Note to Readers

This edition of Healthy People 2010: Understanding and Improving Health supersedes the

January 2000 Conference Edition. It includes updated data. In some cases, these updates have

resulted in revised baselines and targets for objectives and in revisions to the text. For further

explanation of differences between the editions, please refer to the Reader’s Guide in volume I of

Healthy People 2010, 2nd ed.

For detailed information on objectives and data systems, see the companion document Tracking

Healthy People 2010.

To access the Healthy People 2010 documents online, visit http://www.health.gov/healthypeople/.

For more information visit this Web site or call 1-800-367-4725.

Suggested Citation

U.S. Department of Health and Human Services. Healthy People 2010: Understanding and

Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November

2000.

For sale by the U.S. Government Printing Office, Superintendent of Documents, Washington,

DC 20402-9382, Stock Number 017-001-001-00-550-9.
Understanding and

Improving Health

U.S. Department of Health and Human Services

November 2000

Message from the Secretary

Healthy People 2010 provides our Nation with the wide range of public health opportunities that exist

in the first decade of the 21st century. With 467 objectives in 28 focus areas, Healthy People 2010 will

be a tremendously valuable asset to health planners, medical practitioners, educators, elected officials,

and all of us who work to improve health. Healthy People 2010 reflects the very best in public health

planning—it is comprehensive, it was created by a broad coalition of experts from many sectors, it has

been designed to measure progress over time, and, most important, it clearly lays out a series of

objectives to bring better health to all people in this country.

Achieving the vision of “Healthy People in Healthy Communities” represents an opportunity for

individuals to make healthy lifestyle choices for themselves and their families. It challenges clinicians

to put prevention into their practices. It requires communities and businesses to support healthpromoting policies in schools, worksites, and other settings. It calls for scientists to pursue new

research. Above all, it demands that all of us work together, using both traditional and innovative

approaches, to help the American public achieve the 10-year targets defined by Healthy People 2010.

The 20th century brought remarkable and unprecedented improvements in the lives of the people of

the United States. We saw the infant mortality rate plummet and life expectancy increase by 30

years. While we recognize that most of the advances came from prevention efforts, we also saw

almost unimaginable improvements in medical technologies and health care. The challenge for the 21st

century is twofold. First, we must ensure that this rate of advancement continues unabated. Second,

we must make certain that all Americans benefit from advancements in quality of life, regardless of

their age, race, ethnicity, gender, sexual orientation, disability status, income, educational level, or

geographic location. These challenges are substantial, but with the objectives defined by Healthy

People 2010, they are achievable.

I wholeheartedly commend Healthy People 2010, and I challenge all of us to work together to achieve

its ambitious and important vision.

Donna E. Shalala

Secretary of Health and Human Services

Foreword

We have witnessed a great deal of progress in public health and medicine since our Nation first

embarked on the national planning process for the Healthy People initiative. The process began in

1979 with Healthy People: The Surgeon General’s Report on Health Promotion and Disease

Prevention, which was followed in 1990 by Healthy People 2000. Healthy People 2010 represents

the third time that the U.S. Department of Health and Human Services (HHS) has developed 10-year

health objectives for the Nation.

Healthy People 2010 reflects the scientific advances that have taken place over the past 20 years in

preventive medicine, disease surveillance, vaccine and therapeutic development, and information

technology. It also mirrors the changing demographics of our country, the changes that have taken

place in health care, and the growing impact of global forces on our national health status.

Healthy People 2010 incorporates input from a broad cross-section of people. Scientific experts from

many Federal agencies took the lead in developing the focus areas and objectives. The Secretary’s

Council on National Health Promotion and Disease Prevention Objectives for 2010 and the Healthy

People Steering Committee provided guidance to steer the process. The HHS Office of Public Health

and Science, particularly the Office of Disease Prevention and Health Promotion, expertly managed

the process. But perhaps most important to the success of this effort was the overwhelming and

enthusiastic contribution made by the Healthy People Consortium and the public. We received more

than 11,000 comments from people in every State by fax, Internet, letter, and in person through

several public meetings.

The knowledge, commitment, and collaboration of these groups have combined to produce national

health objectives that are even more comprehensive than their predecessors. There are 467 objectives

in 28 focus areas, making Healthy People 2010 an encyclopedic compilation of health improvement

opportunities for the next decade. Building on two decades of success in Healthy People initiatives,

Healthy People 2010 is poised to address the concerns of the 21st century. Two major goals reflect

the Nation’s changing demographics. The first goal, which addresses the fact that we are growing

older as a Nation, is to increase the quality and years of healthy life. The second goal, which

addresses the diversity of our population, is to eliminate health disparities.

And, for the first time, a set of Leading Health Indicators will help individuals and communities target

the actions to improve health. The Leading Health Indicators also will help communities track the

success of these actions.

I sincerely appreciate the number of people, institutions, and organizations that have worked together

to create this important document. But our journey has just begun. I encourage you to stay the course

as we pursue the vision of Healthy People 2010 to create tomorrow’s healthier people today.

David Satcher, M.D., Ph.D.

Assistant Secretary for Health and

 Surgeon General

Acknowledgments

Healthy People 2010: Understanding and Improving Health is part of the Healthy People 2010

initiative sponsored by the U.S. Department of Health and Human Services. Leadership and direction

were provided by David Satcher and Nicole Lurie. Development of Healthy People 2010 has been

coordinated by the Office of Disease Prevention and Health Promotion under the leadership of Claude

Earl Fox, Susanne A. Stoiber, Linda D. Meyers, and Randolph F. Wykoff.

Principal responsibility for Healthy People 2010: Understanding and Improving Health was

carried out by Mark S. Smolinski. Critical editorial and technical support were provided by Carter

Blakey, Mary Jo Deering, Matthew Guidry, Deborah R. Maiese, Linda D. Meyers, Janice T. Radak,

Kelly H. Woodward, and Randolph F. Wykoff. Special thanks are due to David Atkins, Linda A.

Bailey, Ron Davis, Kate-Louise Gottfried, James Harrell, J. Michael McGinnis, Kevin Patrick, Scott

C. Ratzan, Dirk Ruwaard, Susanne A. Stoiber, and Tom Vischi.

Statistical advice and data development were provided by staff of the Division of Health Promotion

Statistics of the National Center for Health Statistics, Centers for Disease Control and Prevention,

which included Jeanette Guyton-Krishnan, Elizabeth Jackson, Richard J. Klein, Cheryl Rose, Colleen

Ryan, J. Fred Seitz, Thomas Socey, Kathleen Turczyn, Jennie Wald, and Jean Williams, under the

leadership of Diane K. Wagener.

Research of the literature and other resources was provided by preventive medicine residents and

medical students: Madhavi Battineni, Joy L. Bottoms, Wayne Brandes, Dominic Cheung Chow, Penny

Shelton-Hoffman, Robin McFee, J. Patrick Moulds, Alex Nettles, Elpidoforos Soteriades, Peter

Thornquist, Edward Van Oeveren, Stephanie Weller, and Amanda Williams.

The development of the Leading Health Indicators was guided by an interagency work group and the

Healthy People Steering Committee, which included Lois Albarelli, David R. Arday, David Atkins,

Delton Atkinson, Linda A. Bailey, Olivia Carter-Pokras, Lynn Cates, Melissa H. Clarke, Marsha G.

Davenport, Tuei Doong, Margaret Gilliam, Chuck Gollmar, William R. Harlan, James Harrell, Suzanne

G. Haynes, Wanda K. Jones, Diane Justice, Nicole Lurie, Evelyn Kappeler, Richard J. Klein, Mary

Ann MacKenzie, John Monahon, J. Henry Montes, Paul W. Nannis, Eileen Parish, Kate Rickard,

Carol Roddy, Theresa Rogers, Dorita Sewell, Mary Beth Skupien, Philip B. Smith, Mark S. Smolinski,

Christine G. Spain, Matthew Stagner, Irma Tetzloff, Betsy L. Thompson, Martina Vogel-Taylor, and

Diane K. Wagener. Important contributions were provided by the Institute of Medicine, National

Academy of Sciences Committee on Leading Health Indicators for Healthy People 2010, which

included Susan Allan, Roger Bulger, Carole A. Chrvala, Donna D. Duncan, Neal Halfon, Barbara S.

Hulka, Thomas J. Kean, Kelly Norsingle, Scott C. Ratzan, Stephen C. Schoenbaum, Mark Smith,

Shoshanna Sofaer, Kathleen R. Stratton, and Robert B. Wallace.

Production for the Conference Edition was handled by staff of IQ Solutions, Inc., which included

Denise Avery, Ted Buxton, Eleanor Hall, Michael Huddleston, E.J. King-Carter, James R. Libbey,

Josue Martinez, Craig Packer, Meredith Pond, Lisa Smith, and Karen Stroud. Production for the

second edition was carried out by staff at Social & Health Services, Ltd., which included Nancy Klein,

Mary Moien, Eric Moore, and Arlene Weitzman.

Finally, a sincere debt of gratitude to all contributors to Healthy People 2010, whose efforts greatly

enhanced the development of this document.

Contents

Introduction ..........................................................................................................1

A Systematic Approach to Health Improvement .....................................7

Healthy People 2010 Goals .................................................................................8

Objectives .........................................................................................................17

Determinants of Health......................................................................................18

Health Status .....................................................................................................21

Leading Health Indicators .............................................................................24

Physical Activity................................................................................................26

Overweight and Obesity ....................................................................................28

Tobacco Use .....................................................................................................30

Substance Abuse..............................................................................................32

Responsible Sexual Behavior............................................................................34

Mental Health ....................................................................................................36

Injury and Violence ...........................................................................................38

Environmental Quality .......................................................................................40

Immunization.....................................................................................................42

Access to Health Care ......................................................................................44

Bibliography ........................................................................................................47

Appendix:

Short Titles for Healthy People 2010 Objectives ................................................53

Healthy People 2010: Understanding and Improving Health 1

Introduction

Healthy People 2010 presents a comprehensive, nationwide health promotion and disease prevention

agenda. It is designed to serve as a roadmap for improving the health of all people in the United States

during the first decade of the 21st century.

Like the preceding Healthy People 2000 initiative—which was driven by an ambitious, yet achievable,

10-year strategy for improving the Nation’s health by the end of the 20th century—Healthy People

2010 is committed to a single, overarching purpose: promoting health and preventing illness, disability,

and premature death.

The History Behind the Healthy People 2010 Initiative

Healthy People 2010 builds on initiatives pursued over the past two decades. In 1979, Healthy

People: The Surgeon General’s Report on Health Promotion and Disease Prevention provided

national goals for reducing premature deaths and preserving independence for older adults. In 1980,

another report, Promoting Health/Preventing Disease:

Objectives for the Nation, set forth 226 targeted health

objectives for the Nation to achieve over the next 10 years.

Healthy People 2000: National Health Promotion and

Disease Prevention Objectives, released in 1990, identified

health improvement goals and objectives to be reached by

the year 2000. The Healthy People 2010 initiative continues

in this tradition as an instrument to improve health for the

first decade of the 21st century.

Healthy People 2010

is grounded in

science, built through

public consensus,

and designed to

measure progress.
2 Healthy People 2010: Understanding and Improving Health

The Development of Healthy People 2010 Goals and Objectives

Healthy People 2010 represents the ideas and expertise of a diverse range of individuals and

organizations concerned about the Nation’s health. The Healthy People Consortium—an alliance of

more than 350 national organizations and 250 State public health, mental health, substance abuse, and

environmental agencies—conducted three national meetings on the development of Healthy People

2010. In addition, many individuals and organizations gave testimony about health priorities at five

Healthy People 2010 regional meetings held in late 1998.

On two occasions—in 1997 and in 1998—the American public was given the opportunity to share its

thoughts and ideas. More than 11,000 comments on draft materials were received by mail or via the

Internet from individuals in every State, the District of Columbia, and Puerto Rico. All the comments

received during the development of Healthy People 2010 can be viewed on the Healthy People Web

site: http://www.health.gov/healthypeople/.

The final Healthy People 2010 objectives were developed by teams of experts from a variety of

Federal agencies under the direction of Health and Human Services Secretary Donna Shalala,

Assistant Secretary for Health and Surgeon General David Satcher, and former Assistant Secretaries

for Health. The process was coordinated by the Office of Disease Prevention and Health Promotion,

U.S. Department of Health and Human Services.

The Goals of Healthy People 2010

Healthy People 2010 is designed to achieve two overarching goals:

■ Increase quality and years of healthy life.

■ Eliminate health disparities.

These two goals are supported by specific objectives in 28 focus areas (see page 17). Each objective

was developed with a target to be achieved by the year 2010. A full explanation of the two goals can

be found in the next section of this document: “A Systematic Approach to Health Improvement.”
Healthy People 2010: Understanding and Improving Health 3

The Relationship Between Individual and Community Health

Over the years, it has become clear that individual health is

closely linked to community health—the health of the community

and environment in which individuals live, work, and play.

Likewise, community health is profoundly affected by the

collective beliefs, attitudes, and behaviors of everyone who lives

in the community.

