A Population Health Framework for Setting National and State Health Goals

With each iteration, the Healthy People process has changed and matured. The next one, now being set and planned for, could be even more useful to public health policy-makers if it incorporated population health perspectives outlined here, such as target setting and quantifying goals whenever possible.

This commentary aims to provide a framework for national and state planning processes to set the next wave of national and state health goals. Healthy People 2020, drafted by the U.S. Department of Health and Human Services Advisory Committee on National Health Promotion and Disease Prevention for 2020 builds on previous state and national health frameworks such as Healthy People 2010, and others.

The commentary specifically addresses the need to, in future, quantify particular objectives that were not quantified in Healthy People 2010, such as "eliminating disparities" and "increasing quality and years of healthy life." The authors present a figure that could be a starting point for a framework more precisely aligned to a population health perspective. Broad population health outcomes are listed on the right side, and on the left side are listed determinants of the population health outcomes listed on the right. All categories have multiple interactions with other categories, including that outcomes can exhibit reverse causality on determinants (e.g., that while low income can have a negative effect on health, poor health can also negatively affect income.)

The authors also point out that planning processes such as Healthy People 2020 should consider target-setting, at least for broad outcomes, something that was not done in Healthy People 2010. Target setting when using a "balanced set of health outcomes" such as the authors proposes can be particularly useful.