Population Health Objectives and Targets

by

Lawrence W. Green

• LAST REVIEWED: 15 June 2015
• LAST MODIFIED: 23 February 2011
• DOI: 10.1093/obo/9780199756797-0125

Introduction

Borrowing from its epidemiological roots and from management science, public health has widely adopted the practice of committing its resources and evaluation of its progress to priorities expressed as quantified, measurable objectives. Such population health objectives and targets generally have four essential ingredients stated in the form of answers to the questions “how much, of what, will be achieved for whom, by when?” The specification of “how much?” draws on epidemiological estimates of an achievable target expressed as a percentage decrease or improvement in the population. The “what?” is usually a specific health indicator rate or ratio (e.g., population morbidity, mortality), or a determinant of health such as a health behavior or an environmental condition. The “for whom?” describes the population in which the change is intended to occur. The “by when?” is usually a date by which the achievement can be expected. The following article provides a collection of resources (textbooks, journals, websites, etc.) that provide insight into health objectives as applied in public health; in addition, resources have been provided that detail the history and evaluation of population health objectives as they relate to US and other public health systems.

Introductory Works

The most comprehensive application of population health objectives and targets is the US Healthy People initiative, which has defined hundreds of specific, quantified, measurable population health objectives for a nation in each of three previous decades and, as of 2010, a new online set of objectives for 2020. The World Health Organization maintains a similar website for publications available on its Health for All initiative and other population health objectives set by its regional offices and specific countries. The rationale and strategy of objectives-based planning and evaluation of programs are detailed in McGinnis, et al. 1997. In that paper, and in McGinnis 1980 and McGinnis and Maiese 1997, McGinnis describes how he and other public health officials used these methods in the US Healthy People initiative throughout its first two decades. Ochiai, et al. 2003 takes this tale into its third decade. Also early in the development of the Healthy People initiative, several publications outlined the rationale for “explicit goals for prevention and public health,” including Green 1980 (Green then headed the federal Office of Health Promotion responsible for coordinating the health promotion objectives), Henderson 1980 (from the perspective of the World Health Organization’s successful smallpox eradication program), and Richmond 1980 (Richmond then served as assistant secretary of health).

• Green, Lawrence W. 1980. Healthy People: The Surgeon General’s Report and the prospects. In Working for a healthier America. Edited by Walter J. McNerney, 95–110. Cambridge, MA: Ballinger.

  A preview of the developing plans and mechanisms for the federal coordination of what the first surgeon general’s report on health promotion and disease prevention had called for in developing a cohesive strategy, and how these articulate the more than two hundred draft objectives developed months earlier by experts and stakeholders from across the country in the fifteen priority target areas of population health.

• Henderson, Donald A. 1980. Explicit goals for prevention and public health. In Working for a healthier America. Edited by Walter J. McNerney, 95–110. Cambridge, MA: Ballinger.

  Reflecting on his experiences in directing the global smallpox eradication program for the World Health Organization, Henderson notes how important explicit objectives became and describes the attempt to satisfy the demand for health care without explicit objectives as futile and illusory when one recognizes the “finite resources and infinite demand” (p. 89).

• McGinnis, J. Michael. 1980. Health promotion and disease prevention: Tracking progress in the eighties. Paper presented at the 18th national meeting of the Public Health Conference on Records and Statistics, 4–6 August 1980, Washington, DC. In New challenges for vital and health records—1980. Edited by the National Center for Health Statistics, 127–131. DHHS (PHS) Publication No. 81–1214. Hyattsville, MD: Public Health Service.

  In one of the first descriptions of the Healthy People initiative of developing population health objectives and targets, McGinnis provides a vision and describes plans for the formulation and tracking of the objectives in the initiative’s first decade.

• McGinnis, J. Michael, and D. R. Maiese. 1997. Defining mission, goals, and objectives. In Principles of public health practice. Edited by F. Douglas Scutchfield and C. William Keck, 131–146. Albany, NY: Delmar.

  A textbook orientation to the distinctions drawn among mission, goals, and population health objectives in the federal Healthy People initiative.

• McGinnis, J. Michael, James A. Harrell, L. M. Artz, A. A. Files, and D. R. Maiese. 1997. Objective-based strategies for disease prevention. In Oxford textbook of public health. Vol. 3. 3d ed. Edited by Roger Detels, Walter W. Holland, James McEwen, and Gilbert S. Omenn, 1621–1631. New York: Oxford Univ. Press.

  This chapter reviews the history and development of the Healthy People initiative in the United States during its first two decades, tracing its roots to the “management by objectives” approach in business. It also discusses this national initiative in the context of international efforts stimulated about the same time (late 1970s and early 1980s) by the World Health Organization’s Health for All initiative.

• Ochiai, Emmeline, Carter Blakey, and Randolph F. Wykoff. 2003. Healthy People: Defining mission, goals, and objectives. In Principles of public health practice. 2d ed. Edited by F. Douglas Scutchfield and C. William Keck, 161–175. Albany, NY: Delmar.

  This update of the McGinnis and Maiese chapter (McGinnis and Maiese 1997) in the first edition of this book builds on the experience of completing the year 2000 objectives and launching the Healthy People 2010 objectives. Discusses the history of the initiative’s first two decades, development, management, federal leadership, selection of twenty-eight focus areas (up from twenty-two in Healthy People 2000, and fifteen in the 1990 objectives), and the organization of the Healthy People Consortium.

• Richmond, Julius B. 1980. The goals now: Health status and quality of life. In Working for a healthier America. Edited by Walter J. McNerney, 79–81. Cambridge, MA: Ballinger.

  In three short pages, the then surgeon general summarizes the historical context of the first Surgeon General’s Report on Health Promotion and Disease Prevention, which launched the Healthy People initiative with an overall goal for each of fifteen areas: five each in health promotion, health protection, and preventive health services.

• US Department of Health and Human Services. Healthy People.

  The US federal government’s Healthy People homepage gives the background and process for the development of objectives, “leading health indicators,” implementation planning and cooperative arrangements with the Healthy People Consortium of public, nonprofit, and private organizations, and the secretary’s Advisory Committee. Also provides information on the 2009 regional public meetings as the 2020 objectives were being developed, and links to official publications and data on the objectives, including free downloadable PDFs of each of the existing state-level Healthy People plans and objectives.

• World Health Organization.

  The World Health Organization’s home page links to numerous official, downloadable documents in which this international organization, its Commission on Social Determinants of Health, and its regional offices establish goals and objectives and monitor progress on them toward achieving targets within the health sectors of member nations. Also discusses how each of the other sectors of a society have an impact on health.