Indeed, the underlying premise of Healthy People 2010 is that the

health of the individual is almost inseparable from the health of

the larger community and that the health of every community in

every State and territory determines the overall health status of

the Nation. That is why the vision for Healthy People 2010 is

“Healthy People in Healthy Communities.”

How Healthy People 2010 Will Improve the Nations Health

One of the most compelling and encouraging lessons learned from the Healthy People 2000 initiative

is that we, as a Nation, can make dramatic progress in improving the Nation’s health in a relatively

short period of time. For example, during the past decade, we achieved significant reductions in infant

mortality. Childhood vaccinations are at the highest levels ever recorded in the United States. Fewer

teenagers are becoming parents. Overall, alcohol, tobacco, and illicit drug use is leveling off. Death

rates for coronary heart disease and stroke have declined. Significant advances have been made in

the diagnosis and treatment of cancer and in reducing unintentional injuries.

But we still have a long way to go. Diabetes and other chronic conditions continue to present a serious

obstacle to public health. Violence and abusive behavior continue to ravage homes and communities

across the country. Mental disorders continue to go undiagnosed and untreated. Obesity in adults has

increased 50 percent over the past two decades. Nearly 40 percent of adults engage in no leisure time

physical activity. Smoking among adolescents has increased in the past decade. And HIV/AIDS

remains a serious health problem, now disproportionately affecting women and communities of color.

Healthy People 2010 will be the guiding instrument for addressing these and emerging health issues,

reversing unfavorable trends, and expanding past achievements in health.

Community health is

profoundly affected

by the collective

beliefs, attitudes,

and behaviors of

everyone who lives in

the community.
4 Healthy People 2010: Understanding and Improving Health

The Key Role of Community Partnerships

Community partnerships, particularly when they reach out to

nontraditional partners, can be among the most effective tools for

improving health in communities.

For the past two decades, Healthy People has been used as a

strategic management tool for the Federal Government, States, communities, and many other public- and private-sector partners. Virtually

all States, the District of Columbia, and Guam have developed their

own Healthy People plans modeled after the national plan. Most

States have tailored the national objectives to their specific needs.

Businesses; local governments; and civic, professional, and religious organizations also have been

inspired by Healthy People to print immunization reminders, set up hotlines, change cafeteria menus,

begin community recycling, establish worksite fitness programs, assess school health education

curriculums, sponsor health fairs, and engage in myriad other activities.

Everyone Can Help Achieve the Healthy People 2010 Objectives

Addressing the challenge of health improvement is a shared responsibility that requires the active

participation and leadership of the Federal Government, States, local governments, policymakers,

health care providers, professionals, business executives, educators, community leaders, and the

American public itself. Although administrative responsibility for the Healthy People 2010 initiative

rests in the U.S. Department of Health and Human Services, representatives of all these diverse

groups shared their experience, expertise, and ideas in developing the Healthy People 2010 goals and

objectives.

Healthy People 2010, however, is just the beginning. The biggest challenges still stand before us, and

we all have a role in building a healthier Nation.

Regardless of your age, gender, education level, income, race, ethnicity, cultural customs, language,

religious beliefs, disability, sexual orientation, geographic location, or occupation, Healthy People 2010

is designed to be a valuable resource in determining how you can participate most effectively in

improving the Nation’s health. Perhaps you will recognize the need to be a more active participant in

decisions affecting your own health or the health of your children or loved ones. Perhaps you will

assume a leadership role in promoting healthier behaviors in your neighborhood or community. Or

perhaps you will use your influence and social stature to advocate for and implement policies and

programs that can improve dramatically the health of dozens, hundreds, thousands, or even millions of

people.

Whatever your role, this document is designed to help you determine what you can do—in your home,

community, business, or State—to help improve the Nation’s health.

Partnerships are

effective tools for

improving health in

communities.
Healthy People 2010: Understanding and Improving Health 5

Other Information Is Available About Healthy People 2010

Healthy People 2010: Understanding and Improving Health

is the first of three parts in the Healthy People 2010 series. The

second part, Healthy People 2010, contains detailed descriptions

of 467 objectives to improve health. These objectives are

organized into 28 specific focus areas. The third part, Tracking

Healthy People 2010, provides a comprehensive review of the

statistical measures that will be used to evaluate progress.

To receive more information about the Healthy People 2010

initiative, visit the Web site at http://www.health.gov/

healthypeople/ or call 1-800-367-4725. To obtain copies of

Healthy People 2010 documents in print or on a CD-ROM, see the order form at the end of this

document.

Healthy People

2010 contains 467

objectives to

improve health,

organized into 28

focus areas.
6 Healthy People 2010: Understanding and Improving Health

Healthy People in Healthy Communities

A Systematic Approach to Health Improvement
Healthy People 2010: Understanding and Improving Health 7

A Systematic Approach to Health

Improvement

Healthy People 2010 is about improving health—the health of each individual, the health of

communities, and the health of the Nation. However, the Healthy People 2010 goals and objectives

cannot by themselves improve the health status of the Nation. Instead, they need to be recognized as

part of a larger, systematic approach to health improvement.

This systematic approach to health improvement is composed of four key elements:

■ Goals

■ Objectives

■ Determinants of health

■ Health status

Whether this systematic approach is used to improve health on a national level, as in Healthy People

2010, or to organize community action on a particular health issue, such as promoting smoking

cessation, the components remain the same. The goals provide a general focus and direction. The

goals, in turn, serve as a guide for developing a set of objectives that will measure actual progress

within a specified amount of time. The objectives focus on

the determinants of health, which encompass the combined

effects of individual and community physical and social

environments and the policies and interventions used to

promote health, prevent disease, and ensure access to

quality health care. The ultimate measure of success in any

health improvement effort is the health status of the target

population.

Healthy People 2010 is built on this systematic approach to health improvement.

Successful community

partnerships use a

systematic approach to

health improvement.
8 Healthy People 2010: Understanding and Improving Health

Goal 1: Increase Quality and Years of Healthy Life

The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and

improve their quality of life.

Life Expectancy

Life expectancy is the average number of years people born in a given year are expected to live

based on a set of age-specific death rates. At the beginning of the 20th century, life expectancy at

birth was 47.3 years. Fortunately, life expectancy has increased dramatically over the past 100 years

(see figure 1). Today, the average life expectancy at birth is nearly 77 years.

Life expectancy for persons at every age group also has increased during the past century. Based on

today’s age-specific death rates, individuals aged 65 years can be expected to live an average of 18

more years, for a total of 83 years. Those aged 75 years can be expected to live an average of 11

more years, for a total of 86 years.

Differences in life expectancy between populations, however, suggest a substantial need and

opportunity for improvement. At least 18 countries with populations of 1 million or more have life

expectancies greater than the United States for both men and women (see figure 2).

Healthy People 2010 Goals

Figure 1. Past and projected female and male life expectancy at birth, United States, 1900–2050.

Life Expectancy at Birth

*Death registration area only. The death registration area increased from 10 States and

the District of Columbia in 1900 to the entire United States in 1933.

Source: U.S. Department of Commerce, Bureau of the Census.
Healthy People 2010: Understanding and Improving Health 9

Figure 2. Life expectancy at birth by gender and ranked by selected countries, 1995.

Sources: World Health Organization, United

Nations; Centers for Disease Control

and Prevention, National Center for

Health Statistics, National Vital

Statistics System 1990–95 and

unpublished data.

Healthy People 2010 Goals

Female Male

Life Expectancy by Country

Japan 82.9

France 82.6

Switzerland 81.9

Sweden 81.6

Spain 81.5

Canada 81.2

Australia 80.9

Italy 80.8

Norway 80.7

Netherlands 80.4

Greece 80.3

Finland 80.3

Austria 80.1

Germany 79.8

Belgium 79.8

England and Wales 79.6

Israel 79.3

Singapore 79.0

United States 78.9

Japan 76.4

Sweden 76.2

Israel 75.3

Canada 75.2

Switzerland 75.1

Greece 75.1

Australia 75.0

Norway 74.9

Netherlands 74.6

Italy 74.4

England and Wales 74.3

France 74.2

Spain 74.2

Austria 73.5

Singapore 73.4

Germany 73.3

New Zealand 73.3

Northern Ireland 73.1

Belgium 73.0

Cuba 73.0

Costa Rica 73.0

Finland 72.8

Denmark 72.8

Ireland 72.5

United States 72.5

Country Years of Life

 Expectancy

Country Years of Life

 Expectancy
Healthy People 2010 Goals

10 Healthy People 2010: Understanding and Improving Health

There are substantial differences in life expectancy among different population groups within the

United States. For example, women outlive men by an average of 6 years. White women currently

have the greatest life expectancy in the United States. The life expectancy for African American

women has risen to be higher today than that for white men. People from households with an annual

income of at least $25,000 live an average of 3 to 7 years longer, depending on gender and race, than

do people from households with annual incomes of less than $10,000.

Quality of Life

Quality of life reflects a general sense of happiness and satisfaction with our lives and environment.

General quality of life encompasses all aspects of life, including health, recreation, culture, rights,

values, beliefs, aspirations, and the conditions that support a life containing these elements. Healthrelated quality of life reflects a personal sense of physical and mental health and the ability to react

to factors in the physical and social environments. Health-related quality of life is more subjective

than life expectancy and therefore can be more difficult to measure. Some tools have been developed

to measure health-related quality of life.

Global assessments, in which a person rates his or her health as “poor,” “fair,” “good,” “very good,”

or “excellent,” can be reliable indicators of one’s perceived health. In 1996, 90 percent of people in

the United States reported their health as good, very good, or excellent.

Healthy days is another measure of health-related quality of life that estimates the number of days of

poor or impaired physical and mental health in the past 30 days. In 1998, adults averaged 5.5 days

during the past month when their physical or mental health was not good—including 1.8 days when

they were not able to do their usual activities. However, 52 percent of adults reported having good

physical and mental health for the entire month in contrast with 10 percent of adults who were

unhealthy for all 30 days. Typically, younger adults report more mentally unhealthy days while older

adults report more physically unhealthy days.

Years of healthy life is a combined measure developed for the Healthy People initiative. The

difference between life expectancy and years of healthy life reflects the average amount of time

spent in less than optimal health because of chronic or acute limitations. Years of healthy life

increased in 1996 to 64.2 years, a level that was only slightly above the 64.0 years at the beginning of

the decade. During the same period, life expectancy increased a full year.

As with life expectancy, various population groups can show dramatic differences in quality of life. For

example, people in the lowest income households are five times more likely to report their health as fair

or poor than people in the highest income households (see figure 3). A higher percentage of women

report their health as fair or poor compared to men. Adults in rural areas are 36 percent more likely to

report their health status as fair or poor than are adults in urban areas.

Achieving a Longer and Healthier Life—the Healthy People Perspective

Healthy People 2010 seeks to increase life expectancy and quality of life over the next 10 years by

helping individuals gain the knowledge, motivation, and opportunities they need to make informed

decisions about their health. At the same time, Healthy People 2010 encourages local and State

leaders to develop communitywide and statewide efforts that promote healthy behaviors, create

healthy environments, and increase access to high-quality health care. Because individual and

community health are virtually inseparable, both the individual and the community need to do their

parts to increase life expectancy and improve quality of life.
Healthy People 2010 Goals

Healthy People 2010: Understanding and Improving Health 11

Goal 2: Eliminate Health Disparities

The second goal of Healthy People 2010 is to eliminate health disparities among segments of the

population, including differences that occur by gender, race or ethnicity, education or income, disability,

geographic location, or sexual orientation. This section highlights ways in which health disparities can

occur among various demographic groups in the United States.

Gender

Whereas some differences in health between men and women are the result of biological differences,

others are more complicated and require greater attention and scientific exploration. Some health

differences are obviously gender specific, such as cervical and prostate cancers.

Overall, men have a life expectancy that is 6 years less than that of women and have higher death

rates for each of the 10 leading causes of death. For example, men are two times more likely than

women to die from unintentional injuries and four times more likely than women to die from firearmrelated injuries. Although overall death rates for women may currently be lower than for men, women

have shown increased death rates over the past decade in areas where men have experienced

improvements, such as lung cancer. Women are also at greater risk for Alzheimer’s disease than men

are and twice as likely as men to be affected by major depression.

Figure 3. Percentage of persons with perceived fair or poor health status by household income,

United States, 1995.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics.

National Health Interview Survey. 1995.

Relationship Between Household Income and Fair or Poor Health Status
Healthy People 2010 Goals

12 Healthy People 2010: Understanding and Improving Health

Race and Ethnicity

Current information about the biologic and genetic characteristics of African Americans, Hispanics,

American Indians, Alaska Natives, Asians, Native Hawaiians, and Pacific Islanders does not explain

the health disparities experienced by these groups compared with the white, non-Hispanic population

in the United States. These disparities are believed to be the result of the complex interaction among

genetic variations, environmental factors, and specific health behaviors.

