In This Article Healthy People Initiative

  • Introduction
  • General Overviews
  • Through the Years
  • The Process of Setting Objectives
  • Challenges in Measuring Progress
  • Impact of Objective Setting on Health
  • Strategies and Resources for Meeting Objectives
  • Evolving Focus on Disparities
  • At the State and Local Level
  • Criticisms
  • Beyond the United States

Public Health Healthy People Initiative
by
Graham Colditz, Carolyn R. T. Stoll
  • LAST REVIEWED: 04 October 2016
  • LAST MODIFIED: 30 January 2014
  • DOI: 10.1093/obo/9780199756797-0082

Introduction

The Healthy People initiative is a program of national health objectives set by the US Department of Health and Human Services for each decade. The Healthy People initiative emerged in the United States following the creation of the World Health Organization in 1948 and the Lalonde Report in Canada in 1974. The initial report, Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention (US Department of Health, Education, and Welfare 1979, cited under Through the Years), was released in 1979 and set national health objectives to be achieved by 1990, and the scope and range of objectives to promote health in the United States have been update and expanded each decade since then. It now sets the health promotion and disease prevention agenda for the nation. Concurrent with efforts by the United States, a similar focus on national and international objective setting grew with the World Health Organization’s Alma-Ata Declaration in 1978 and their Health for All by the Year 2000 movement. This article traces the Healthy People initiative from its early beginnings in 1979 to its current role in American health policy. Challenges in setting objectives and measuring progress are explored. For more information see the Oxford Bibliographies article Population Health Objectives and Targets by Lawrence W. Green.

General Overviews

These articles provide general overviews of Healthy People in the United States from 1979 to the present. Breslow 1987 and McGinnis 1990 provide overviews of the early objective-setting process in the 1980s and 1990s. Green and Fielding 2011 provides a detailed history of the initiative and traces the evolving social context and national concerns, and the scientific evidence base, that underlie changes in goals and objectives over the decades.

  • Breslow, L. 1987. Setting objectives for public health. Annual Review of Public Health 8.1: 289–307.

    DOI: 10.1146/annurev.pu.08.050187.001445E-mail Citation »

    This thoughtful review of methods of setting long-range measurable goals in the United States and beyond explores the changing focus from mortality to enhancing health implicit in the national health objectives. The process of designing objectives for 1990, the necessity of state efforts to achieve goals, and the difficulty in tracking these goals are described.

  • Green, L. W., and J. Fielding. 2011. The US Healthy People initiative: Its genesis and its sustainability. Annual Review of Public Health 32:451–470.

    DOI: 10.1146/annurev-publhealth-031210-101148E-mail Citation »

    This detailed history of the development of Healthy People and the subsequent evolution of goals and objectives provides insight to the process, the ethical and political issues encountered, and remaining barriers. The authors summarize a range of firsthand lessons, which include a stronger link to the budget and responsibility for implementation to achieve the goals.

  • McGinnis, J. M. 1990. Setting objectives for public health in the 1990s: Experience and prospects. Annual Review of Public Health 11.1: 231–249.

    DOI: 10.1146/annurev.pu.11.050190.001311E-mail Citation »

    The review details the process to develop and track the 1990 objectives, the progress to date, and the implications for the establishment of health objectives for 2000. McGinnis concludes that setting objectives is only the starting point, and if they are to be achieved, substantial commitment at all levels is necessary.

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