As the year 2000 approaches, the United States is again building consensus around national objectives that will lead the country's health improvement effort into the 21st Century. To be grounded in science and good data, the national Healthy People 2010 initiative must address the scenarios and trends that will affect health in the coming decade. The aging of Americans, the increasing diversity of the population, and rising numbers of uninsured people form a backdrop of challenging demographic trends. Prevention  research and scientific breakthroughs such as the human genome map provide exciting new possibilities for prevention and treatment interventions. To meet these challenges, new objectives are being developed to address genetic screening, counseling, and testing. A new focus area on mental and physical impairment and disability will provide objectives for healthy people with disabilities. A new focus area on public health infrastructure will track data and surveillance capacity, workforce training, and research capacity that are needed to support population-based health. There will also be a focus on access to quality health services that addresses not only preventive and primary care services, but  emergency medicine, long-term care, and health communication issues.

The 2010 objectives development process is a time for listening to the people. Members of the Healthy People Consortium have been participating in the development of the 2010 initiative. There are 350 national membership organizations in the Consortium, in addition to all State Public Health Departments, Mental Health Service Agencies, State Substance Abuse Officials and Environmental Agencies. The Association of State and Territorial Health Officials (ASTHO), NACCHO, and the National Association of Local Boards of Health are all active members.

Consultations began on Healthy People 2010 in 1996, with local and state representatives being convened by the National Center for Health Statistics to evaluate the use of the 18 health status indicators. ASTHO and NACCHO were represented in the first focus group to evaluate what has been useful in the year 2000 framework and should be preserved, and what has not worked and needs to be recast. Both groups have also been actively involved in developing the objectives planned for the public health infrastructure focus area.

The initial consultations resulted in the Public Health Service publishing in the fall of 1997 a proposed framework for organizing the Healthy People 2010 objectives. The vision statement "Healthy People in Healthy Communities" recognizes that health  improvements begin at the local level. This statement resonated with the more than 700 people who chose to comment on the framework. Two-thirds of the comments were accepted on the Internet and one-third of the comments came in on paper over a 90-day comment period. Comments were received from official state agencies in nearly half of the states. However, few local health departments officially commented. These  comments are posted on the Healthy People 2010 website for use by localities in their health improvement efforts: web.health.gov/healthypeople.

On April 27, 1998 a series of five audio conference calls began. These sessions are meant to start states and localities on developing their own set of health improvement targets for the first decade of the new millennium. Supported by the Department of Health and Human Services, the audio conferences are designed for participants to share their experiences with year 2000 objectives and their development plans for 2010. One of the five sessions is specifically focused on localities in the objectives-setting process. Another goal of the state/local consultation is to support the development of data for a comprehensive set of objectives that include mental health, substance abuse, and environmental health. The State Healthy People Action contacts who are listed in Developing Objectives for Healthy People 2010 are the points of contact for these conferences.

Local health leaders are encouraged to participate in the national Healthy People development to ensure that the national benchmarks are relevant to local settings. Local people are also encouraged to find a seat at the table in their own state plan development Using both the state and national health improvement plans as menus of objectives against which communities can assess their local situation and compare themselves with their neighbors should make the job of choosing indicators easier. This is not meant to discourage innovations but rather to suggest that the adaptation of existing indicators for a local situation is one route to pursue. In June, 1998, the Office of Disease Prevention and Health Promotion will release Healthy People in Healthy Communities: A Guide for Community Leaders that packages year 2000 community-based objectives in schools, work sites, and health provider settings for communities to use in their activities.

In the fall of 1998, the draft national objectives will be published for public comments. The objectives will be posted on an Internet website that will accept public comment. In addition to taking written public comments, testimony will be gathered across the country in regional meetings. To be conducted in Philadelphia, Chicago, New Orleans, Seattle, and Sacramento, these meetings present an opportunity for communities around the country to evaluate the utility of this framework for their own use. On November 12 and 13, the Healthy People Consortium will meet in Washington D.C. The hope is that citizens, by participating in one of these public consultations around the country, will influence the national objectives development and in turn be motivated to conduct a similar process locally.

Deborah Maiese is Senior Prevention Policy Advisor for the Office of Disease Prevention and Health Promotion at the U.S. Department of Health and Human Services.