Even though the Nation’s infant mortality rate is down, the infant death rate among African

Americans is still more than double that of whites. Heart disease death rates are more than 40

percent higher for African Americans than for whites. The death rate for all cancers is 30 percent

higher for African Americans than for whites; for prostate cancer, it is more than double that for

whites. African American women have a higher death rate from breast cancer despite having a

mammography screening rate that is nearly the same as the rate for white women. The death rate

from HIV/AIDS for African Americans is more than seven times that for whites; the rate of homicide

is six times that for whites.

Hispanics living in the United States are almost twice as likely to die from diabetes as are nonHispanic whites. Although constituting only 11 percent of the total population in 1996, Hispanics

accounted for 20 percent of the new cases of tuberculosis. Hispanics also have higher rates of high

blood pressure and obesity than non-Hispanic whites. There are differences among Hispanic

populations as well. For example, whereas the rate of low birth weight infants is lower for the total

Hispanic population compared with that of whites, Puerto Ricans have a low birth weight rate that is

50 percent higher than the rate for whites.

American Indians and Alaska Natives have an infant death rate almost double that for whites. The

rate of diabetes for this population group is more than twice that for whites. The Pima of Arizona

have one of the highest rates of diabetes in the world. American Indians and Alaska Natives also

have disproportionately high death rates from unintentional injuries and suicide.

Asians and Pacific Islanders, on average, have indicators of being one of the healthiest population

groups in the United States. However, there is great diversity within this population group, and health

disparities for some specific segments are quite marked. Women of Vietnamese origin, for example,

suffer from cervical cancer at nearly five times the rate for white women. New cases of hepatitis and

tuberculosis are also higher in Asians and Pacific Islanders living in the United States than in whites.

Income and Education

Inequalities in income and education underlie many health disparities in the United States. Income and

education are intrinsically related and often serve as proxy measures for each other (see figure 4).

In general, population groups that suffer the worst health status are also those that have the highest

poverty rates and the least education. Disparities in income and education levels are associated with

differences in the occurrence of illness and death, including heart disease, diabetes, obesity, elevated

blood lead level, and low birth weight. Higher incomes permit increased access to medical care,

enable people to afford better housing and live in safer neighborhoods, and increase the opportunity to

engage in health-promoting behaviors.
Healthy People 2010 Goals

Healthy People 2010: Understanding and Improving Health 13

Income inequality in the United States has increased over the past three decades. There are distinct

demographic differences in poverty by race, ethnicity, and household composition (see figure 5) as

well as geographical variations in poverty across the United States. Recent health gains for the U.S.

population as a whole appear to reflect achievements among the higher socioeconomic groups; lower

socioeconomic groups continue to lag behind.

Figure 4. Relationship between education and median household income among adults aged 25

years and older, by gender, United States, 1996.

Relationship Between Education and Income

Source: U.S. Department of Commerce, Bureau of the Census. Current Population Survey.

March 1997.
Healthy People 2010 Goals

14 Healthy People 2010: Understanding and Improving Health

Overall, those with higher incomes tend to fare better than those with lower incomes. For example,

among white men aged 65 years, those in the highest income families could expect to live more than 3

years longer than those in the lowest income families. The percentage of people in the lowest income

families reporting limitation in activity caused by chronic disease is three times that of people in the

highest income families.

The average level of education in the U.S. population has increased steadily over the past several

decades—an important achievement given that more years of education usually translate into more

years of life. For women, the amount of education achieved is a key determinant of the welfare and

survival of their children. Higher levels of education also may increase the likelihood of obtaining or

understanding health-related information needed to develop health-promoting behaviors and beliefs in

prevention. But again, educational attainment differs by race and ethnicity (see figure 6). Among

people aged 25 to 64 years in the United States, the overall death rate for those with less than 12

years of education is more than twice that for people with 13 or more years of education. The infant

mortality rate is almost double for infants of mothers with less than 12 years of education compared

with those with an educational level of 13 or more years.

Figure 5. Percentage of persons below the poverty level by race and ethnicity and type of household,

United States, 1996.

Source: U.S. Department of Commerce, Bureau of the Census. 1997.

Persons Below the Poverty Level
Healthy People 2010 Goals

Healthy People 2010: Understanding and Improving Health 15

Disability

People with disabilities are identified as persons having an activity limitation, who use assistance, or

who perceive themselves as having a disability. In 1994, 54 million people in the United States, or

roughly 21 percent of the population, had some level of disability. Although rates of disability are

relatively stable or falling slightly for people aged 45 years and older, rates are on the rise among the

younger population. People with disabilities tend to report more anxiety, pain, sleeplessness, and days

of depression and fewer days of vitality than do people without activity limitations. People with

disabilities also have other disparities, including lower rates of physical activity and higher rates of

obesity. Many people with disabilities lack access to health services and medical care.

Source: U.S. Department of Commerce, Bureau of the Census. Current Population

Survey. 1996.

Figure 6. Percentage of adults aged 25 to 64 years by educational level and race, and ethnicity,

United States, 1996.

Educational Attainment
16 Healthy People 2010: Understanding and Improving Health

Geographic Location

Twenty-five percent of Americans live in rural areas, that is, places with fewer than 2,500 residents.

Injury-related death rates are 40 percent higher in rural populations than in urban populations. Heart

disease, cancer, and diabetes rates exceed those for urban areas. People living in rural areas are less

likely to use preventive screening services, exercise regularly, or wear safety belts. In 1996, 20

percent of the rural population was uninsured compared with 16 percent of the urban population.

Timely access to emergency services and the availability of specialty care are other issues for this

population group.

Sexual Orientation

America’s gay and lesbian population comprises a diverse community with disparate health concerns.

Major health issues for gay men are HIV/AIDS and other sexually transmitted diseases, substance

abuse, depression, and suicide. Gay male adolescents are two to three times more likely than their

peers to attempt suicide. Some evidence suggests lesbians have higher rates of smoking, overweight,

alcohol abuse, and stress than heterosexual women. The issues surrounding personal, family, and

social acceptance of sexual orientation can place a significant burden on mental health and personal

safety.

Achieving Equity—The Healthy People Perspective

Although the diversity of the American population may be one of the Nation’s greatest assets, it also

represents a range of health improvement challenges—challenges that must be addressed by

individuals, the community and State in which they live, and the Nation as a whole.

Healthy People 2010 recognizes that communities, States, and national organizations will need to take

a multidisciplinary approach to achieving health equity—an approach that involves improving health,

education, housing, labor, justice, transportation, agriculture, and the environment, as well as data

collection itself. In fact, current data collection methods make it impossible to assess accurately the

health status for some populations, particularly relatively small ones. However, the greatest

opportunities for reducing health disparities are in empowering individuals to make informed health

care decisions and in promoting communitywide safety, education, and access to health care.

Healthy People 2010 is firmly dedicated to the principle that—regardless of age, gender, race or

ethnicity, income, education, geographic location, disability, and sexual orientation—every person in

every community across the Nation deserves equal access to comprehensive, culturally competent,

community-based health care systems that are committed to serving the needs of the individual and

promoting community health.

Healthy People 2010 Goals
Healthy People 2010: Understanding and Improving Health 17

The Nation’s progress in achieving the two

goals of Healthy People 2010 will be

monitored through 467 objectives in 28 focus

areas. Many objectives focus on interventions

designed to reduce or eliminate illness,

disability, and premature death among

individuals and communities. Others focus on

broader issues, such as improving access to

quality health care, strengthening public health

services, and improving the availability and

dissemination of health-related information.

Each objective has a target for specific

improvements to be achieved by the year

2010.

Together, these objectives reflect the depth of

scientific knowledge as well as the breadth of

diversity in the Nation’s communities. More

importantly, they are designed to help the

Nation achieve Healthy People 2010’s two

overarching goals and realize the vision of

healthy people living in healthy communities.

A list of the short titles of all Healthy People

2010 objectives by focus area can be found

in the Appendix. In addition, Healthy People

2010 provides an overview of the issues,

trends, and opportunities for action in each of

the 28 focus areas. It also contains detailed

language of each objective, underlying

rationale, target for the year 2010, and

national data tables of its measures.

Healthy People 2010

Focus Areas

1. Access to Quality Health Services

2. Arthritis, Osteoporosis, and Chronic

Back Conditions

3. Cancer

4. Chronic Kidney Disease

5. Diabetes

6. Disability and Secondary Conditions

7. Educational and Community-Based

Programs

8. Environmental Health

9. Family Planning

10. Food Safety

11. Health Communication

12. Heart Disease and Stroke

13. HIV

14. Immunization and Infectious Diseases

15. Injury and Violence Prevention

16. Maternal, Infant, and Child Health

17. Medical Product Safety

18. Mental Health and Mental Disorders

19. Nutrition and Overweight

20. Occupational Safety and Health

21. Oral Health

22. Physical Activity and Fitness

23. Public Health Infrastructure

24. Respiratory Diseases

25. Sexually Transmitted Diseases

26. Substance Abuse

27. Tobacco Use

28. Vision and Hearing

Objectives
18 Healthy People 2010: Understanding and Improving Health

Topics covered by the objectives in Healthy People 2010 reflect the array of critical influences that

determine the health of individuals and communities.

For example, individual behaviors and environmental factors are responsible for about 70 percent of all

premature deaths in the United States. Developing and implementing policies and preventive

interventions that effectively address these determinants of health can reduce the burden of illness,

enhance quality of life, and increase longevity.

Individual biology and behaviors influence health through their interaction with each other and with

the individual’s social and physical environments. In addition, policies and interventions can

improve health by targeting factors related to individuals and their environments, including access to

quality health care (see figure 7).

Determinants of Health

Figure 7. Determinants of health.
Healthy People 2010: Understanding and Improving Health 19

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.

Determinants of Health
20 Healthy People 2010: Understanding and Improving Health

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.

The determinants of health—individual biology and behavior, physical and social environments, policies

and interventions, and access to quality health care—have a profound effect on the health of

individuals, communities, and the Nation. An evaluation of these determinants is an important part of

developing any strategy to improve health.

Our understanding of these determinants and how they relate to one another, coupled with our

understanding of how individual and community health affects the health of the Nation, is perhaps the

most important key to achieving our Healthy People 2010 goals of increasing the quality and years of

life and of eliminating the Nation’s health disparities.

Determinants of Health
Healthy People 2010: Understanding and Improving Health 21

To understand the health status of a population, it is essential to monitor and evaluate the

consequences of the determinants of health.

The health status of the United States is a description of the health of the total population, using

information representative of most people living in this country. For relatively small population groups,

however, it may not be possible to draw accurate conclusions about their health using current data

collection methods. The goal of eliminating health disparities will necessitate improved collection and

use of standardized data to identify correctly disparities among select population groups.

Health status can be measured by birth and death rates, life expectancy, quality of life, morbidity from

specific diseases, risk factors, use of ambulatory care and inpatient care, accessibility of health

personnel and facilities, financing of health care, health insurance coverage, and many other factors.

The information used to report health status comes from a variety of sources, including birth and death

records; hospital discharge data; and health information collected from health care records, personal

interviews, physical examinations, and telephone surveys. These measures are monitored on an annual

basis in the United States and are reported in a variety of publications, including Health, United

States, and Healthy People Reviews.

The leading causes of death are used frequently to describe the health status of the Nation. Over the

past 100 years, the Nation has seen a great deal of change in the leading causes of death (see figure

8). At the beginning of the 1900s, infectious diseases ran rampant in the United States and worldwide

and topped the leading causes of death. A century later, with the control of many infectious agents

and the increasing age of the population, chronic diseases top the list.

A very different picture emerges when the leading causes of death are viewed for various population

groups. Unintentional injuries, mainly motor vehicle crashes, are the fifth leading cause of death for

the total population, but they are the leading cause of death for people aged 1 to 44 years. Similarly,

HIV/AIDS is the 14th leading cause of death for the total population but the leading cause of death

for African American men aged 25 to 44 years (see figure 9).

The leading causes of death in the United States generally result from a mix of behaviors; injury,

violence, and other factors in the environment; and the unavailability or inaccessibility of quality health

services. Understanding and monitoring behaviors, environmental factors, and community health

systems may prove more useful to monitoring the Nation’s true health, and in driving health

improvement activities, than the death rates that reflect the cumulative impact of these factors. This

more complex approach has served as the basis for developing the Leading Health Indicators.

Health Status
Health Status

22 Healthy People 2010: Understanding and Improving Health

Figure 8. The leading causes of death as a percentage of all deaths in the United States,

1900 and 1997.

*Not all States are represented.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics.

National Vital Statistics System and unpublished data. 1997.

Leading Causes of Death, 1997

Leading Causes of Death, 1900*
Health Status

Healthy People 2010: Understanding and Improving Health 23

Source: Centers for Disease Control and Prevention, National Center for Health Statistics.

National Vital Statistics System. 1999.

Leading Causes of Death by Age Group

Figure 9. The three leading causes of death by age group, United States, 1997.

