Improving Americans' health takes a community

WASHINGTON (AP) — The government's new 10-year blueprint to improve Americans' health aims to help whole communities get in better shape, not just the couch potatoes.

The issue: Social and environmental factors play a big role in preventing disease. Kids who live in city apartment buildings without safe yards or parks to play in tend to watch a lot of TV instead of exercising, for example.

And if the nearest grocery store requires a 30-minute bus ride, people eat more salty, fatty packaged food from the corner convenience store than fresh fruits and veggies.

So the nation's Healthy People 2020 goals, to be released Thursday, add a little something new to the traditional measures of well-being — by encouraging policies for states and communities that can help make people's surroundings more conducive to healthier lifestyles.

Take the target of dropping obesity by 10 percent. Other goals might help get there: Healthier food in schools and day care. Pushing more states to require daily physical activity in day care and P.E. in school. Getting more schools to open the gym or track after-hours so parents can exercise. Building policies that include more sidewalks and other opportunities for physical activity.

Another example: About 21 percent of Americans smoke and the target is to drop that to 12 percent by 2020. Goals to help get there include more worksite smoking bans and more state Medicaid programs that pay for proven smoking-cessation treatments.

"Health is more than just focusing on individuals," Dr. Howard Koh, assistant secretary at the U.S. Department of Health and Human Services, told The Associated Press. "It's all interrelated."

For the past 30 years, the nation has set "Healthy People" goals, targets for better health over the coming decade.

How did we do in 2010? Final numbers aren't due until spring, but clearly the past decade was a mixed bag. Life expectancy is at an all-time high of nearly 78 years. Deaths from heart disease are steadily dropping, and cancer death rates inched down a bit. More children are getting properly vaccinated.

But obesity exploded during that time span. Diabetes is rising. So is high blood pressure. Progress against smoking has stalled, more children have untreated cavities, and the nation came nowhere close to its goal of far fewer premature births.

Overall, the government says about 19 percent of the Healthy People 2010 goals were met as of last year, with some progress made in another 52 percent.

Looking ahead, many of HHS' health goals for 2020 anticipate just modest improvements rather than the more lofty targets of previous decades.

Consider that in 2000, nearly a quarter of all adults were obese and the nation aimed to drop that to 15 percent by this year. Instead, about 34 percent of adults now are obese — and the new goal for 2020 is to drop that to just under 31 percent.

"We need to balance the aspirational and the achievable," said HHS' Koh.

Some other goals:

—Continue to reduce deaths from heart disease and stroke by another 20 percent.

—Reduce deaths from cancer by 10 percent.

—Cut by 10 percent new cases of diabetes.

—Slash food poisonings from E. coli, salmonella and other microbes.

The document's nearly 600 goals run the gamut of health issues — from increasing the number of people with insurance to cutting use of tanning beds and even lowering the number of children exposed to asthma-induced cockroach allergen.

"There has to be some prioritization," cautioned public health expert Jeff Levi of Trust for America's Health, who thinks the Healthy People program could be more successful by focusing on fewer areas at a time.

Starting this year, the Healthy People program aims to help communities do some that prioritizing by electronically comparing how their residents match up to the health goals so they can tailor their own work for improvements.

Sonoma County, Calif., has begun to do that using the Healthy People 2010 goals. Its "Health Action" program is bringing sale of affordable fresh fruits and vegetable to five communities that lacked that option, prompted the planting of 600 community gardens, and is working to create safe routes for walking and biking to schools, said Rita Scardaci, director of the county health department.

"We hope to have the healthiest county in the state of California by 2020," said Scardaci, who is adding some of the national 2020 goals as her community's next steps.

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