         **Cost(\$)**   **Justification**   **Funding Source**

  1\.                                                             

  2\.                                                             

  3\.                                                             

  4\.                                                             

  5\.                                                             

  6\.                                                             

  7\.                                                             

  8\.                                                             

  9\.                                                             

  10\.                                                            

  **Totals**                                                      
  ---------------------------- -------------- ------------------- ------------------

> **FORM G**

**BUDGET INFORMATION**

**APPLICANT AGENCY NAME
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Name of Person responsible for managing the project funds:**

Position with agency:

Address:

Zip Code:

Email:

Telephone:

**ATTACHMENT A**

Healthy People 2020 Proposed Framework (3.12.09)

The vision, mission and overarching goals provide structure and guidance
for achieving the Healthy People 2020 objectives. While general in
nature, they offer specific, important areas of emphasis where action
must be taken if the United States is to achieve better health by the
year 2020. Developed under the leadership of the Federal Interagency
Workgroup (FIW), the Healthy People 2020 framework is the product of an
exhaustive collaborative process among HHS and other Federal agencies,
public stakeholders, and the advisory committee.

+-----------------------------------------------------------------------+
| Vision                                                                |
|                                                                       |
| A society in which all people live long, healthy lives.               |
|                                                                       |
| Mission                                                               |
|                                                                       |
| Healthy People 2020 strives to:                                       |
|                                                                       |
| -   Identify nationwide health improvement priorities;                |
|                                                                       |
| -   Increase public awareness and understanding of the determinants   |
|     of health, disease, and disability and the opportunities for      |
|     progress;                                                         |
|                                                                       |
| -   Provide measurable objectives and goals that are applicable at    |
|     the national, state, and local levels;                            |
|                                                                       |
| -   Engage multiple sectors to take actions to strengthen policies    |
|     and improve practices that are driven by the best available       |
|     evidence and knowledge;                                           |
|                                                                       |
| -   Identify critical research, evaluation, and data collection       |
|     needs.                                                            |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| Overarching Goals                                                     |
|                                                                       |
| -   Attain high quality, longer lives free of preventable disease,    |
|     disability, injury, and premature death.                          |
|                                                                       |
| -   Achieve health equity, eliminate disparities, and improve the     |
|     health of all groups.                                             |
|                                                                       |
| -   Create social and physical environments that promote good health  |
|     for all.                                                          |
|                                                                       |
| -   Promote quality of life, healthy development and healthy          |
|     behaviors across all life stages.                                 |
+-----------------------------------------------------------------------+

***Framework Background***

For three decades, Healthy People has provided a comprehensive set of
national 10-year health promotion and disease prevention objectives
aimed at improving the health of all Americans. It is grounded in the
notion that establishing objectives and providing benchmarks to track
and monitor progress over time can motivate, guide, and focus action.
Healthy People 2020 will continue in the tradition of its predecessors
to define the vision and strategy for building a healthier Nation.

**I. Healthy People 2020 Development Process**

The Healthy People 2020 framework consists of a vision, mission, and
overarching goals. The framework uses a risk factors and determinants of
health approach to inform and guide improvements in health. It builds on
past iterations of Healthy People. It is the product of a multi-year
process and reflects deliberative input from a diverse array of
individuals and organizations, both within and outside the Federal
government, with a common interest in improving the Nation's health. The
framework constitutes Phase I of the Healthy People 2020 development
process and provides the foundation for Phase II, the development of
specific objectives and strategies to achieve them. The development
process will culminate in 2010 with the launch of the objectives, their
baselines and targets, and implementation strategies for achieving the
targets.

[Federal Interagency Workgroup]{.underline}

Within the Federal government, a Federal Interagency Workgroup (FIW) led
the development effort. The FIW members include representatives from US
Department of Health and Human Service agencies and offices as well as
the US Departments of Agriculture, Education, Housing and Urban
Development, Justice, Interior and Veterans Affairs, and the
Environmental Protection Agency. The participation of other Federal
entities is expected to expand throughout the development process. The
FIW and its various subgroups met regularly and frequently over an
18-month period to develop the Healthy People 2020 framework. During its
deliberations, the FIW drew on the diverse backgrounds and expertise of
its member agencies, lessons learned from past Healthy People efforts,
broad-based public comment, and the work of the Secretary's Advisory
Committee on National Health Promotion and Disease Prevention Objectives
for 2020.

[Public Comment]{.underline}

Far reaching public input has been sought through a variety of
mechanisms throughout the development process to ensure that Healthy
People 2020 will reflect the needs and warrant the commitment of a broad
spectrum of stakeholders. Stakeholders range from Federal, state and
local government agencies to private sector organizations and businesses
to public health professionals and policy makers. Public comment was
received during a series of six regional meetings across the country,
via a public comment website, during a public meeting of the advisory
committee, and through a request for public comment published in the
*Federal Register*.

[Secretary's Advisory Committee on National Health Promotion and Disease
Prevention Objectives]{.underline}

HHS convened the Secretary's Advisory Committee on National Health
Promotion and Disease Prevention Objectives for 2020 to aid in the
development of Healthy People 2020. Its 13 members are nationally known
experts with diverse expertise on different aspects of public health.
The fully public-member advisory committee was charged with providing
advice and consultation to the Secretary on the development and
implementation of the national objectives. During the first phase of its
work (January 2008 -- October 2008), the advisory committee and its
subcommittees produced recommendations for the Healthy people format,
framework, and guidelines for implementation. Over the course of its
deliberations, the advisory committee considered the work of the FIW,
subject area experts, and public comment.