Under 1 Year Number of Deaths

Birth defects 6,178

Disorders related to premature birth 3,925

Sudden infant death syndrome 2,991

1-4 Years

■ Unintentional injuries 2,005

Birth defects 589

■ Cancer 438

5-14 Years

■ Unintentional injuries 3,371

■ Cancer 1,030

Homicide 457

15-24 Years

■ Unintentional injuries 13,367

Homicide 6,146

■ Suicide 4,186

25-44 Years

■ Unintentional injuries 27,129

■ Cancer 21,706

■ Heart disease 16,513

45-64 Years

■ Cancer 131,743

■ Heart disease 101,235

■ Unintentional injuries 17,521

65 Years and Older

■ Heart disease 606,913

■ Cancer 382,913

■ Stroke 140,366

Bullets above link to the conditions listed in the charts in figure 8.
24 Healthy People 2010: Understanding and Improving Health

Leading Health Indicators

Leading Health

Indicators

n Physical activity

n Overweight and obesity

n Tobacco use

n Substance abuse

n Responsible sexual

 behavior

n Mental health

n Injury and violence

n Environmental quality

n Immunization

n Access to health care

The Leading Health Indicators reflect the

major public health concerns in the United

States and were chosen based on their ability to

motivate action, the availability of data to

measure their progress, and their relevance as

broad public health issues.

The Leading Health Indicators illuminate

individual behaviors, physical and social

environmental factors, and important health

system issues that greatly affect the health of

individuals and communities. Underlying each

of these indicators is the significant influence of

income and education (see Income and

Education, page 12).

The process of selecting the Leading Health

Indicators mirrored the collaborative and

extensive efforts undertaken to develop

Healthy People 2010. The process was led by

an interagency work group within the U.S.

Department of Health and Human Services.

Individuals and organizations provided

comments at national and regional meetings or

via mail and the Internet. A report by the

Institute of Medicine, National Academy of

Sciences, provided several scientific models on
Leading Health Indicator

Healthy People 2010: Understanding and Improving Health 25

which to support a set of indicators. Focus groups were used to ensure that the indicators are

meaningful and motivating to the public.

For each of the Leading Health Indicators, specific objectives

derived from Healthy People 2010 will be used to track

progress. This small set of measures will provide a snapshot of

the health of the Nation. Tracking and communicating progress

on the Leading Health Indicators through national- and Statelevel report cards will spotlight achievements and challenges in

the next decade. The Leading Health Indicators serve as a link

to the 467 objectives in Healthy People 2010 and can become

the basic building blocks for community health initiatives.

The Leading Health Indicators are intended to help everyone

more easily understand the importance of health promotion and disease prevention and to encourage

wide participation in improving health in the next decade. Developing strategies and action plans to

address one or more of these indicators can have a profound effect on increasing the quality of life

and the years of healthy life and on eliminating health disparities—creating healthy people in healthy

communities.

A major challenge

throughout the history

of Healthy People has

been to balance a

comprehensive set of

health objectives with

a smaller set of health

priorities.
Leading Health Indicator

26 Healthy People 2010: Understanding and Improving Health

Physical Activity

Regular physical activity throughout life is important for maintaining a healthy body, enhancing

psychological well-being, and preventing premature death.

In 1999, 65 percent of adolescents engaged in the recommended amount of physical activity. In 1997,

only 15 percent of adults performed the recommended amount of physical activity, and 40 percent of

adults engaged in no leisure-time physical activity.

The objectives selected to measure progress among adolescents and adults for this Leading

Health Indicator are presented below. These are only indicators and do not represent all the

physical activity and fitness objectives included in Healthy People 2010.

22-7. Increase the proportion of adolescents who engage in vigorous physical

activity that promotes cardiorespiratory fitness 3 or more days per week for

20 or more minutes per occasion.

22-2. Increase the proportion of adults who engage regularly, preferably daily, in

moderate physical activity for at least 30 minutes per day.

Participation in regular physical activity, United States, 1990–99

* The definition of moderate physical activity was changed in 1997.

Sources: Centers for Disease Control and Prevention. Youth Risk Behavior Survey. 1991–97.

Centers for Disease Control and Prevention, National Center for Health Statistics. National

Health Interview Survey. 1990–99.
Leading Health Indicator

Healthy People 2010: Understanding and Improving Health 27

Health Impact of Physical Activity

Regular physical activity is associated with lower death rates for adults of any age, even when only

moderate levels of physical activity are performed. Regular physical activity decreases the risk of

death from heart disease, lowers the risk of developing diabetes, and is associated with a decreased

risk of colon cancer. Regular physical activity helps prevent high blood pressure and helps reduce

blood pressure in persons with elevated levels.

Regular physical activity also:

■ Increases muscle and bone strength.

■ Increases lean muscle and helps decrease body fat.

■ Aids in weight control and is a key part of any weight loss effort.

■ Enhances psychological well-being and may even reduce the risk of developing depression.

■ Appears to reduce symptoms of depression and anxiety and to improve mood.

In addition, children and adolescents need weight-bearing exercise for normal skeletal development,

and young adults need such exercise to achieve and maintain peak bone mass. Older adults can

improve and maintain strength and agility with regular physical activity. This can reduce the risk of

falling, helping older adults maintain an independent living status. Regular physical activity also

increases the ability of people with certain chronic, disabling conditions to perform activities of daily

living.

Populations With Low Rates of Physical Activity

■ Women generally are less active than men at all ages.

■ People with lower incomes and less education are typically not as physically active as those

with higher incomes and education.

■ African Americans and Hispanics are generally less physically active than whites.

■ Adults in northeastern and southern States tend to be less active than adults in North-Central

and Western States.

■ People with disabilities are less physically active than people without disabilities.

■ By age 75, one in three men and one in two women engage in no regular physical activity.

Other Issues

The major barriers most people face when trying to increase physical activity are lack of time,

lack of access to convenient facilities, and lack of safe environments in which to be active.

For more information on Healthy People 2010 objectives or on physical activity and fitness,

visit http://www.health.gov/healthypeople/ or call 1-800-367-4725.
Leading Health Indicator

28 Healthy People 2010: Understanding and Improving Health

Overweight and Obesity

Overweight and obesity are major contributors to many preventable causes of death. On average,

higher body weights are associated with higher death rates. The number of overweight children,

adolescents, and adults has risen over the past four decades. Total costs (medical cost and lost

productivity) attributable to obesity alone amounted to an estimated $99 billion in 1995.

During 1988–94, 11 percent of children and adolescents aged 6 to 19 years were overweight or obese.

During the same years, 23 percent of adults aged 20 years and older were considered obese.

The objectives selected to measure progress among children, adolescents, and adults for

this Leading Health Indicator are presented below. These are only indicators and do not

represent all the nutrition and overweight objectives included in Healthy People 2010.

19-3c. Reduce the proportion of children and adolescents who are overweight

or obese.

19-2. Reduce the proportion of adults who are obese.

* In those aged 6 to 19 years, overweight or obesity is defined as at or above the sex- and agespecific 95th percentile of Body Mass Index (BMI) based on CDC Growth Charts: United States.

**In adults, obesity is defined as a BMI of 30 kg/m2 or more; overweight is a BMI of 25 kg/m2 or

more.

Body mass index (BMI) is calculated as weight in kilograms (kg) divided by the square of height in

meters (m2

) (BMI = weight[kg]/height[m2]). To estimate BMI using pounds (lbs) and inches (in),

divide weight in pounds by the square of height in inches. Then multiply the resulting number by

704.5 (BMI = weight[lbs]/height[in2

] X 704.5).

Source: Centers for Disease Control and Prevention, National Center for Health Statistics.

National Health and Nutrition Examination Survey. 1988–94.

Overweight and obesity, United States, 1988–94
Leading Health Indicator

Healthy People 2010: Understanding and Improving Health 29

Health Impact of Overweight and Obesity

Overweight and obesity substantially raise the risk of illness from high blood pressure, high cholesterol,

type 2 diabetes, heart disease and stroke, gallbladder disease, arthritis, sleep disturbances and

problems breathing, and certain types of cancers. Obese individuals also may suffer from social

stigmatization, discrimination, and lowered self-esteem.

Populations With High Rates of Overweight and Obesity

More than half of adults in the United States are estimated to be overweight or obese. The proportion

of adolescents from poor households who are overweight or obese is twice that of adolescents from

middle- and high-income households. Obesity is especially prevalent among women with lower

incomes and is more common among African American and Mexican American women than among

white women. Among African Americans, the proportion of women who are obese is 80 percent

higher than the proportion of men who are obese. This gender difference also is seen among Mexican

American women and men, but the percentage of white, non-Hispanic women and men who are

obese is about the same.

Reducing Overweight and Obesity

Obesity is a result of a complex variety of social, behavioral, cultural, environmental, physiological, and

genetic factors. Efforts to maintain a healthy weight should start early in childhood and continue

throughout adulthood, as this is likely to be more successful than efforts to lose substantial amounts of

weight and maintain weight loss once obesity is established.

A healthy diet and regular physical activity are both important for maintaining a healthy weight. Over

time, even a small decrease in calories eaten and a small increase in physical activity can help prevent

weight gain or facilitate weight loss. It is recommended that obese individuals who are trying to lose

substantial amounts of weight seek the guidance of a health care provider.

Dietary and Physical Activity Recommendations

The Dietary Guidelines for Americans recommend that to build a healthy base, persons aged 2

years and older choose a healthful assortment of foods that includes vegetables; fruits; grains

(especially whole grains); fat-free or low-fat milk products; and fish, lean meat, poultry, or beans. The

guidelines further emphasize the importance of choosing foods that are low in saturated fat and added

sugars most of the time and, whatever the food, eating a sensible portion size. It is recognized,

however, that this guidance may be particularly challenging when eating out because the consumer

may be offered large portion sizes with unknown amounts of saturated fat and added sugars.

The Dietary Guidelines for Americans recommend that all adults be more active throughout the day

and get at least 30 minutes of moderate physical activity most, or preferably all, days of the week.

Adults who are trying to maintain healthy weight after weight loss are advised to get even more

physical activity. The guidelines also recommend that children get at least 60 minutes of physical

activity daily and limit inactive forms of play such as television watching and computer games.

For more information on Healthy People 2010 objectives or on overweight and obesity, visit

http://www.health.gov/healthypeople/ or call 1-800-367-4725.
Leading Health Indicator

30 Healthy People 2010: Understanding and Improving Health

Cigarette smoking is the single most preventable cause of disease and death in the United States.

Smoking results in more deaths each year in the United States than AIDS, alcohol, cocaine,

heroin, homicide, suicide, motor vehicle crashes, and fires—combined.

Tobacco-related deaths number more than 430,000 per year among U.S. adults, representing more

than 5 million years of potential life lost. Direct medical costs attributable to smoking total at least

$50 billion per year.

In 1999, 35 percent of adolescents were current cigarette smokers. In 1998, 24 percent of adults

were current cigarette smokers.

Tobacco Use

The objectives selected to measure progress among adolescents and adults for this

Leading Health Indicator are presented below. These are only indicators and do not

represent all the tobacco use objectives included in Healthy People 2010.

27-2b. Reduce cigarette smoking by adolescents.

27-1a. Reduce cigarette smoking by adults.

Cigarette smoking, United States, 1990–99

Sources: Centers for Disease Control and Prevention. Youth Risk Behavior Survey. 1991–99.

Centers for Disease Control and Prevention, National Center for Health Statistics. National

Health Interview Survey. 1990–98.
Leading Health Indicator

Healthy People 2010: Understanding and Improving Health 31

Health Impact of Cigarette Smoking

Smoking is a major risk factor for heart disease, stroke, lung cancer, and chronic lung diseases—all

leading causes of death. Smoking during pregnancy can result in miscarriages, premature delivery, and

sudden infant death syndrome. Other health effects of smoking result from injuries and environmental

damage caused by fires.

Environmental tobacco smoke (ETS) increases the risk of heart disease and significant lung

conditions, especially asthma and bronchitis in children. ETS is responsible for an estimated 3,000 lung

cancer deaths each year among adult nonsmokers.

Trends in Cigarette Smoking

Adolescents. Overall, the percentage of adolescents in grades 9 through 12 who smoked in the past

month increased in the 1990s. Every day, an estimated 3,000 young persons start smoking. These

trends are disturbing because the vast majority of adult smokers tried their first cigarette before age

18 years; more than half of adult smokers became daily smokers before this same age. Almost half of

adolescents who continue smoking regularly will die eventually from a smoking-related illness.

Adults. Following years of steady decline, rates of smoking among adults appear to have leveled off

in the 1990s.

Populations With High Rates of Smoking

Adolescents. Adolescent rates of cigarette smoking have increased in the 1990s among white,

African American, and Hispanic high school students after years of declining rates during the 1970s

and 1980s. In 1999, 39 percent of white high school students currently smoked cigarettes compared

with 33 percent for Hispanics and 20 percent for African Americans. Among African Americans in

1999, only 19 percent of high school girls, compared with 22 percent of boys, currently smoked

cigarettes.

Adults. Overall, American Indians and Alaska Natives, blue-collar workers, and military personnel

have the highest rates of smoking in adults. Rates of smoking in Asian and Pacific Islander men are

more than four times higher than for women of the same race. Men have only somewhat higher rates

of smoking than women within the total U.S. population. Low-income adults are more likely to smoke

than are high-income adults. The percentage of people aged 25 years and older with less than 12

years of education who are current smokers is nearly three times that for persons with 16 or more

years of education.

