By Connie Goldsmith, MPA, RN
March 13, 2000
Photos: Photodisc/Comstock

It’s official. People in the United States are too fat and too lazy, and too many young people are starting to smoke. On Jan. 25, Department of Health and Human Services (HHS) Secretary Donna Shalala and U.S. Surgeon General David Satcher announced new goals designed to produce significant improvements in the nation’s most troublesome health problems by the end of the decade. Most of the objectives target the lifestyle choices and environmental conditions that cause 70 percent of premature deaths in the United States.

Since the surgeon general released the first Healthy People goals in 1979, they’ve been updated each decade to reflect the changing health status of the United States. There’s still a lot of work to do. Adult obesity has increased 50 percent in the past two decades, and 40 percent of today’s adults don’t exercise. Childhood asthma is on the rise, as are diabetes and other chronic diseases. HIV/AIDS remains a serious problem, affecting women and people of color disproportionately. Smoking among adolescents is increasing. Mental disorders continue to go undiagnosed and untreated. Violence and abusive behavior plague homes and communities across the country.

National organizations also are targeting their efforts toward the HP2010 goals. "Type 2 diabetes is increasing because Americans are becoming more obese, less active, and are aging. In addition, diabetes is more prevalent in expanding minority populations. The American Diabetes Association has always had programs to address the issues of diabetes and to campaign for increased public awareness," said Christine Beebe, MS, registered dietician, certified diabetes educator, and past president of healthcare education for the ADA.

Evaluating the results of Healthy People 2000 is an exercise in answering the question "Is the glass half-empty or half-full?" On one hand, the nation has failed to meet 85 percent of the HP2000 goals established 10 years ago, especially those for smoking, obesity, and exercise. Satcher says for about 20 percent of the objectives, the nation is becoming less healthy, and is actually moving away from the goals. But on the other hand, he points out that the nation has completely met 15 percent of the goals and made substantial progress toward another 44 percent.

"We can be proud that we’ve made significant strides in improving the health of Americans," Shalala said.

Notable areas of improvement in the past 10 years include better maternal-child health, an increase in breast-feeding, mammography screening, higher numbers of people with regular dental visits, and reductions in infant and child mortality, breast cancer deaths, and outbreaks of waterborne and foodborne diseases.

While past Healthy People goals recognized racial and ethnic disparities and worked to reduce them, HP2010 intends to eliminate them by setting one target for all population groups. For example, one goal of Healthy People 2000 was reducing "cigarette smoking to a prevalence of no more than 18 percent among blacks ages 18 and older." The equivalent HP2010 goal is reducing "cigarette smoking by adults from 24 percent (1997 baseline) to 12 percent."

"Healthy People 2010 is a framework for all Americans to use," Satcher said.

Still, significant differences do exist in the health status of minorities. According to Shalala, "Americans are living longer and are in better health than ever before. But not all Americans are sharing equally in this improvement."

Hispanics continue to experience significant disparities in mental health, substance abuse, occupational and environmental health, and the effects of violence. They also have more incidences of high blood pressure and obesity than non-Hispanic whites, and are twice as likely to die from diabetes.

Nurses are taking action to address these issues. According to Marie Cowan, PhD, RN, dean of the UCLA School of Nursing, "We’re working to learn how nurses can facilitate culturally and linguistically competent public health to Hispanic women and children. We also have research under way to develop strategies to drive racial and ethnic data collection."

For African Americans, inequities in health status include infant mortality, heart disease, stroke, and oral health. The death rate from all cancers is 30 percent higher than for whites, and seven times higher for AIDS, according to Healthy People 2010 figures. "The rate of diabetes among African Americans is one in 11, compared to 1 in 20 for whites," Beebe said. To combat this, the ADA sponsors a program called "Diabetes Sundays," where clergy address diabetes concerns as well as distribute information and offer blood glucose screenings.

Asian Americans are one of the healthiest population groups in the United States. However, immigrant groups from Southeast Asia suffer disparities in the areas of smoking, cancer, suicide, hepatitis B, tuberculosis, and heart disease.

Problems that hit American Indians and Alaskan Natives include diabetes, women’s health, alcoholism, substance abuse, family violence, and maternal-child health.

"It’s important for nurses to assess patients—especially minority patients—for use of alternative therapies administered outside of traditional healthcare settings. Implementation of nursing care must be culturally sensitive, as not all things work for all patients," said Rebecca Jones, DNSc, RN, director of the School of Nursing and Health Science at Texas A&M University.

Leading indicators

Ten leading health indicators were selected by an interagency work group headed by the HHS. The indicators 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. They serve as a convenient tool to monitor movement toward the HP2010 objectives. The objectives themselves—467 of them in 28 focus areas—reflect the depth and breadth of the environmental and health problems facing the country’s communities.

For example, childhood asthma is increasing, as is obesity among the young. Joan Greene, RN, past president of the National Association of Pediatric Nurse Associates and Practitioners, is the organization’s representative for HP2010. "We promote many of the goals, and are particularly concerned with access to care for all children, childhood immunization, asthma treatment and education, and preventing and treating obesity," she said.

What nurses can do

"Because Healthy People 2010 emphasizes prevention and health promotion, practically all of it pertains to nursing," Cowan said. "For example, we’re working on programs to help communities prevent teen pregnancy, and to prevent TB and sexually transmitted diseases in homeless women."

In addition, research into the effects of cancer, heart disease, and aging on quality of life directly addresses the overarching goals of HP2010. According to Jones, "Health promotion and education are central to nursing practice. Nurses need to develop an awareness of the HP2010 program, and incorporate it as a benchmark for nursing intervention."

Sue Karen Donaldson, PhD, RN, FAAN, dean of Johns Hopkins University School of Nursing, believes nurses are key to HP2010. "Nurses are well educated and prepared to partner with individuals, families, and communities to meet the special needs of vulnerable populations and eliminate health disparities. To achieve the goals of Healthy People 2010, more nurses at all educational levels are needed, especially advanced practice nurses and nurse researchers."

Shalala said, "Achieving the vision of Healthy People 2010 challenges clinicians to put prevention into their practices. It requires communities and businesses to support health-promoting policies in schools and at work sites."

Nurses have a pivotal role in reaching individuals and communities about health issues. The public trusts nurses and is receptive to their teaching and intervention. Nurses can use their unique position to help meet the goals of HP2010, and in doing so, can improve the health of our nation.