Since 1979, Healthy People initiatives have outlined American health and healthcare priorities each decade. Healthy People 2030 envisions “a society in which all people can
achieve their full potential for health and well-being across the lifespan” in order to “improve the health and well-being of all people” (Office of Disease Prevention and Health Promotion [ODPHP], 2018a, para. 12 & 13). The current iteration, Healthy People 2030, is in its public comment period until mid-January (check it out here: link). As nurses, we have an obligation to be politically engaged. Because Healthy People 2030 establishes a national agenda for healthcare services and research for the coming decade, it is vital that we use our expertise to influence these priorities.
One of the things I like most about Healthy People 2030 is the apparent transparency with which the advisory committee approaches priority-setting. The process is outlined from its origins in 1979 through to the current efforts out develop the fifth set of health objectives. The Office of Disease Prevention and Health Promotion (2018a) HealthyPeople.gov website includes everything from timelines to profiles of the advisory committee to proposed objectives. It also includes the guiding framework and principles used for developing priorities and objectives. To this end, Healthy People 2030 is built on the following foundational principles (quoted here from the Healthy People 2030 website):
- Health and well-being of all people and communities are essential to a thriving, equitable society.
- Promoting health and well-being and preventing disease are linked efforts that encompass physical, mental and social health dimensions.
- Investing to achieve the full potential for health and well-being for all provides valuable benefits to society.
- Achieving health and well-being requires eliminating health disparities, achieving health equity, and attaining health literacy.
- Healthy physical, social, and economic environments strengthen the potential to achieve health and well-being.
- Promoting and achieving the Nation’s health and well-being is a shared responsibility that is distributed across the national, state, tribal, and community levels, including the public, private, and not-for-profit sectors.
- Working to attain the full potential for health and well-being of the population is a component of decision-making and policy formulation across all sectors (ODPHP, 2018a)
These foundations lead to the following goals (again quoted from the ODPHP website):
- Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury and premature death.
- Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.
- Create social, physical, and economic environments that promote attaining full potential for health and well-being for all.
- Promote healthy development, healthy behaviors and well-being across all life stages.
- Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all (ODPHP, 2018a).
These premises are congruent with our Radical Nursing values, I think. In particular, the emphasis here on building healthy environments and eliminating health disparities in the foundations suggests that Healthy People 2030 is invested in building a just, inclusive, and equitable future for the American people.
But while the professed foundations and goals of Healthy People 2030 are progressive and expansive, the realities of the proposed objectives are less compelling. No doubt, the current political climate being what it precipitates actions that are uncontroversial, designed for stability rather than upsetting the status quo. While in principle increasing the proportion of people with health, drug, and dental insurance may increase access to health services, I think the reality is much more tenuous. Plans with high deductibles and premiums may well contribute to further delayed care, undermining other goals under the heading of “access to health services” (ODPHP, 2018b)
The measures suggested under Family Planning and Maternal, Infant, and Child Health are likewise quite limited. For one thing, no connection is made between increased access to healthcare and the impact this might have on maternal, infant, and child health. Goals are proposed to reduce maternal morbidity and mortality which is a critical problem we face in US healthcare. No mention, however, is made of the vastly disproportionate share of this morbidity and mortality that is borne by African American women. None of the goals proposed address structural racism and the inequities of a profit-driven health care delivery system. In short, a worthy philosophical foundation is reduced to something tepid, lukewarm.
This is just scratching the surface. Don’t take my word for it, though. Please take your nursing expertise over to the HealthyPeople.gov website and review the proposed objectives (link to .pdf organized by topic) and comment where you see fit (link to public comment function). Make liberal use of the mechanism to propose your own objectives (here). Clarify how health is connected to liberation and how nursing is connected to health. You might also mention that one nurse on the advisory panel is perhaps not enough (though certainly better than none, as was the case for Healthy People 2020 advisory panel). Use your nursing perspective to make Healthy People 2030 stronger, better, faster, more.
Office of Disease Prevention and Health Promotion. (2018a). Healthy People 2030 Framework. Retrieved from https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Framework
Office of Disease Prevention and Health Promotion. (2018b). Proposed Objectives for Inclusion in Healthy People 2030. [report]. Retrieved from https://www.healthypeople.gov/sites/default/files/ObjectivesPublicComment508.updated%2012.20.2018.pdf
Jess Dillard-Wright is a radical nurse, midwife, nurse educator, and PhD student living in the South. She has three kids, an old dog named Pearl, and a partner Devi.