Other Important Tobacco Issues

There is no safe tobacco alternative to cigarettes. Spit tobacco (chew) causes cancer of the

mouth, inflammation of the gums, and tooth loss.Cigar smoking causes cancer of the mouth,

throat, and lungs and can increase the risk of heart disease and chronic lung problems.

For more information on Healthy People 2010 objectives or on tobacco use, visit

http://www.health.gov/healthypeople/ or call 1-800-367-4725.
Leading Health Indicator

32 Healthy People 2010: Understanding and Improving Health

Alcohol and illicit drug use are associated with many of this country’s most serious problems, including

violence, injury, and HIV infection. The annual economic costs to the United States from alcohol

abuse were estimated to be $167 billion in 1995, and the costs from drug abuse were estimated to be

$110 billion.

In 1998, 79 percent of adolescents aged 12 to 17 years reported that they did not use alcohol or illicit

drugs in the past month. In the same year, 6 percent of adults aged 18 years and older reported using

illicit drugs in the past month; 17 percent reported binge drinking in the past month, which is defined as

consuming five or more drinks on one occasion.

Substance Abuse

Use of alcohol and/or illicit drugs, United States, 1994–98

Source: Substance Abuse and Mental Health Services Administration, Office of the Assistant

Secretary. National Household Survey on Drug Abuse. 1994–98.

The objectives selected to measure progress among adolescents and adults for this

Leading Health Indicator are presented below. These are only indicators and do not

represent all the substance abuse objectives in Healthy People 2010.

26-10a. Increase the proportion of adolescents not using alcohol or any illicit

drugs during the past 30 days.

26-10c. Reduce the proportion of adults using any illicit drug during the past

30 days.

26-11c. Reduce the proportion of adults engaging in binge drinking of alcoholic

beverages during the past month.
Leading Health Indicator

Healthy People 2010: Understanding and Improving Health 33

Health Impact of Substance Abuse

Alcohol and illicit drug use are associated with child and spousal abuse; sexually transmitted diseases,

including HIV infection; teen pregnancy; school failure; motor vehicle crashes; escalation of health

care costs; low worker productivity; and homelessness. Alcohol and illicit drug use also can result in

substantial disruptions in family, work, and personal life.

Alcohol abuse alone is associated with motor vehicle crashes, homicides, suicides, and drowning—

leading causes of death among youth. Long-term heavy drinking can lead to heart disease, cancer,

alcohol-related liver disease, and pancreatitis. Alcohol use during pregnancy is known to cause fetal

alcohol syndrome, a leading cause of preventable mental retardation.

Trends in Substance Abuse

Adolescents. Although the trend from 1994 to 1998 has shown some fluctuations, about 77 percent

of adolescents aged 12 to 17 years report being both alcohol-free and drug-free in the past month.

Alcohol is the drug most frequently used by adolescents aged 12 to 17 years. In 1998, 19 percent of

adolescents aged 12 to 17 years reported drinking alcohol in the past month. Alcohol use in the past

month for this age group has remained at about 20 percent since 1992. Eight percent of this age group

reported binge drinking, and 3 percent were heavy drinkers (five or more drinks on the same occasion

on each of 5 or more days in the past 30 days).

Data from 1998 show that 10 percent of adolescents aged 12 to 17 years reported using illicit drugs in

the past 30 days. This rate remains well below the all-time high of 16 percent in 1979. Current illicit

drug use had nearly doubled for those aged 12 to 13 years between 1996 and 1997 but then decreased

between 1997 and 1998. Youth are experimenting with a variety of illicit drugs, including marijuana,

cocaine, crack, heroin, acid, inhalants, and methamphetamines, as well as misuse of prescription drugs

and other “street” drugs. The younger a person becomes a habitual user of illicit drugs, the stronger

the addiction becomes and the more difficult it is to stop use.

Adults. Binge drinking has remained at the same approximate level of 17 percent for all adults since

1988, with the highest current rate of 32 percent among adults aged 18 to 25 years. Illicit drug use has

been near the present rate of 6 percent since 1980. Men continue to have higher rates of illicit drug

use than women have, and rates of illicit drug use in urban areas are higher than in rural areas.

For more information on Healthy People 2010 objectives or on substance abuse, visit

http://www.health.gov/healthypeople/ or call 1-800-367-4725.
Leading Health Indicator

34 Healthy People 2010: Understanding and Improving Health

Unintended pregnancies and sexually transmitted diseases (STDs), including infection with the human

immunodeficiency virus that causes AIDS, can result from unprotected sexual behaviors. Abstinence

is the only method of complete protection. Condoms, if used correctly and consistently, can help

prevent both unintended pregnancy and STDs.

In 1999, 85 percent of adolescents abstained from sexual intercourse or used condoms if they were

sexually active. In 1995, 23 percent of sexually active women reported that their partners used

condoms.

Responsible Sexual Behavior

The objectives selected to measure progress among adolescents and adults for this Leading

Health Indicator are presented below. These are only indicators and do not represent all the

responsible sexual behavior objectives in Healthy People 2010.

25-11. Increase the proportion of adolescents who abstain from sexual intercourse

or use condoms if currently sexually active.

13-6a. Increase the proportion of sexually active persons who use condoms.

Responsible sexual behavior, United States, 1995 and 1999

* This 85 percent includes 50 percent of students in grades 9-12 who were not ever sexually active,

14 percent who were not sexually active in the past 3 months, and 21 percent who were sexually

active but used a condom at the last intercourse.

** Data on males aged 15 to 49 years will be collected in 2003.

Sources: Centers for Disease Control and Prevention. Youth Risk Behavior Survey. 1999.

Centers for Disease Control and Prevention, National Center for Health Statistics. National

Survey of Family Growth. 1995.
Leading Health Indicator

Healthy People 2010: Understanding and Improving Health 35

Trends in Sexual Behavior

In the past 6 years there has been both an increase in abstinence among all youth and an increase in

condom use among those young people who are sexually active. Research has shown clearly that the

most effective school-based programs are comprehensive ones that include a focus on abstinence and

condom use. Condom use in sexually active adults has remained steady at about 25 percent.

Unintended Pregnancies

Half of all pregnancies in the United States are unintended; that is, at the time of conception the

pregnancy was not planned or not wanted. Unintended pregnancy rates in the United States have

been declining. The rates remain highest among teenagers, women aged 40 years or older, and lowincome African American women. Approximately 1 million teenage girls each year in the United

States have unintended pregnancies. Nearly half of all unintended pregnancies end in abortion.

The cost to U.S. taxpayers for adolescent pregnancy is estimated at between $7 billion and $15 billion

a year.

Sexually Transmitted Diseases

Sexually transmitted diseases are common in the United States, with an estimated 15 million new

cases of STDs reported each year. Almost 4 million of the new cases of STDs each year occur in

adolescents. Women generally suffer more serious STD complications than men, including pelvic

inflammatory disease, ectopic pregnancy, infertility, chronic pelvic pain, and cervical cancer from the

human papilloma virus. African Americans and Hispanics have higher rates of STDs than whites.

The total cost of the most common STDs and their complications is conservatively estimated at $17

billion annually.

HIV/AIDS

Nearly 700,000 cases of AIDS have been reported in the United States since the HIV/AIDS epidemic

began in the 1980s. The latest estimates indicate that 800,000 to 900,000 people in the United States

currently are infected with HIV. The lifetime cost of health care associated with HIV infection, in

light of recent advances in HIV diagnostics and therapies, is $155,000 or more per person.

About one-half of all new HIV infections in the United States are among people under age 25 years,

and the majority are infected through sexual behavior. HIV infection is the leading cause of death for

African American men aged 25 to 44 years. Compelling worldwide evidence indicates that the

presence of other STDs increases the likelihood of both transmitting and acquiring HIV infection.

For more information on Healthy People 2010 objectives or on responsible sexual behavior, visit

http://www.health.gov/healthypeople/ or call 1-800-367-4725.
Leading Health Indicator

36 Healthy People 2010: Understanding and Improving Health

Approximately 20 percent of the U.S. population is affected by mental illness during a given year; no

one is immune. Of all mental illnesses, depression is the most common disorder. More than 19 million

adults in the United States suffer from depression. Major depression is the leading cause of disability

and is the cause of more than two-thirds of suicides each year.

In 1997, only 23 percent of adults diagnosed with depression received treatment.

Mental Health

The objective selected to measure progress among adults for this Leading Health Indicator is

presented below. This is only an indicator and does not represent all the mental health

objectives in Healthy People 2010.

18-9b. Increase the proportion of adults with recognized depression who receive

treatment.

Adults with depression* who received treatment,** United States, 1994–97

* Depression is defined as major depressive episode in the past year.

**Treatment is defined as treatment in the past year for psychological problems or

emotional difficulties at a mental health clinic or by a mental health professional on an

outpatient basis or treatment for psychological or emotional difficulties at a hospital

overnight or longer.

Source: Substance Abuse and Mental Health Services Administration, Office of Applied

Studies. National Household Survey on Drug Abuse. 1994–97.
Leading Health Indicator

Healthy People 2010: Understanding and Improving Health 37

Definition of Mental Health

Mental health is sometimes thought of as simply the absence of a mental illness but is actually much

broader. Mental health is a state of successful mental functioning, resulting in productive activities,

fulfilling relationships, and the ability to adapt to change and cope with adversity. Mental health is

indispensable to personal well-being, family and interpersonal relationships, and one’s contribution to

society.

Impact of Depression

A person with a depressive disorder often is unable to fulfill the daily responsibilities of being a spouse,

partner, or parent. The misunderstanding of mental illness and the associated stigmatization prevent

many persons with depression from seeking professional help. Many people will be incapacitated for

weeks or months because their depression goes untreated.

Depression is associated with other medical conditions, such as heart disease, cancer, and diabetes as

well as anxiety and eating disorders. Depression also has been associated with alcohol and illicit drug

abuse. An estimated 8 million persons aged 15 to 54 years had coexisting mental and substance abuse

disorders within the past year.

The total estimated direct and indirect cost of mental illness in the United States in 1996 was

$150 billion.

Treatment of Depression

Depression is treatable. Available medications and psychological treatments, alone or in combination,

can help 80 percent of those with depression. With adequate treatment, future episodes of depression

can be prevented or reduced in severity. Treatment for depression can enable people to return to

satisfactory, functioning lives.

Populations With High Rates of Depression

Serious mental illness clearly affects mental health and can affect children, adolescents, adults, and

older adults of all ethnic and racial groups, both genders, and people at all educational and income

levels.

Adults and older adults have the highest rates of depression. Major depression affects approximately

twice as many women as men. Women who are poor, on welfare, less educated, unemployed, and

from certain racial or ethnic populations are more likely to experience depression. In addition,

depression rates are higher among older adults with coexisting medical conditions. For example, 12

percent of older persons hospitalized for problems such as hip fracture or heart disease are diagnosed

with depression. Rates of depression for older persons in nursing homes range from 15 to 25 percent.

For more information on Healthy People 2010 objectives or on mental health, visit

http://www.health.gov/healthypeople/ or call 1-800-367-4725.
Leading Health Indicator

38 Healthy People 2010: Understanding and Improving Health

More than 400 Americans die each day from injuries due primarily to motor vehicle crashes, firearms,

poisonings, suffocation, falls, fires, and drowning. The risk of injury is so great that most persons

sustain a significant injury at some time during their lives.

Motor vehicle crashes are the most common cause of serious injury. In 1998, there were 15.6 deaths

from motor vehicle crashes per 100,000 persons.

Because no other crime is measured as accurately and precisely, homicide is a reliable indicator of all

violent crime. In 1998, the murder rate in the United States fell to its lowest level in three decades—

6.5 homicides per 100,000 persons.

Injury and Violence

The objectives selected to measure progress for this Leading Health Indicator are presented

below. These are only indicators and do not represent all the injury and violence prevention

objectives in Healthy People 2010.

15-15a. Reduce deaths caused by motor vehicle crashes.

15-32. Reduce homicides.

Motor vehicle deaths and homicides, United States, 1998

Source: Centers for Disease Control and Prevention, National Center for Health Statistics.

National Vital Statistics System. 1998.
Leading Health Indicator

Healthy People 2010: Understanding and Improving Health 39

Impact of Injury and Violence

In 1995, the cost of injury and violence in the United States was estimated at more than $224 billion

per year. These costs include direct medical care and rehabilitation as well as productivity losses to

the Nation’s workforce. The total societal cost of motor vehicle crashes alone exceeds $150 billion

annually.

Motor Vehicle Crashes

Motor vehicle crashes often are predictable and preventable. Increased use of safety belts and

reductions in driving while impaired are two of the most effective means to reduce the risk of death

and serious injury of occupants in motor vehicle crashes.

Death rates associated with motor vehicle-traffic injuries are highest in the age group 15 to 24 years.

In 1996, teenagers accounted for only 10 percent of the U.S. population but 15 percent of the deaths

from motor vehicle crashes. Those aged 75 years and older had the second highest rate of motor

vehicle-related deaths.

