Target Setting: How Low or High Do We Aim?

 By Valerie Welsh 

Senior Health Policy Analyst, Office of Minority Health, HHS 

Closing the Gap, Healthy People 2010 and Beyond • August/September 1998 

One of the toughest challenges of Healthy People 2010 is 

how to target policy attention and resources to Americans 

with the poorest health in order to achieve improved health 

for all. The approach to target-setting that has been generally used to 

date in the Healthy People initiative is one of setting targets at a level 

of improvement (e.g., 30 percent) over a total population average. 

The major drawback of this approach is that it hides the fact that, in 

some instances, one or more groups (often Whites, but sometimes 

racial and ethnic minorities) are actually doing better than the target. 

For example, the year 2000 infant mortality objective was an 

overall target for the total population of 7 deaths per 1,000 live births. 

The targets for those racial and ethnic populations depicted are 11 for 

Blacks, 8.5 for American Indians/Alaska Natives, and 8 for Puerto 

Ricans. Current rates for Chinese, Japanese, and Filipino Americans 

(6.2, 6.6, and 6.6 per 1,000 live births, respectively), are better than 

the 2000 target and give these groups no room for improvement. 

Thus, current discussions related to the 2010 objectives support 

an option to set targets at levels that are “better than the best,” allowing room for improvement for all groups. This approach is more consistent with President Clinton’s initiative to eliminate racial and ethnic 

disparities and set the same targets for all groups. It is also consistent 

with the guidelines used to develop the Healthy People 2010 draft 

for public comment. 

The “better than the best” approach has drawbacks as well. It 

moves the targets even farther away for populations which suffer the 

greatest disparities. 

The guidelines being used to develop targets in the draft Healthy 

People 2010 document are as follows:

 • A single target for the year 2010 should be set—one that 

would be applicable to all populations. The target-setting methodology should support the goal of eliminating health disparities. Targets 

should be set so that there will be an improvement for all segments of 

the population. 

•	 For those six objectives contained in the HHS Initiative to Eliminate Racial and Ethnic Disparities in Health, the goal would be a 

health outcome better than the best currently achieved by any 

population group. 

•	 For those objectives that in the short-term can be influenced by 

lifestyle choices, behaviors and health services, the target also 

would be better than the existing best. Examples include physical activity, modifiable risk factors, specifically those relating to 

smoking and blood pressure, and access to services including 

prenatal care and mammography. 

•	 For objectives for which we are unlikely to achieve an equal 

health outcome within 10 years by applying the health interventions currently available, the target would be set at a level that 

represents an improvement for a substantial proportion of the 

population. This target would be regarded as a minimally acceptable improvement. An example would be occupational exposure and the resultant lung cancer. Even with such a goal, we 

still would expect to achieve health status improvements for those 

population groups whose health is already better than the 2010 

target. 

Is it realistic to think we can eliminate racial and ethnic health 

disparities by the year 2010 when, in many instances, the gaps are so 

wide? If not by 2010, then when? 

The upcoming public comment period on the proposed Healthy People 

objectives opens September 15, 1998 and closes December 15, 1998. We 

strongly encourage you and your colleagues to participate. For more information, visit the Healthy People Web site: http://web.health.gov/ 

healthypeople.

Office of Minority Health Resource Center	 U.S. Department of Health and Human Services