Lessons Learned From the Healthy People 2020 Midcourse Review
Each decade, the nation, under the direction of the federal government’s Office of Disease Prevention and Health Promotion, sets public health goals and objectives to strive for with regard to the promotion of health and prevention of disease. The overarching goals of Healthy People 2020 are to1:
1 Attain high-quality, longer lives, free of preventable disease, disability, injury, and premature death;
2 Achieve health equity, eliminate disparities, and improve the health of all groups;
3 Create social and physical environments that promote good health for all; and
4 Promote quality of life, healthy development, and health behaviors across all life stages.
Although work is already underway to develop a new set of goals for the next decade (Healthy People 2030), the federal government recently took stock of the progress made toward achieving the goals for this decade, in the Healthy People 2020 Midcourse Review. This review is vitally important to determine if our country is on the right track for, or is falling behind in, achieving our national health promotion and prevention goals.
Tracking and measuring the nation’s health is no easy undertaking. Healthy People 2020 consists of 42 topic areas, with more than 1200 objectives, which were closely analyzed to evaluate progress across a variety of measures of health.
How are we doing?
As with most midpoint evaluations, there are positives and negatives. In many aspects of our nation’s health, we are exceeding expectations. Great strides are being made in maternal, infant, and child health, with lower rates of preterm births and infant deaths, and lower rates of exposure of children to secondhand smoke. In several topic areas, all measurable objectives that track health improvement have either stayed the same or exceeded their targets, with no worsening of targeted objectives over time, including adolescent health, arthritis, diabetes, HIV, and nutrition and weight status. Unfortunately, in considering the status of mental health in the US, the story is not as positive: none of the main measurable objectives of mental health status have demonstrated statistically significant improvement, and many are, alarmingly, getting worse (Table).
Some good news
We have seen some gains in the expansion of mental health treatment in recent years. For example, more adults are receiving services for co-occurring disorders (from 3.3% in 2008 to 4.2% in 2013); there was a slight increase in screening for depression in primary care settings as well (from 2.2% in 2007 to 2.4% in 2010). A number of improvements in screening for and treatment of alcohol and substance use disorders have been documented, and fewer young people are binge drinking.1 Despite these small gains, many more people need treatment for substance use disorders, all patients in primary care settings would ideally be screened for depression, and we would eliminate binge drinking among young adults.
Dr. Shim is Associate Professor of Clinical Psychiatry, Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA; Dr. Compton is Professor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY.
The authors report no conflicts of interest concerning the subject matter of this article.
1. National Center for Health Statistics. Healthy People 2020 Midcourse Review. Hyattsville, MD; 2016.
2. Compton MT, Shim RS, eds. The Social Determinants of Mental Health. Washington, DC: American Psychiatric Publishing; 2015.
3. Marmot M. Social determinants of health inequalities. Lancet. 2005;9464:1099-1104.
4. Frieden TR. A framework for public health action: the health impact pyramid. AJPH. 2010;4:590-595.
5. Kalra G, Christodoulou G, Jenkins R, et al. Mental health promotion: guidance and strategies. Eur Psychiatry. 2010;27:81-86.