Nearly 40 percent of traffic fatalities in 1997 were alcohol related. Each year in the United States it is

estimated that more than 120 million episodes of impaired driving occur among adults. In 1996, 21

percent of traffic fatalities of children aged 14 years and under involved alcohol; 60 percent of the

time the driver of the car in which the child was a passenger was impaired.

The highest intoxication rates in fatal crashes in 1995 were recorded for drivers aged 21 to 24 years.

Young drivers who have been arrested for driving while impaired are more than four times as likely to

die in future alcohol-related crashes.

Homicides

In 1997, 32,436 individuals died from firearm injuries; of this number, 42 percent were victims of

homicide. In 1997, homicide was the third leading cause of death for children aged 5 to 14 years, an

increasing trend in childhood violent deaths. In 1996, more than 80 percent of infant homicides were

considered to be fatal child abuse.

Many factors that contribute to injuries are also closely associated with violent and abusive behavior,

such as low income, discrimination, lack of education, and lack of employment opportunities.

Males are most often the victims and the perpetrators of homicides. African Americans are more than

five times as likely as whites to be murdered. There has been a decline in the homicide of intimates,

including spouses, partners, boyfriends, and girlfriends, over the past decade, but this problem remains

significant.

For more information on Healthy People 2010 objectives or on injury and violence, visit

 http://www.health.gov/healthypeople/ or call 1-800-367-4725.
Leading Health Indicator

40 Healthy People 2010: Understanding and Improving Health

An estimated 25 percent of preventable illnesses worldwide can be attributed to poor environmental

quality. In the United States, air pollution alone is estimated to be associated with 50,000 premature

deaths and an estimated $40 billion to $50 billion in health-related costs annually. Two indicators of air

quality are ozone (outdoor) and environmental tobacco smoke (indoor).

In 1997, approximately 43 percent of the U.S. population lived in areas designated as nonattainment

areas for established health-based standards for ozone. During the years 1988 to 1994, 65 percent of

nonsmokers were exposed to environmental tobacco smoke (ETS).

Environmental Quality

The objectives selected to measure progress among children, adolescents, and adults for this

Leading Health Indicator are presented below. These are only indicators and do not represent

all the environmental quality objectives in Healthy People 2010.

8-1a. Reduce the proportion of persons exposed to air that does not meet the

U.S. Environmental Protection Agency’s health-based standards for ozone.

27-10. Reduce the proportion of nonsmokers exposed to environmental tobacco

smoke.

Ozone and environmental tobacco smoke exposure,

United States, 1988–94 and 1997

Sources: U.S. Environmental Protection Agency. Aerometric Information Retrieval System. 1997.

Centers for Disease Control and Prevention, National Center for Health Statistics. National Health

and Nutrition Examination Survey. 1988–94.
Leading Health Indicator

Healthy People 2010: Understanding and Improving Health 41

Defining the Environment

Physical and social environments play major roles in the health of individuals and communities. The

physical environment includes the air, water, and soil through which exposure to chemical, biological,

and physical agents may occur. The social environment includes housing, transportation, urban

development, land use, industry, and agriculture and results in exposures such as work-related stress,

injury, and violence.

Global Concern

Environmental quality is a global concern. Ever-increasing numbers of people and products cross

national borders and may transfer health risks such as infectious diseases and chemical hazards. For

example, pesticides that are not registered or are restricted for use in the United States potentially

could be imported in the fruits, vegetables, and seafood produced abroad.

Health Impact of Poor Air Quality

Poor air quality contributes to respiratory illness, cardiovascular disease, and cancer. For example,

asthma can be triggered or worsened by exposure to ozone and ETS. The overall death rate from

asthma increased 57 percent between 1980 and 1993, and for children it increased 67 percent.

Air Pollution. Dramatic improvements in air quality in the United States have occurred over the past

three decades. Between 1970 and 1997, total emissions of the six principal air pollutants decreased 31

percent. Still, millions of tons of toxic pollutants are released into the air each year from automobiles,

industry, and other sources. In 1997, despite continued improvements in air quality, approximately 120

million people lived in areas with unhealthy air based on established standards for one or more

commonly found air pollutants, including ozone. In 1996, a disproportionate number of Hispanics and

Asian and Pacific Islanders lived in areas that failed to meet these standards compared with whites,

African Americans, and American Indians or Alaska Natives.

Tobacco Smoke. Exposure to ETS, or secondhand smoke, among nonsmokers is widespread. Home

and workplace environments are major sources of exposure. A total of 15 million children are

estimated to have been exposed to secondhand smoke in their homes in 1996. ETS increases the risk

of heart disease and respiratory infections in children and is responsible for an estimated 3,000 cancer

deaths of adult nonsmokers.

Improvement in Environmental Quality

In the United States, ensuring clean water, safe food, and effective waste management has

contributed greatly to a declining threat from many infectious diseases; however, there is still more

that can be done. Work to improve the air quality and to understand better threats such as chronic,

low-level exposures to hazardous substances also must continue.

For more information on Healthy People 2010 objectives or on environmental quality, visit

http://www.health.gov/healthypeople/ or call 1-800-367-4725.
Leading Health Indicator

42 Healthy People 2010: Understanding and Improving Health

Vaccines are among the greatest public health achievements of the 20th century. Immunizations can

prevent disability and death from infectious diseases for individuals and can help control the spread of

infections within communities.

In 1998, 73 percent of children received all vaccines recommended for universal administration.

In 1998, influenza immunization rates were 64 percent in adults aged 65 years and older—almost

double the 1989 immunization rate of 33 percent. In 1998, only 46 percent of persons aged 65 years

and older had ever received a pneumococcal vaccine.

Immunization

The objectives selected to measure progress among children and adults for this Leading

Health Indicator are presented below. These are only indicators and do not represent all the

immunization and infectious diseases objectives in Healthy People 2010.

14-24a. Increase the proportion of young children who receive all vaccines that

have been recommended for universal administration for at least 5 years.

14-29a, b. Increase the proportion of noninstitutionalized adults who are

vaccinated annually against influenza and ever vaccinated against

pneumococcal disease.

Immunization coverage, United States, 1991–98

*Four or more doses of diphtheria/tetanus/acellular pertussis (DTaP) vaccine, three or more

doses of polio vaccine, one or more dose of measles/mumps/rubella (MMR) vaccine, three or

more doses of Haemophilus influenzae type b (Hib) vaccine, and three or more doses of

hepatitis B (Hep B) vaccine.

Sources: Centers for Disease Control and Prevention, National Center for Health Statistics and

National Immunization Program. National Immunization Survey. 1996–98. Centers for Disease

Control and Prevention, National Center for Health Statistics. National Health Interview Survey. 1991–98.
Leading Health Indicator

Healthy People 2010: Understanding and Improving Health 43

Impact of Immunization

Many once-common vaccine-preventable diseases now are controlled. Smallpox has been eradicated,

poliomyelitis has been eliminated from the Western Hemisphere, and measles cases in the United

States are at a record low.

Immunizations against influenza and pneumococcal disease can prevent serious illness and death.

Pneumonia and influenza deaths together constitute the sixth leading cause of death in the United

States. Influenza causes an average of 110,000 hospitalizations and 20,000 deaths annually;

pneumococcal disease causes 10,000 to 14,000 deaths annually.

Recommended Immunizations

As of November 1, 1999, all children born in the United States (11,000 per day) should be receiving

12 to 16 doses of vaccine by age 2 years to be protected against 10 vaccine-preventable childhood

diseases. This recommendation will change in the years ahead as new vaccines are developed,

including combinations of current vaccines that may even reduce the number of necessary shots.

Recommended immunizations for adults aged 65 years and older include a yearly immunization against

influenza (the “flu shot”) and a one-time immunization against pneumococcal disease. Most of the

deaths and serious illnesses caused by influenza and pneumococcal disease occur in older adults and

others at increased risk for complications of these diseases because of other risk factors or medical

conditions.

Trends in Immunization

National coverage levels in children now are greater than 90 percent for each immunization

recommended during the first 2 years of life, except for hepatitis B and varicella vaccines. The

hepatitis B immunization rate in children was 87 percent in 1998—the highest level ever reported. In

1998, 70 percent of children aged 19 to 35 months from the lowest income households received the

combined series of recommended immunizations, compared with 77 percent of children from higher

income households.

Both influenza and pneumococcal immunization rates are significantly lower for African American

and Hispanic adults than for white adults.

Other Immunization Issues

Coverage levels for immunizations in adults are not as high as those achieved in children, yet the

health effects may be just as great. Barriers to adult immunization include not knowing immunizations

are needed, misconceptions about vaccines, and lack of recommendations from health care providers.

For more information on Healthy People 2010 objectives or on immunization and infectious diseases,

visit http://www.health.gov/healthypeople/ or call 1-800-367-4725.
Leading Health Indicator

44 Healthy People 2010: Understanding and Improving Health

Strong predictors of access to quality health care include having health insurance, a higher income

level, and a regular primary care provider or other source of ongoing health care. Use of clinical

preventive services, such as early prenatal care, can serve as indicators of access to quality health

care services.

In 1997, 83 percent of persons under age 65 years had health insurance. In 1998, 87 percent of

persons of all ages had a usual source of health care. Also in that year, 83 percent of pregnant

women received prenatal care in the first trimester of pregnancy.

Access to Health Care

The objectives selected to measure progress for this Leading Health Indicator are presented

below. These are only indicators and do not represent all the access to quality health services

objectives in Healthy People 2010.

1-1. Increase the proportion of persons with health insurance.

1-4a. Increase the proportion of persons who have a specific source of ongoing

care.

16-6a. Increase the proportion of pregnant women who begin prenatal care in the

first trimester of pregnancy.

Access to health care, United States, 1997 and 1998

Sources: Centers for Disease Control and Prevention, National Center for Health Statistics.

National Health Interview Survey. *1997 and **1998. Centers for Disease Control and

Prevention, National Center for Health Statistics. National Vital Statistics System. ***1998.
Leading Health Indicator

Healthy People 2010: Understanding and Improving Health 45

Health Insurance

Health insurance provides access to health care. Persons with health insurance are more likely to

have a primary care provider and to have received appropriate preventive care such as a recent Pap

test, immunization, or early prenatal care. Adults with health insurance are twice as likely to receive a

routine checkup as are adults without health insurance.

More than 44 million persons in the United States do not have health insurance, including 11 million

uninsured children. Over the past decade, the proportion of persons under age 65 years with health

insurance remained steady at about 85 percent. About one-third of adults under age 65 years below

the poverty level were uninsured. For persons of Hispanic origin, approximately one in three was

without health insurance coverage in 1997. Mexican Americans had one of the highest uninsured

rates at 40 percent.

Ongoing Sources of Primary Care

More than 40 million Americans do not have a particular doctor’s office, clinic, health center, or other

place where they usually go to seek health care or health-related advice. Even among privately

insured persons, a significant number lacked a usual source of care or reported difficulty in accessing

needed care due to financial constraints or insurance problems.

People aged 18 to 24 years were the most likely to lack a usual source of ongoing primary care. Only

80 percent of individuals below the poverty level and 79 percent of Hispanics had a usual source of

ongoing primary care.

Barriers to Access

Financial, structural, and personal barriers can limit access to health care. Financial barriers include

not having health insurance, not having enough health insurance to cover needed services, or not

having the financial capacity to cover services outside a health plan or insurance program. Structural

barriers include the lack of primary care providers, medical specialists, or other health care

professionals to meet special needs or the lack of health care facilities. Personal barriers include

cultural or spiritual differences, language barriers, not knowing what to do or when to seek care, or

concerns about confidentiality or discrimination.

For more information on Healthy People 2010 objectives or on access to health care, visit

http://www.health.gov/healthypeople/ or call 1-800-367-4725.
46 Healthy People 2010: Understanding and Improving Health
Healthy People 2010: Understanding and Improving Health 47

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Healthy People 2010: Understanding and Improving Health 51

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52 Healthy People 2010: Understanding and Improving Health
Healthy People 2010: Understanding and Improving Health 53

1. Access to Quality Health Services

Goal: Improve access to comprehensive,

high-quality health care services.

Objective Number and Short Title

Clinical Preventive Care

1-1 Persons with health insurance

1-2 Health insurance coverage for clinical

preventive services

1-3 Counseling about health behaviors

Primary Care

1-4 Source of ongoing care

1-5 Usual primary care provider

1-6 Difficulties or delays in obtaining needed

health care

1-7 Core competencies in health provider training

1-8 Racial and ethnic representation in health

professions

1-9 Hospitalization for ambulatory-care-sensitive

conditions

Emergency Services

1-10 Delay or difficulty in getting emergency care

1-11 Rapid prehospital emergency care

1-12 Single toll-free number for poison control

centers

1-13 Trauma care systems

1-14 Special needs of children

Long-Term Care and Rehabilitative Services

1-15 Long-term care services

1-16 Pressure ulcers among nursing home

residents

Appendix: Short Titles for Healthy People 2010

Objectives

2. Arthritis, Osteoporosis, and Chronic

Back Conditions

Goal: Prevent illness and disability related to

arthritis and other rheumatic conditions,

osteoporosis, and chronic back

conditions.

