番茄社区

With the reveal of , national public health goals for the next 10 years now place greater emphasis on social determinants of health and quality of life.

It's the latest iteration of the decennial objectives-setting project of the U.S. Department of Health and Human Services (HHS), establishing population-level health targets for older adults, adolescents, LGBTQ individuals, quality of life and well-being, sleep, and more for the next decade.

For example, HHS wants 79.8% of adults to be self-reporting good or better physical health and 80.1% good or better mental health by the year 2030.

HHS is also tracking various metrics in economic stability, education, healthcare access, neighborhood characteristics, and social and family life for possible goal-setting within the decade.

Whereas much of Healthy People 2020's focus was on individual health behaviors, the new set of targets pays more attention to overall well-being, a "very important area" that is related in part to the consequences of diabetes, heart disease, and stroke, commented Robert Eckel, MD, of the University of Colorado in Aurora.

Basic core goals in diabetes, heart disease, and stroke were mostly retained from Healthy People 2020.

Slight revisions include the target diabetes death rate being adjusted from 65.8 to 66.6 per 100,000 people and the target proportion of hypertensive patients taking blood pressure-lowering medications dropping from 77.4% to 69.5%.

"Healthy People 2030 prioritizes key areas such as eliminating health disparities, achieving health equity and attaining health literacy to ensure all populations can live longer, healthier lives," said a .

"Healthy People 2030 closely aligns with the AHA's health priorities by emphasizing health conditions including heart disease and stroke; healthy behaviors including healthy eating, abstaining from tobacco and nicotine use, engaging in physical activity and practicing preventive care; the settings where people spend a majority of their time and social determinants of health," according to the statement.

So how did the U.S. fare in meeting Healthy People 2020 goals?

As of 2017, there were mixed results, according to HHS data:

• Coronary heart disease deaths totaled 92.9 per 100,000 people (down from 129.2 per 100,000 people in 2007) compared with the goal of 103.4 per 100,000 people
• Stroke deaths were 37.6 per 100,000 people (down from 43.5 per 100,000 people in 2007) compared with the goal of 34.8 per 100,000 people
• Proportion of adults who are obese didn't go down. Disappointingly, in fact, it rose from 33.9% in 2005-2008 to 38.6% in 2013-2016. The goal is 30.5% in 2030.

"We certainly didn't achieve as much as we would have liked in obesity," highlighted AHA president-elect Donald Lloyd-Jones, MD, of Northwestern University Feinberg School of Medicine in Chicago.

"There are consequences of that. Fewer people have blood pressure in good control, and there's more diabetes. We have more of these things flowing directly from the obesity epidemic, which is a key epidemic that we need to combat in this coming decade," he said in an interview.

A focus on socioeconomic determinants of health is "critically important," according to Lloyd-Jones. The good news is there is more knowledge about why cardiovascular health can decline in various groups and contribute to socioeconomic and other disparities, he said.

"Healthy People 2030 comes as our nation faces an [sic] historic public health crisis in the COVID-19 pandemic," according to the AHA press release.

"It has become abundantly clear that people in some racial and ethnic groups are disproportionately affected by COVID-19 – an outcome driven in part by disparities in health conditions, behaviors and most importantly, social determinants of health. The pandemic makes it more important than ever to address population health and determinants of health to reduce susceptibility to infectious and chronic disease," the statement said.

Comment