America / Healthcare

A Pandemic, a Plan, and Some Patience

Introduction

The COVID-19 pandemic has left many with the impression that the United States does little public health planning, in general, and had no planned response to a pandemic, in particular. In fact, each decade the Department of Health and Human Services (HHS) develops quantifiable objectives to target national heath deficits. The timing of the planning process for the 2030 goals preceded the COVID-19 pandemic, but several of the targets – vaccine allocation, health inequities and disparities, and mental health disorders – are closely correlated with the impact of COVID-19, so progress toward those targets will reduce the impact of any future pandemic.

In the next section, I review the basic planning process and then turn to progress toward the 2020 goals. Next, I look at the 2030 goals and their relation to the fallout of the COVID-19 pandemic. The final section is a summary and conclusion.

Background

The Healthy People objectives are created by the United States Department of Health and Human Services (HHS) and managed by the Office of Disease Prevention and Health Promotion (ODPHP). These objectives highlight key public health efforts at the forefront of each decade—thus, we have just concluded the 2020 initiative and transition into the 2030 initiative. Surgeon General Julius Richmond issued Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention back in 1979 in an effort to establish quantifiable national health priorities and objectives within each decade. With COVID-19 still a main international health concern, challenges lie in ensuring other important national health campaigns are not overlooked and still prioritized.

Progress Toward 2020 Goals

The final data report of the Healthy People 2020 initiative has yet to be released but based on the 2014 progress update, approximately 54% of the leading health indicators of the 2020 initiative achieved their targets or found overall improvement. Unfortunately, many indicators showed minimal change or worsening numbers. In 2014, targets were met for air quality, children exposed to secondhand smoke, homicides, and adult physical activity. Improvements were seen in clinical preventative services as well as maternal and child health, adolescent drug use, and high school graduation rates. The United States has made significant progress in main public health priorities since the first initiative launched in 1990.  As a nation, major reductions in deaths due to heart disease and cancer and increases in preventive health behaviors and risk factors are attributed to the healthy people initiatives. The Department of Health and Human Services reports many lessons learned thus far such as the necessity of systematic collaboration, going beyond just the public health field. Additionally, HHS emphasizes the importance of widely accessible plans across all health system levels in order to achieve the goals. While only being implemented just a few decades, the nation has already seen major progress in health, and will continue to thoroughly address emerging diseases and health challenges faced in the years to come.

2030 Goals and COVID-19

Healthy People 2030 is the fifth iteration of the initiative and the HHS approved the 2030 framework in June of 2018. Considering COVID-19 arose at the end of the prior decade in 2019 and the start of the 2020’s, the virus missed the cut off to be explicitly included in either health campaign. With nearly 355 measurable objectives currently defined, COVID-19 does not find itself at the core of any; however, numerous objectives lay the foundation for better management of major public health issues at large, therefore addressing similar priorities as would be seen for COVID-19-specific objectives. For example, HHS highlights the need to increase the proportion of people with health insurance, the number of those trained prevention, detection, and public health response, as well as data collection and reporting measures—all of which aim to improve the direction of future pandemics and mitigate those adversely impacted.

Relevant Health Deficits

There are three particular health deficits targeted in the 2030 goals that have large implications highlighted by COVID-19: Vaccines, Mental Health and Substance Use, and Health Inequities and Disparities.

Vaccines-

The COVID-19 pandemic emphasized the urgent need for improvement in vaccine planning, distribution, administration, and reporting. In regard to COVID-19 vaccination efforts, the current apprehension toward receipt of the vaccine is unsurprising. Healthy People 2030 Leading Health Indicators discusses the current effort to increase those vaccinated annually against seasonal influenza, which finds itself in a longstanding struggle with public reception. Additionally, other health behavior objectives seek to improve vaccination uptake with regard to other diseases. For example, the following objectives are priorities of the 2030 initiative: increasing the proportion of adolescents receiving the HPV vaccines, pregnant women receiving Tdap vaccine, and even increasing the proportion of people with vaccination records in an information system. The United States health system already planned for improvement of vaccine administration and reporting, but COVID-19 vaccination efforts publicly highlighted this existing shortcoming. The CDC states that the proportion of Americans needed to be vaccinated in order to achieve herd immunity remains uncertain, but immediately producing a new vaccine for global distribution within one year is groundbreaking. The production of vaccines remains a leading public health achievement decade after decade, and the COVID-19 vaccine response breaks records. A recent Nature journal article noted that the fastest vaccine produced was last seen in the 1960s for mumps which took four years, showing great promise for the future of health. As aforementioned, despite the 2030 initiative lacking descriptive COVID-19 objectives, the current pandemic response does show hope, and the HHS health goals directly contribute to pandemic response at large, specifically with regard to vaccination uptake.

Mental Health and Substance Use-

A common challenge still persists today—the decline of mental health and increasing rates of suicide and depressive episodes. While the Healthy People 2020 data report has yet to be finalized and released, anticipating improvement in mental health since the 2014 report is unlikely. The Kaiser Family Foundation reported 4 in 10 adults in the US suffering symptoms of anxiety or depressive disorders during the pandemic, and similar patterns can be seen across other age groups and populations. There is hope as President Biden’s American Rescue Plan appropriates $4 billion for the Substance Abuse and Mental Health Services Administration and Health Resources and Services Administration to expand these services. The Healthy People 2030 initiative also plans to address mental health across numerous populations by providing a variety of accessible resources and treatment options. As discussed, mental health remains high priority in the midst of the coronavirus pandemic and continues to be over the coming decades. In just the last few years, major improvements in reducing the stigma against mental health have been made and will continued to require studying as discussions regarding one’s mental health become more commonplace.

Inequities and Disparities-

The Healthy People objectives further describe the intent of defining these health efforts, stating that the overarching goals for the nation at large includes attaining healthy lives “free of preventable disease, disability, injury, and premature death.” In addition, contributing to the elimination of health disparities, and “achieving health equity” also holds priority. These goals, while important, remain vague, especially in our current political and social climate and the clear evidence of health disparities in regard to handling of the COVID-19 pandemic. This Healthy People 2030 initiative further expands on this overarching goal, outlining the plans to specifically focus on improvement in reporting for better public transparency of these deficits by providing midcourse data reports acknowledging progress toward addressing disparities and demographics for the 355 core objectives. Aside from improvements in reporting, the 2030 goals explicitly plan for disparity reduction by increasing accessibility of commonplace necessities. For example, increasing broadband Internet access across populations as health systems continue transitioning to internet-based patient communication. Despite the predetermined effort to improve health equity, COVID-19 brought a major deficit to the forefront of political conversation and public knowledge. It is important to remember that unfortunately, mitigating health inequities and disparities happens over time, not overnight and requires collaboration across professions.

Conclusion

The impact the coronavirus plays on other health promotion efforts is complicated. The pandemic publicly highlighted numerous deficits in the nation’s health care system, but many were brought to light as a result of COVID-19 and were already written into existing health promotion efforts with quantifiable goals for the coming years. Additionally, the magnitude of impact the pandemic has played on other health issues remains uncertain, and researchers will continue to study that impact for years to come. The coronavirus brought important preexisting health deficits to the forefront of political conversation and unfortunately these broader issues will not change immediately, regardless of how many COVID-19 vaccines are sent to underserved populations. The Healthy People 2030 initiative, while outlaid prior to COVID-19, remains an imperative health campaign with quantifiable, attainable, and realistic processes toward prevention and mitigation of current and future pandemics for the entire United States population. Ultimately, the hope for COVID-19 is that it is not around long enough to have progressive health objectives that last over an entire decade, but only in the lessons learned for public health improvement.

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