Objective Number and Short Title

Arthritis and Other Rheumatic Conditions

2-1 Mean number of days without severe pain

2-2 Activity limitations due to arthritis

2-3 Personal care limitations

2-4 Help in coping

2-5 Employment rate

2-6 Racial differences in total knee replacement

2-7 Seeing a health care provider

2-8 Arthritis education

Osteoporosis

2-9 Cases of osteoporosis

2-10 Hospitalization for vertebral fractures

Chronic Back Conditions

2-11 Activity limitations due to chronic back

conditions
54 Healthy People 2010: Understanding and Improving Health

3. Cancer

Goal: Reduce the number of new cancer

cases as well as the illness, disability,

and death caused by cancer.

Objective Number and Short Title

3-1 Overall cancer deaths

3-2 Lung cancer deaths

3-3 Breast cancer deaths

3-4 Cervical cancer deaths

3-5 Colorectal cancer deaths

3-6 Oropharyngeal cancer deaths

3-7 Prostate cancer deaths

3-8 Melanoma deaths

3-9 Sun exposure and skin cancer

3-10 Provider counseling about cancer prevention

3-11 Pap tests

3-12 Colorectal cancer screening

3-13 Mammograms

3-14 Statewide cancer registries

3-15 Cancer survival

4. Chronic Kidney Disease

Goal: Reduce new cases of chronic kidney

disease and its complications, disability,

death, and economic costs.

Objective Number and Short Title

4-1 End-stage renal disease

4-2 Cardiovascular disease deaths in persons

with chronic kidney failure

4-3 Counseling for chronic kidney failure care

4-4 Use of arteriovenous fistulas

4-5 Registration for kidney transplantation

4-6 Waiting time for kidney transplantation

4-7 Kidney failure due to diabetes

4-8 Medical therapy for persons with diabetes and

proteinuria

5. Diabetes

Goal: Through prevention programs, reduce

the disease and economic burden of

diabetes, and improve the quality of life

for all persons who have or are at risk

for diabetes.

Objective Number and Short Title

5-1 Diabetes education

5-2 New cases of diabetes

5-3 Overall cases of diagnosed diabetes

5-4 Diagnosis of diabetes

5-5 Diabetes deaths

5-6 Diabetes-related deaths

5-7 Cardiovascular disease deaths in persons

with diabetes

5-8 Gestational diabetes

5-9 Foot ulcers

5-10 Lower extremity amputations

5-11 Annual urinary microalbumin measurement

5-12 Annual glycosylated hemoglobin measurement

5-13 Annual dilated eye examinations

5-14 Annual foot examinations

5-15 Annual dental examinations

5-16 Aspirin therapy

5-17 Self-blood-glucose-monitoring

6. Disability and Secondary Conditions

Goal: Promote the health of people with

disabilities, prevent secondary conditions, and eliminate disparities between

people with and without

disabilities in the U.S. population.

Objective Number and Short Title

6-1 Standard definition of people with disabilities

in data sets

6-2 Feelings and depression among children with

disabilities

6-3 Feelings and depression interfering with

activities among adults with disabilities

6-4 Social participation among adults with

disabilities

6-5 Sufficient emotional support among adults with

disabilities

6-6 Satisfaction with life among adults with

disabilities

6-7 Congregate care of children and adults with

disabilities

6-8 Employment parity

6-9 Inclusion of children and youth with disabilities

in regular education programs

6-10 Accessibility of health and wellness programs

6-11 Assistive devices and technology

6-12 Environmental barriers affecting participation in

activities

6-13 Surveillance and health promotion programs
Healthy People 2010: Understanding and Improving Health 55

7. Educational and Community-Based

Programs

Goal: Increase the quality, availability, and

effectiveness of educational and

community-based programs designed

to prevent disease and improve health

and quality of life.

Objective Number and Short Title

School Setting

7-1 High school completion

7-2 School health education

7-3 Health-risk behavior information for college

and university students

7-4 School nurse-to-student ratio

Worksite Setting

7-5 Worksite health promotion programs

7-6 Participation in employer-sponsored health

promotion activities

Health Care Setting

7-7 Patient and family education

7-8 Satisfaction with patient education

7-9 Health care organization sponsorship of

community health promotion activities

Community Setting and Select Populations

7-10 Community health promotion programs

7-11 Culturally appropriate and linguistically

competent community health promotion

programs

7-12 Older adult participation in community health

promotion activities

8. Environmental Health

Goal: Promote health for all through a healthy

environment.

Objective Number and Short Title

Outdoor Air Quality

8-1 Harmful air pollutants

8-2 Alternative modes of transportation

8-3 Cleaner alternative fuels

8-4 Airborne toxins

Water Quality

8-5 Safe drinking water

8-6 Waterborne disease outbreaks

8-7 Water conservation

8-8 Surface water health risks

8-9 Beach closings

8-10 Fish contamination

Toxics and Waste

8-11 Elevated blood lead levels in children

8-12 Risks posed by hazardous sites

8-13 Pesticide exposures

8-14 Toxic pollutants

8-15 Recycled municipal solid waste

Healthy Homes and Healthy Communities

8-16 Indoor allergens

8-17 Office building air quality

8-18 Homes tested for radon

8-19 Radon-resistant new home construction

8-20 School policies to protect against

environmental hazards

8-21 Disaster preparedness plans and protocols

8-22 Lead-based paint testing

8-23 Substandard housing

Infrastructure and Surveillance

8-24 Exposure to pesticides

8-25 Exposure to heavy metals and other toxic

chemicals

8-26 Information systems used for environmental

health

8-27 Monitoring environmentally related diseases

8-28 Local agencies using surveillance data for

vector control

Global Environmental Health

8-29 Global burden of disease

8-30 Water quality in the U.S.-Mexico border region

9. Family Planning

Goal: Improve pregnancy planning and spacing and prevent unintended pregnancy.

Objective Number and Short Title

9-1 Intended pregnancy

9-2 Birth spacing

9-3 Contraceptive use

9-4 Contraceptive failure

9-5 Emergency contraception

9-6 Male involvement in pregnancy prevention

9-7 Adolescent pregnancy

9-8 Abstinence before age 15 years

9-9 Abstinence among adolescents aged

15 to 17 years

9-10 Pregnancy prevention and sexually transmitted

disease (STD) protection

9-11 Pregnancy prevention education

9-12 Problems in becoming pregnant and

maintaining a pregnancy

9-13 Insurance coverage for contraceptive supplies

and services
56 Healthy People 2010: Understanding and Improving Health

10. Food Safety

Goal: Reduce foodborne illnesses.

Objective Number and Short Title

10-1 Foodborne infections

10-2 Outbreaks of foodborne infections

10-3 Antimicrobial resistance of Salmonella

species

10-4 Food allergy deaths

10-5 Consumer food safety practices

10-6 Safe food preparation practices in retail

establishments

10-7 Organophosphate pesticide exposure

11. Health Communication

Goal: Use communication strategically to

improve health.

Objective Number and Short Title

11-1 Households with Internet access

11-2 Health literacy

11-3 Research and evaluation of communication

programs

11-4 Quality of Internet health information sources

11-5 Centers for excellence

11-6 Satisfaction with health care providers’

communication skills

12. Heart Disease and Stroke

Goal: Improve cardiovascular health and

quality of life through the prevention,

detection, and treatment of risk factors;

early identification and treatment of

heart attacks and strokes; and prevention of recurrent cardiovascular events.

Objective Number and Short Title

Heart Disease

12-1 Coronary heart disease (CHD) deaths

12-2 Knowledge of symptoms of heart attack and

importance of calling 911

12-3 Artery-opening therapy

12-4 Bystander response to cardiac arrest

12-5 Out-of-hospital emergency care

12-6 Heart failure hospitalizations

Stroke

12-7 Stroke deaths

12-8 Knowledge of early warning symptoms of

stroke

Blood Pressure

12-9 High blood pressure

12-10 High blood pressure control

12-11 Action to help control blood pressure

12-12 Blood pressure monitoring

Cholesterol

12-13 Mean total blood cholesterol levels

12-14 High blood cholesterol levels

12-15 Blood cholesterol screening

12-16 LDL-cholesterol level in CHD patients

13. HIV

Goal: Prevent HIV infection and its related

illness and death.

Objective Number and Short Title

13-1 New AIDS cases

13-2 AIDS among men who have sex with men

13-3 AIDS among persons who inject drugs

13-4 AIDS among men who have sex with men and

who inject drugs

13-5 New HIV cases

13-6 Condom use

13-7 Knowledge of serostatus

13-8 HIV counseling and education for persons in

substance abuse treatment

13-9 HIV/AIDS, STD, and TB education in State

prisons

13-10 HIV counseling and testing in State prisons

13-11 HIV testing in TB patients

13-12 Screening for STDs and immunization for

hepatitis B

13-13 Treatment according to guidelines

13-14 HIV-infection deaths

13-15 Interval between HIV infection and AIDS

diagnosis

13-16 Interval between AIDS diagnosis and death

from AIDS

13-17 Perinatally acquired HIV infection

14. Immunization and Infectious

Diseases

Goal: Prevent disease, disability, and death

from infectious diseases, including

vaccine-preventable diseases.

Objective Number and Short Title

Diseases Preventable Through Universal Vaccination

14-1 Vaccine-preventable diseases

14-2 Hepatitis B in infants and young children

14-3 Hepatitis B in adults and high-risk groups

14-4 Bacterial meningitis in young children

14-5 Invasive pneumococcal infections
Healthy People 2010: Understanding and Improving Health 57

Diseases Preventable Through Targeted Vaccination

14-6 Hepatitis A

14-7 Meningococcal disease

14-8 Lyme disease

Infectious Diseases and Emerging Antimicrobial

Resistance

14-9 Hepatitis C

14-10 Identification of persons with chronic

hepatitis C

14-11 Tuberculosis

14-12 Curative therapy for tuberculosis

14-13 Treatment for high-risk persons with latent

tuberculosis infection

14-14 Timely laboratory confirmation of tuberculosis

cases

14-15 Prevention services for international travelers

14-16 Invasive early onset group B streptococcal

disease

14-17 Peptic ulcer hospitalizations

14-18 Antibiotics prescribed for ear infections

14-19 Antibiotics prescribed for common cold

14-20 Hospital-acquired infections

14-21 Antimicrobial use in intensive care units

Vaccination Coverage and Strategies

14-22 Universally recommended vaccination of

children aged 19 to 35 months

14-23 Vaccination coverage for children in day care,

kindergarten, and first grade

14-24 Fully immunized young children and

adolescents

14-25 Providers who measure childhood vaccination

coverage levels

14-26 Children participating in population-based

immunization registries

14-27 Vaccination coverage among adolescents

14-28 Hepatitis B vaccination among high-risk

groups

14-29 Influenza and pneumococcal vaccination of

high-risk adults

Vaccine Safety

14-30 Adverse events from vaccinations

14-31 Active surveillance for vaccine safety

15. Injury and Violence Prevention

Goal: Reduce injuries, disabilities, and deaths

due to unintentional injuries and

violence.

Objective Number and Short Title

Injury Prevention

15-1 Nonfatal head injuries

15-2 Nonfatal spinal cord injuries

15-3 Firearm-related deaths

15-4 Proper firearm storage in homes

15-5 Nonfatal firearm-related injuries

15-6 Child fatality review

15-7 Nonfatal poisonings

15-8 Deaths from poisoning

15-9 Deaths from suffocation

15-10 Emergency department surveillance systems

15-11 Hospital discharge surveillance systems

15-12 Emergency department visits

Unintentional Injury Prevention

15-13 Deaths from unintentional injuries

15-14 Nonfatal unintentional injuries

15-15 Deaths from motor vehicle crashes

15-16 Pedestrian deaths

15-17 Nonfatal motor vehicle injuries

15-18 Nonfatal pedestrian injuries

15-19 Safety belts

15-20 Child restraints

15-21 Motorcycle helmet use

15-22 Graduated driver licensing

15-23 Bicycle helmet use

15-24 Bicycle helmet laws

15-25 Residential fire deaths

15-26 Functioning smoke alarms in residences

15-27 Deaths from falls

15-28 Hip fractures

15-29 Drownings

15-30 Dog bite injuries

15-31 Injury protection in school sports

Violence and Abuse Prevention

15-32 Homicides

15-33 Maltreatment and maltreatment fatalities of

children

15-34 Physical assault by intimate partners

15-35 Rape or attempted rape

15-36 Sexual assault other than rape

15-37 Physical assaults

15-38 Physical fighting among adolescents

15-39 Weapon carrying by adolescents on school

property
58 Healthy People 2010: Understanding and Improving Health

16. Maternal, Infant, and Child Health

Goal: Improve the health and well-being of

women, infants, children, and families.

