The challenge for Community Health in the 21st century is twofold. First, we must ensure that the rate of advancement in health status continues unabated. Second, we must work to remove any disparities in health status that currently exist. To begin this journey, CKHS has adopted as one of its goals a commitment to achieve the Healthy People 2010 health improvement objectives.
CKHS convened a Steering Committee that included 20 key clinical and administrative leaders from primary care, psychiatry, internal medicine, obstetrics and gynecology, oncology, and cardiology. The committee met to review accomplishments in public health over the last decade and approve a set of working principles for selecting health improvement goals for the next ten years. According to these principles, health improvement goals for Delaware County should:
• reflect major public health concerns
• address disparities in health status
• have recognized, professionally accepted preventive interventions
• be measurable by available data
• support clinical initiatives in cancer, cardiovascular health, maternal and child health, and behavioral medicine
The Steering Committee used these principles to focus, review and prioritize national health status objectives identified in Healthy People 2010, a set of goals building on work by the U.S. Surgeon General since 1979. Healthy People 2010 goals seek to increase the quality and years of healthy life for individuals of all ages in the United States and eliminate disparities in health among segments of the population. Healthy People 2010 has 476 separate goals that are grouped in 28 focus areas. These areas are defined on the basis of scientific evidence compiled and analyzed by an alliance of more than 350 national organizations and 250 state health, mental health, substance abuse, and environmental agencies as well as more than 11,000 public comments gathered at regional and national meetings and over the Internet.
Of a total of ten Leading Health Indicators within Healthy People 2010, the Steering Committee identified eight major areas of focus for Delaware County over the next ten years:
• access to health care
• maternal, infant, and child health
• responsible sexual behavior
• cardiovascular health improvement
• early detection of cancer
• improvement of behavioral health
• injury/violence prevention
The Committee also chose 30 specific Community Health Objectives to pursue over the next decade (see Table 2). Some of these objectives will assure that we maintain the gains in the health of the community achieved over the past decade. As shown in Table 2, baseline performance in Delaware County meets or exceeds national benchmarks for many objectives.
Other objectives appear to be only slightly below national goals. Baseline performance in the year 2000 for infant mortality across all populations is already 1.6% higher than the Healthy People 2010 target; however, infant mortality among minorities is four times greater than the 2010 goal. The 2010 goal therefore seeks to remove disparities in the health of infants among segments of our population.
Some objectives will hold us to higher standards than Healthy People 2010. Delaware County already exceeds the Healthy People 2010 goal for biennial mammography rates. Therefore, with significant effort, the community can achieve mammography rates greater than 70%.