**II. The Importance of an Ecological and Determinants Approach to
Health Promotion and Disease Prevention**

Health and health behaviors are determined by influences at multiple
levels, including personal (i.e., biological, psychological),
organizational/institutional, environmental (i.e., both social and
physical), and policy levels. Because significant and dynamic
inter-relationships exist among these different levels of health
determinants, interventions are most likely to be effective when they
address determinants at all levels. Historically, many health fields
have focused on individual-level health determinants and interventions.
Healthy People 2020 should therefore expand its focus to emphasize
health-enhancing social and physical environments. Integrating
prevention into the continuum of education---from the earliest ages
on---is an integral part of this ecological and determinants approach.

**III. The Role of Health Information Technology and Health
Communication**

Health IT and health communication should be encouraged and supported as
being an integral part of the implementation and success of Healthy
People 2020. Efforts should include building and integrating, where
feasible, the public health IT infrastructure in conjunction with the
National Health Information Network; extending the ONC-Coordinated
Federal Health IT Strategic Plan: 2008-2012 developed by the HHS Office
of the National Coordinator; integrating the various aspects of IT to
meet the direct needs of Healthy People 2020 for measures and
interventions; building on current health literacy and health
communication efforts.

**IV. Addressing "All Hazards" Preparedness as a Public Health Issue**

Since the 2000 launch of Healthy People 2010, the attacks of September
11, 2001, the subsequent anthrax attacks, the devastating effects of
natural disasters such as hurricanes Katrina and Ike, and concerns about
an Influenza pandemic have added urgency to the importance of
preparedness as a public health issue. Being prepared for any emergency
must be a high priority for public health in the coming decade, and
Healthy People 2020 should highlight this issue. Because preparedness
for all emergencies involves common elements, an \"all hazards\"
approach is necessary.

**ATTACHMENT B**

> **Background - Excerpts from Healthy People 2010 (determinants of
> health)\***
>
> **Biology** refers to the individual's genetic makeup (those factors
> with which he or she is born), family history (which may suggest risk
> for disease), and the physical and mental health problems acquired
> during life. Aging, diet, physical activity, smoking, stress, alcohol
> or illicit drug abuse, injury or violence, or an infectious or toxic
> agent may result in illness or disability and can produce a "new"
> biology for the individual.
>
> **Behaviors** are individual responses or reactions to internal
> stimuli and external conditions. Behaviors can have a reciprocal
> relationship to biology; in other words, each can react to the other.
> For example, smoking (behavior) can alter the cells in the lung and
> result in shortness of breath, emphysema, or cancer (biology) that
> then may lead an individual to stop smoking (behavior). Similarly, a
> family history that includes heart disease (biology) may motivate an
> individual to develop good eating habits, avoid tobacco, and maintain
> an active lifestyle (behaviors), which may prevent his or her own
> development of heart disease (biology).
>
> Personal choices and the social and physical environments surrounding
> individuals can shape behaviors. The social and physical environments
> include all factors that affect the life of individuals, positively or
> negatively, many of which may not be under their immediate or direct
> control.
>
> **Social environment** includes interactions with family, friends,
> coworkers, and others in the community. It also encompasses social
> institutions, such as law enforcement, the workplace, places of
> worship, and schools. Housing, public transportation, and the presence
> or absence of violence in the community are among other components of
> the social environment. The social environment has a profound effect
> on individual health, as well as on the health of the larger
> community, and is unique because of cultural customs; language; and
> personal, religious, or spiritual beliefs. At the same time,
> individuals and their behaviors contribute to the quality of the
> social environment.
>
> **Physical environment** can be thought of as that which can be seen,
> touched, heard, smelled, and tasted. However, the physical environment
> also contains less tangible elements, such as radiation and ozone. The
> physical environment can harm individual and community health,
> especially when individuals and communities are exposed to toxic
> substances; irritants; infectious agents; and physical hazards in
> homes, schools, and worksites. The physical environment also can
> promote good health, for example, by providing clean and safe places
> for people to work, exercise, and play.
>
> **Policies and interventions** can have a powerful and positive effect
> on the health of individuals and the community. Examples include
> health promotion campaigns to prevent smoking; policies mandating
> child restraints and safety belt use in automobiles; disease
> prevention services, such as immunization of children, adolescents,
> and adults; and clinical services, such as enhanced mental health
> care. Policies and interventions that promote individual and community
> health may be implemented by a variety of agencies, such as
> transportation, education, energy, housing, labor, justice, and other
> venues, or through places of worship, community-based organizations,
> civic groups, and businesses.
>
> The health of individuals and communities also depends greatly on
> **access to quality health care**. Expanding access to quality health
> care is important to eliminate health disparities and to increase the
> quality and years of healthy life for all people living in the United
> States. Health care in the broadest sense not only includes services
> received through health care providers but also health information and
> services received through other venues in the community.

\*Source: Healthy People 2010 Volume I. U.S. Department of Health and
Human Services. November 2000.