| Updated 11/26/1999
**Healthy People 2000**

**Clinical Preventive Services Progress    Review****"Setting Priorities for the Delivery, Quality,    Measurement, and Coverage of Clinical Preventive Services"*******January 20, 1999    2-4:30 p.m.    A live broadcast from Wilson Auditorium    On the campus of the National Institutes for Health*    Public Health Training Network Announcement**Presentation made by:    Edward J. Sondik, Ph.D.****Other NCHS Sites**Healthy People 2000 **Clinical Preventive Services****Diabetes and Chronic Disabling Conditions****Educational and Community-based Programs****Family Planning****Food and Drug Safety****Heart Disease and Stroke****Immunizations and Infectious Diseases****Maternal and Infant Health****Mental Health and Mental Disorders****Occupational Safety and Health****Oral    Health****Unintentional Injuries****Violent and Abusive Behavior**National Vital Statistics System

Dr. David Satcher, Assistant Secretary for Health and    Surgeon General will be joined by a panel of experts representing purchasers of preventive    services, health plans, consumers, national provider organizations, local health    departments, quality measurement organizations, Federal agencies funding health care    services, State Medicaid agencies, health professions schools, and other stakeholders.    Participants will review the progress made on meeting the goals and targets for the    Clinical Preventive Services priority area of Healthy People 2000, and to enable the    policy planners, educators, and providers of health care services to set priorities for    the delivery, quality, measurement, and coverage of clinical preventive services.

**Briefing Book Materials**    Objective charts

**Data Section(These tables can be viewed only with Adobe Acrobat    3.0.)******Summary tablesIndividual objectives tableObjective chartsStatistical Note No. 17******Presentation made by:    Edward J. Sondik, Ph.D.    Director    National Center for Health Statistics    January 20, 1998    Wilson Auditorium    National Institutes of Health**

Thank you. This afternoon, we’re    focusing on the Nation's use of clinical preventive services. As in past Healthy People    reviews, we’ll examine where progress has been made, where progress has lagged, and    where disparities still remain. The investment in preventive services has truly paid off,    so we'll also highlight a few examples of the impact of these services over the past    decade.

The data we are using come from several key    data sets. National data are primarily from the National Health Interview Survey which    gathers data on health promotion and disease prevention, through a household interview    survey. We just completed the 1998 survey which will provide data for the final assessment    on Healthy People 2000. While these estimates for the nation as a whole tell us a great    deal, they can’t illustrate and highlight critical differences which emerge as we    examine the data state-by-state. So we use complementary data on states from the    Behavioral Risk Factor Surveillance System, a collection of state surveys based on    telephone interviews, coordinated by our CDC colleagues. 

Now let’s take a look at some of the    specific objectives. First, those where we're making progress. 

SLIDE 1    (Progress) - We have done well in raising levels of childhood immunization and seeing that    the elderly receive flu shots. And more Americans than ever before are being screened for    high cholesterol and breast and cervical cancer. The next series of slides focus on these    objectives.SLIDE 2 (Child Immunization) - For the year 2000, we set a target that at least    90 percent of our children, ages 19-35 months old, receive a recommended set of childhood    immunizations. I am pleased to report that progress in this area has been impressive, with    all of the recommended immunizations nearing or exceeding the target.SLIDE 2A.    Even the newly recommended vaccination for hepatitis B has increased four-fold, going from    16 percent of children immunized in 1993 to 82 percent by 1996.    Now for the elderly. . . .SLIDE 3 (Flu shots) - A vaccination can prevent what    often could be a fatal bout of the flu or lessen its severity. In 1997, vaccination rates    among the elderly had reached or exceeded the goal of 60 percent in all but the six states    and the District of Columbia, shown in red. States that have met the target are in gray    and blue; those in blue have achieved a 70 percent vaccination rate. Turning now to    cholesterol screening . . .SLIDE 4 (Chol screen) - High cholesterol is an    important risk factor for cardiovascular disease. Cholesterol can be lowered through diet    and, if necessary, medication, but first individuals and their health care providers need    to screen and take appropriate action. These data show an improvement in the percent of    adults who have been screened in the past two years.SLIDE 4A.    Looking at the two top groups shown on this chart, note that from 1991 to 1993, 19 percent    more black Americans and 30 percent more American Indian and Alaska Natives reported being    screened for cholesterol--a very significant improvement. SLIDE 5.    (Chol prev) - In fact that increase in screening has paid off. As shown here, by the    mid-1990s, fewer than 20 percent of the population had elevated cholesterol levels,    surpassing the Year 2000 target. SLIDE 6. (Chol screen - map) - Using 1997 data from the    Behavioral Risk Factor Surveillance System, we see that screening varies across the    country. In that year, only five states and DC--shown in dark blue--had reached the target    of 75 percent of the population screened in the past 5 years, and 10 states, in red, are    still below 65 percent. So we can and need to do more. SLIDE 7. (Pap test) Two of the objectives in this chapter address    cancer. Let’s look first at pap smears which are the principal reason that cervical    cancer death rates have fallen 75 percent in the past 40 years. The data show that    screening rates vary considerably by race.SLIDE 7A. African American women 18 and over had a screening rate    of 84 percent in 1994, compared to 73 percent for American Indian and Alaska Native, and a    low of 66 percent for Asian and Pacific Islander women. These disparities are cause for    concern, and, in fact, cervical cancer screening has been made a component of the    Secretary's Initiative to Eliminate Health Disparities. SLIDE 8. (Pap test - map) When we look at screening by state, a    majority of states -- shown here in blue -- have reached the target of 85 percent of adult    women having had a pap test in the past 3 years. That's good news, but still four states,    the ones you see in red, are under 80 percent. SLIDE 9. (Mam - map) Another service which can reduce cancer    deaths is mammography coupled with breast exams. In 1987, only 25 percent of women aged 50    and older were regularly screened. These data from 1997 show that all but five    states--those in red--met the Year 2000 target of 60 percent of women ages 50 and over    having had a mammogram and clinical breast exam in the past two years. This progress in    screening and advances in treatment have paid off. In fact, after remaining constant for    almost 40 years, death rates for breast cancer have fallen 17 percent over the past    decade. SLIDE 10 (Mam - race/eth) - When we look at mammography by race    and ethnicity, there is very little difference among white, black and Hispanic women.SLIDE 10A. However, the differences by income and education in    breast cancer screening are quite dramatic. Women at the highest education or income    levels are twice as likely to have had a mammogram than women at the lower end of the    socioeconomic scale. 

