Health progress in the United States. Results of the 1990 objectives for the nation
McGinnis, J.M.; Richmond, J.B.; Brandt, E.N.; Windom, R.E.; Mason, J.O.
JAMA 268(18): 2545-2552
1992
ISSN/ISBN: 0098-7484 PMID: 1404822 Document Number: 395154
In 1979 in the USA, Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention (Washington DC, USA: Department of Health, Education and Welfare PAS publication No 797-55071, 1979) introduced and quantified new opportunities for improving the health of Americans through changes in behavioural choices (health promotion), the environment (health protection) and access to screening, immunization and counselling (clinical preventive services). Specific goals were set for achievements by the year 1990 according to age groups. In 1980 measurable objectives designed to achieve these goals were released in Promoting Health/Prevention Disease: Objectives for the Nation (Washington DC, USA: Department of Health and Human Services 1980). This article summarizes the progress in the USA towards those health goals and objectives, reviews the role of the objectives process in offering a sense of the opportunities and describes the relationship to the current agenda set out in Healthy People 2000: National Health Promotion and Disease Prevention Objectives (Washington DC, USA: Department of Health and Human Services, publication No PAS 91-50212, 1990). The goals have been best achieved in respect of infants and children and to a lesser extent adults. This exercise has revealed how far there is still to go in addressing inequalities in health in the USA between different ethnic groups and of particular concern must be the deteriorating position of adolescents for whom rates of homicide and suicide have been increasing. The difficulties of improving health through behavioural change if not reinforced by service/regulatory efforts is underlined as is the weakness of behavioural intervention for problems rooted in the impulses of youths and problems that are influenced substantially by culture and social situation. The resurgence of measles is put forward to illustrate the dangers of complacency once health gains have been made. The problem of inadequate data to monitor health progress is stressed. J. Ashton.