Objective Number and Short Title

Fetal, Infant, Child, and Adolescent Deaths

16-1 Fetal and infant deaths

16-2 Child deaths

16-3 Adolescent and young adult deaths

Maternal Deaths and Illnesses

16-4 Maternal deaths

16-5 Maternal illness and complications due to

pregnancy

Prenatal Care

16-6 Prenatal care

16-7 Childbirth classes

Obstetrical Care

16-8 Very low birth weight infants born at level III

hospitals

16-9 Cesarean births

Risk Factors

16-10 Low birth weight and very low birth weight

16-11 Preterm births

16-12 Weight gain during pregnancy

16-13 Infants put to sleep on their backs

Developmental Disabilities and Neural Tube Defects

16-14 Developmental disabilities

16-15 Spina bifida and other neural tube defects

16-16 Optimum folic acid levels

Prenatal Substance Exposure

16-17 Prenatal substance exposure

16-18 Fetal alcohol syndrome

Breastfeeding, Newborn Screening, and Service

Systems

16-19 Breastfeeding

16-20 Newborn bloodspot screening

16-21 Sepsis among children with sickle cell disease

16-22 Medical homes for children with special health

care needs

16-23 Service systems for children with special

health care needs

17. Medical Product Safety

Goal: Ensure the safe and effective use of

medical products.

Objective Number and Short Title

17-1 Monitoring of adverse medical events

17-2 Linked, automated information systems

17-3 Provider review of medications taken by

patients

17-4 Receipt of useful information about

prescriptions from pharmacies

17-5 Receipt of oral counseling about medications

from prescribers and dispensers

17-6 Blood donations

18. Mental Health and Mental Illness

Goal: Improve mental health and ensure

access to appropriate, quality mental

health services.

Objective Number and Short Title

Mental Health Status Improvement

18-1 Suicide

18-2 Adolescent suicide attempts

18-3 Serious mental illness (SMI) among homeless

adults

18-4 Employment of persons with SMI

18-5 Eating disorder relapses

Treatment Expansion

18-6 Primary care screening and assessment

18-7 Treatment for children with mental health

problems

18-8 Juvenile justice facility screening

18-9 Treatment for adults with mental disorders

18-10 Treatment for co-occurring disorders

18-11 Adult jail diversion programs

State Activities

18-12 State tracking of consumer satisfaction

18-13 State plans addressing cultural competence

18-14 State plans addressing elderly persons
Healthy People 2010: Understanding and Improving Health 59

19. Nutrition and Overweight

Goal: Promote health and reduce chronic

disease associated with diet and

weight.

Objective Number and Short Title

Weight Status and Growth

19-1 Healthy weight in adults

19-2 Obesity in adults

19-3 Overweight or obesity in children and

adolescents

19-4 Growth retardation in children

Food and Nutrient Consumption

19-5 Fruit intake

19-6 Vegetable intake

19-7 Grain product intake

19-8 Saturated fat intake

19-9 Total fat intake

19-10 Sodium intake

19-11 Calcium intake

Iron Deficiency and Anemia

19-12 Iron deficiency in young children and in

females of childbearing age

19-13 Anemia in low-income pregnant females

19-14 Iron deficiency in pregnant females

Schools, Worksites, and Nutrition Counseling

19-15 Meals and snacks at school

19-16 Worksite promotion of nutrition education and

weight management

19-17 Nutrition counseling for medical conditions

Food Security

19-18 Food security

20. Occupational Safety and Health

Goal: Promote the health and safety of people

at work through prevention and early

intervention.

Objective Number and Short Title

20-1 Work-related injury deaths

20-2 Work-related injuries

20-3 Overexertion or repetitive motion

20-4 Pneumoconiosis deaths

20-5 Work-related homicides

20-6 Work-related assaults

20-7 Elevated blood lead levels from work exposure

20-8 Occupational skin diseases or disorders

20-9 Worksite stress reduction programs

20-10 Needlestick injuries

20-11 Work-related, noise-induced hearing loss

21. Oral Health

Goal: Prevent and control oral and craniofacial

diseases, conditions, and injuries and

improve access to related services.

Objective Number and Short Title

21-1 Dental caries experience

21-2 Untreated dental decay

21-3 No permanent tooth loss

21-4 Complete tooth loss

21-5 Periodontal diseases

21-6 Early detection of oral and pharyngeal cancers

21-7 Annual examinations for oral and pharyngeal

cancers

21-8 Dental sealants

21-9 Community water fluoridation

21-10 Use of oral health care system

21-11 Use of oral health care system by residents in

long-term care facilities

21-12 Dental services for low-income children

21-13 School-based health centers with oral health

component

21-14 Health centers with oral health service

components

21-15 Referral for cleft lip or palate

21-16 Oral and craniofacial State-based surveillance

system

21-17 Tribal, State, and local dental programs

22. Physical Fitness and Activity

Goal: Improve health, fitness, and quality of

life through daily physical activity.

Objective Number and Short Title

Physical Activity in Adults

22-1 No leisure-time physical activity

22-2 Moderate physical activity

22-3 Vigorous physical activity

Muscular Strength/Endurance and Flexibility

22-4 Muscular strength and endurance

22-5 Flexibility

Physical Activity in Children and Adolescents

22-6 Moderate physical activity in adolescents

22-7 Vigorous physical activity in adolescents

22-8 Physical education requirement in schools

22-9 Daily physical education in schools

22-10 Physical activity in physical education class

22-11 Television viewing

Access

22-12 School physical activity facilities

22-13 Worksite physical activity and fitness

22-14 Community walking

22-15 Community bicycling
60 Healthy People 2010: Understanding and Improving Health

23. Public Health Infrastructure

Goal: Ensure that Federal, Tribal, State, and

local health agencies have the infrastructure to provide essential public

health services effectively.

Objective Number and Short Title

Data and Information Systems

23-1 Public health employee access to the Internet

23-2 Public access to information and surveillance

data

23-3 Use of geocoding in health data systems

23-4 Data for all population groups

23-5 Data for Leading Health Indicators, Health

Status Indicators, and Priority Data Needs at

Tribal, State, and local levels

23-6 National tracking of Healthy People 2010

objectives

23-7 Timely release of data on objectives

Workforce

23-8 Competencies for public health workers

23-9 Training in essential public health services

23-10 Continuing education and training by public

health agencies

Public Health Organizations

23-11 Performance standards for essential public

health services

23-12 Health improvement plans

23-13 Access to public health laboratory services

23-14 Access to epidemiology services

23-15 Model statutes related to essential public

health services

Resources

23-16 Data on public health expenditures

Prevention Research

23-17 Population-based prevention research

24. Respiratory Diseases

Goal: Promote respiratory health through

better prevention, detection, treatment,

and education efforts.

Objective Number and Short Title

Asthma

24-1 Deaths from asthma

24-2 Hospitalizations for asthma

24-3 Hospital emergency department visits for

asthma

24-4 Activity limitations

24-5 School or work days lost

24-6 Patient education

24-7 Appropriate asthma care

24-8 Surveillance systems

Chronic Obstructive Pulmonary Disease (COPD)

24-9 Activity limitations due to chronic lung and

breathing problems

24-10 Deaths from COPD

Obstructive Sleep Apnea (OSA)

24-11 Medical evaluation and followup

24-12 Vehicular crashes related to excessive

sleepiness

25. Sexually Transmitted Diseases

Goal: Promote responsible sexual behaviors,

strengthen community capacity, and

increase access to quality services to

prevent sexually transmitted diseases

(STDs) and their complications.

Objective Number and Short Title

Bacterial STD Illness and Disability

25-1 Chlamydia

25-2 Gonorrhea

25-3 Primary and secondary syphilis

Viral STD Illness and Disability

25-4 Genital herpes

25-5 Human papillomavirus infection

STD Complications Affecting Females

25-6 Pelvic inflammatory disease (PID)

25-7 Fertility problems

25-8 Heterosexually transmitted HIV infection in

women
Healthy People 2010: Understanding and Improving Health 61

STD Complications Affecting the Fetus and Newborn

25-9 Congenital syphilis

25-10 Neonatal STDs

Personal Behaviors

25-11 Responsible adolescent sexual behavior

25-12 Responsible sexual behavior messages on

television

Community Protection Infrastructure

25-13 Hepatitis B vaccine services in STD clinics

25-14 Screening in youth detention facilities and jails

25-15 Contracts to treat nonplan partners of STD

patients

Personal Health Services

25-16 Annual screening for genital chlamydia

25-17 Screening of pregnant women

25-18 Compliance with recognized STD treatment

standards

25-19 Provider referral services for sex partners

26. Substance Abuse

Goal: Reduce substance abuse to protect the

health, safety, and quality of life for all,

especially children.

Objective Number and Short Title

Adverse Consequences of Substance Use and

Abuse

26-1 Motor vehicle crash deaths and injuries

26-2 Cirrhosis deaths

26-3 Drug-induced deaths

26-4 Drug-related hospital emergency department

visits

26-5 Alcohol-related hospital emergency

department visits

26-6 Adolescents riding with a driver who has been

drinking

26-7 Alcohol- and drug-related violence

26-8 Lost productivity

Substance Use and Abuse

26-9 Substance-free youth

26-10 Adolescent and adult use of illicit substances

26-11 Binge drinking

26-12 Average annual alcohol consumption

26-13 Low-risk drinking among adults

26-14 Steroid use among adolescents

26-15 Inhalant use among adolescents

Risk of Substance Use and Abuse

26-16 Peer disapproval of substance abuse

26-17 Perception of risk associated with substance

abuse

Treatment for Substance Abuse

26-18 Treatment gap for illicit drugs

26-19 Treatment in correctional institutions

26-20 Treatment for injection drug use

26-21 Treatment gap for problem alcohol use

State and Local Efforts

26-22 Hospital emergency department referrals

26-23 Community partnerships and coalitions

26-24 Administrative license revocation laws

26-25 Blood alcohol concentration (BAC) levels for

motor vehicle drivers

27. Tobacco Use

Goal: Reduce illness, disability, and death

related to tobacco use and exposure to

secondhand smoke.

Objective Number and Short Title

Tobacco Use in Population Groups

27-1 Adult tobacco use

27-2 Adolescent tobacco use

27-3 Initiation of tobacco use

27-4 Age at first tobacco use

Cessation and Treatment

27-5 Smoking cessation by adults

27-6 Smoking cessation during pregnancy

27-7 Smoking cessation by adolescents

27-8 Insurance coverage of cessation treatment

Exposure to Secondhand Smoke

27-9 Exposure to tobacco smoke at home among

children

27-10 Exposure to environmental tobacco smoke

27-11 Smoke-free and tobacco-free schools

27-12 Worksite smoking policies

27-13 Smoke-free indoor air laws

Social and Environmental Changes

27-14 Enforcement of illegal tobacco sales to minors

laws

27-15 Retail license suspension for sales to minors

27-16 Tobacco advertising and promotion targeting

adolescents and young adults

27-17 Adolescent disapproval of smoking

27-18 Tobacco control programs

27-19 Preemptive tobacco control laws

27-20 Tobacco product regulation

27-21 Tobacco tax
62 Healthy People 2010: Understanding and Improving Health

28. Vision and Hearing

Goal: Improve the visual and hearing health of

the Nation through prevention, early

detection, treatment, and rehabilitation.

Objective Number and Short Title

Vision

28-1 Dilated eye examinations

28-2 Vision screening for children

28-3 Impairment due to refractive errors

28-4 Impairment in children and adolescents

28-5 Impairment due to diabetic retinopathy

28-6 Impairment due to glaucoma

28-7 Impairment due to cataract

28-8 Occupational eye injury

28-9 Protective eyewear

28-10 Vision rehabilitation services and devices

Hearing

28-11 Newborn hearing screening, evaluation, and

intervention

28-12 Otitis media

28-13 Rehabilitation for hearing impairment

28-14 Hearing examination

28-15 Evaluation and treatment referrals

28-16 Hearing protection

28-17 Noise-induced hearing loss in children

28-18 Noise-induced hearing loss in adults
United States Government Credit card orders are welcome!

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___ Healthy People 2010 (second edition; Volume I, 608 pages; Volume II, 664 pages) - 

Presents the 467 national health objectives that cover 28 focus areas. Includes data

on population groups. Volume I includes black and white version of Understanding and

Improving Health (see below). Two-volume set: $70 ($87.50 foreign), S/N 017-001-00547-9.

___ Healthy People 2010, Understanding and Improving Health (second edition; 

76 pages; four-color version) - Explains the history of the Healthy People initiative,

the model on which Healthy People 2010 is based, how to use Healthy People 2010 

as a systematic approach to health improvement, and the Leading Health Indicators. 

$10 ($12.50 foreign), S/N 017-001-00550-9.

___ Tracking Healthy People 2010 (996 pages) - A statistical compendium that 

provides information on measuring the objectives, technical notes, and operational 

definitions. $66 ($82.50 foreign), S/N 017-001-00548-7.

___ Healthy People 2010 CD-ROM - Contains electronic files of Understanding and 

Improving Health, Healthy People 2010 , and Tracking Healthy People 2010 (Microsoft 

Word, HTML, PDF, and RTF). $19 ($23.75 foreign), S/N 017-001-00549-5.

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