Now, I’d like to turn now to some    objectives where our progress has fallen far short of the Healthy People targets: SLIDE 11. (Pneumo elderly) - For pneumonococcal vaccinations, the    goal of 60 percent of persons 65 and over ever having received a vaccination is far from a    reality. Although there is some modest progress for all of the groups shown in this chart,    we need to substantially increase the rate in all race and ethnic groups in order to reach    the goal. SLIDE 12. (Pneumo Map) And, not a single state has met the 60    percent vaccination target. The western and northeastern states rank higher on this    measure, but if we are to reach this target it is going to require a concerted effort    across the country. SLIDE 13. (Reg care) - To receive preventive services, it's    important to have a regular source of health care. A regular source of care means doctors,    nurses and other health professionals who know their patients. They inform their patients    about testing, they schedule them for regular screening, and they assist them in obtaining    preventive services. While there was some improvement in this measure, most recently    there’s been very little change and no group has reached the target of 95 percent.SLIDE 14. (Blank) Progress is also weak for other recommended    preventive service objectives related directly to having a regular source of care. By the    way, we have included data for those objectives as well as the rest of the objectives in    this area in your briefing book. And for all of you the data are available over the    Internet. Let me just mention a couple of these services now. For example, there has been    little improvement in the percentage of adult Americans who’ve had a routine checkup    in the past three years. And we've also seen no increase in the percent who report that    their doctor has asked them about health habits, such as diet and exercise at their last    visit. SLIDE 15. (No coverage) - Having regular health care is strongly    associated with having health care coverage. An ambitious goal for the nation is for no    one to be without health care coverage, but as this chart shows, we are a long way from    achieving that goal. Overall some 16 percent of the population under 65 years of    age--that’s one in every 6--had no health care coverage in 1996.SLIDE 15A. And for Mexican Americans, more than one in three is    without private health insurance or coverage under public programs.SLIDE 15B. The income gradient--certainly not unexpected--shows    that those in the lower income groups are far less likely to have health care coverage. In    fact, 33 percent of the lowest income group lacks health care coverage compared to only 8    percent of those with the highest income. SLIDE 16. (Minorities) - Objective 21.8 looks not at specific    clinical services but at the health care system itself. Healthy People 2000 calls for an    increase in minority participation in the health professions, targeted to more closely    reflect the diversity of our society. There has been some improvement as measured by an    increase in the proportion of degrees awarded to black health professionals. However,    African Americans received only 6 percent of the health professional degrees in 1996,    although they comprise about 12 percent of the population. For Hispanics, the gap is even    greater, with only about 4 percent of degrees awarded to a group which makes up about 11    percent of our population today. Clearly, there’s a need to change this pattern in    order to improve the diversity of our health care. SLIDE 17.    (Conclusions) - To conclude: We certainly have made progress. More Americans now receive    preventive clinical services than a decade ago. And disparities--by race, ethnicity,    income and education--have surely been reduced for some objectives. For other objectives,    challenges persist. Many of you have been involved in the process of setting the goals and    objectives for Healthy People 2010. One of these goals will be the elimination of all    health disparities--clearly a major challenge. 

Our future progress will also be challenged    by changes in our health care system. The various health care plans, which include or    exclude certain preventive services, and barriers based on level or type of coverage may    create new disparities in our health and health care. To meet those challenges we need new    data sources -- sources to provide data on service coverage and to monitor the quality as    well as the receipt of such services. The Medical Expenditures Panel Survey, conducted by    AHCPR, is one of those new data systems which surely will be important for Healthy People    2010.SLIDE 18.    BLANK Indeed, data are at the core of Healthy People, and adequate data to evaluate    progress and identify problems will also be a challenge for the entire Healthy People    effort. With your help, we are working to find the ways to meet those challenges —    not only for the Clinical Preventive Services we’ve talked about today — but for    all of the Healthy People objectives, now and in the future. 
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