HEALTHY NORTH CAROLINA 2020: A Better State of Health 5
HEALTHY NORTH CAROLINA 2020
2020 OBJECTIVES - DEVELOPMENT PROCESS
Every 10 years since 1990, North Carolina has set decennial health objectives with the goal of making North Carolina a healthier state. One of the primary aims of this objective-setting process is to mobilize the state to achieve a common set of health objectives. North Carolina had more than 100 objectives for the year 2010. Although these objectives formed a comprehensive list of health indicators, the large number of them made it difficult to focus attention on key objectives that could lead to overall health improvement. Thus, one of the goals of the Healthy NC 2020 project was to develop a limited number of health objectives. There are 40 objectives within 13 specific focus areas for the year 2020. An objective is what we aim to accomplish, such as a reduction in the percentage of people with diabetes. Each Healthy NC 2020 objective includes a discrete target that provides a quantifiable way to measure our success in achieving each Healthy NC 2020 objective, such as a 10% reduction in the percentage of people with diabetes. Thus, the Healthy NC 2020 objectives provide a common set of health indicators that we, as a state, can work to improve, while the targets assigned to each objective enable us to monitor our progress, or lack thereof, toward achieving these common health objectives.
The Healthy NC 2020 objectives were developed over a one-year period on behalf of the Governor’s Task Force for Healthy Carolinians. (See page 38 for the Governor’s Task Force member list.) The Governor’s Task Force was charged by the Governor to develop these health objectives. According to the Executive Order, objectives “must be measurable, include measures to benefit the State’s disparate populations, emphasize individual and community intervention, emphasize the value of health promotion and disease prevention in our society, and be achievable by the year 2020.”d Due to the NCIOM’s work in developing the state’s Prevention Action Plane, the Governor’s Task Force asked the NCIOM to facilitate the development of the 2020 objectives. The NCIOM, in collaboration with the Governor’s Task Force for Healthy Carolinians; the Division of Public Health, North Carolina Department of Health and Human Services (NC DHHS); the Office of Healthy Carolinians and Health Education, NC DHHS; and the State Center for Health Statistics, NC DHHS, helped lead the development of the 2020 objectives. This work was generously supported by The Duke Endowment, the Kate B. Reynolds Charitable Trust, and the North Carolina Health and Wellness Trust Fund.
The overall work in developing the 2020 objectives and targets was led by a steering committee that comprised the State Health Director, Chair of the Governor’s Task Force for Healthy Carolinians, and other public health and prevention experts. (See page 40 for the steering committee member list.) These experts provided guidance for the development of the objectives and the selection of targets. Building off the prior work of the NCIOM Prevention Task Force in developing the Prevention Action Plan, the steering committee identified 13 focus areas for the Healthy NC 2020 objectives. Nine of the 13 Healthy NC 2020 focus areas had been identified in the NCIOM Prevention Action Plan as major preventable risk factors contributing to the state’s leading causes of death and disability. These nine Healthy NC 2020 focus areas are tobacco use, nutrition and physical activity, sexually transmitted disease and unintended pregnancy, substance abuse, environmental risks, injury and violence, infectious disease and foodborne illness, mental health, and social determinants of health.f The steering committee added four additional focus areas (for a total of 13): maternal and infant health, oral health, chronic disease, and a cross-cutting focus area. These focus areas were incorporated to capture other significant public health problems as well as summary measures for population health.
In addition to establishing the 13 focus areas, the steering committee identified different methods for establishing the targets for the 2020 objectives. The goal was to establish targets that were aspirational yet achievable. The steering committee examined several different target-setting methods for states.10 Among those reviewed were using an absolute percentage change over time, using a compounded percentage change over time, and using current Healthy People targets.g The review of these methods helped to inform the specific methods ultimately used in the Healthy
d North Carolina Executive Order No. 26, Reestablishing the Governor’s Task Force for Healthy Carolinians. October 8, 2009.
e For the full Prevention Task Force report: http://www.nciom.org/task-forces-and-projects/?task-force-on-prevention
f “Violence” was not part of the Prevention Task Force’s injury study area, but was included for Healthy North Carolina 2020.
g The Healthy NC 2020 objectives were developed before the Healthy People 2020 national objectives were finalized, thus these processes were completed independently.