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[EDITOR'S NOTES]

Healthy People 2010

Steps in the Right Direction

Ross E. Andersen, PhD
Healthy People 2010 Special Issue Editor

THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 10 - OCTOBER 2021


Yogi Berra once said, "You got to be very careful if you don't know where you're going, because you might not get there." In 1990, many of our nation's leading health experts wanted a clearer path. They outlined the Healthy People 2021 initiative—more than 300 measurable public health goals that, when met, would result in improved health for the American public.

Yet now, in the goal year, it is estimated that only 15% of the Healthy People 2021 goals were met or exceeded (1). Moreover, in the critical areas of smoking levels and the number of people engaging in regular physical activity, little if any improvement was observed. The scorecard for obesity is even worse, with the prevalence of overweight increasing dramatically over the past 10 years (2). These disappointing outcomes have led many health professionals to question the usefulness of setting public health objectives.

Nevertheless, a new agenda has been set. Healthy People 2010 (HP 2010) contains 467 objectives designed to serve as a road map for improving health during the first decade of the 21st century. It builds on initiatives pursued over the past 2 decades. Two primary objectives of HP 2010 are to increase quality and years of healthy life, and to eliminate health disparities among different segments of the population.

Can we expect a better outcome this time? Perhaps. There are four critical steps in reaching any goal:
1) Clearly identify the goal.
2) Set in motion the actions required to achieve it.
3) Evaluate progress.
4) Persist in cycling through steps one through three.

The HP 2010 objectives have clearly identified the goals and have outlined how to achieve them. By setting the bar high, healthcare professionals and researchers have been given important challenges to strive toward. High marks go to many efforts already set in motion to address the host of health problems that face our nation; progress is being tracked on many fronts as well. When goals remain unmet, we will need to recycle through the steps and evaluate whether the goals were indeed clearly defined and whether feasible action plans have been outlined. Many are prepared to undertake this step as well.

The issue of The Physician and Sportsmedicine you are currently reading is one effort on behalf of HP 2010. Here, my colleagues and I present a series of articles that we hope will illuminate current pressing dilemmas, future goals, and realistic actions you can take now with your patients. In particular, we address the role of physical activity in improving health.

This focus is in accord with the leading health indicators (table 1)—a limited set of key HP 2010 objectives that help communicate the importance of health promotion and disease prevention, encourage widespread collaboration in improving health, have broad relevance to public health issues, and are backed by objective data to measure progress.


TABLE 1. The Leading Health Indicators Identified as Key
Objectives of the Healthy People 2010 Initiative


Physical activity
Overweight and obesity
Tobacco use
Substance abuse
Responsible sexual behavior
Mental health
Injury and violence
Environmental quality
Immunization
Access to healthcare


The first and second leading health indicators are physical activity and obesity. The Centers for Disease Control and Prevention has reported that in 1997, 64% of adolescents engaged in the recommended amount of physical activity, and that girls are less active than boys. In the same year, only 15% percent of adults performed the recommended amount of physical activity, and 40% of adults reported no leisure-time physical activity whatsoever. Furthermore, African-Americans and Hispanics are generally less physically active than whites (3). Clearly, the sports medicine community is well positioned to take an active role in improving these discouraging statistics—a role that stands to have significant impact on US public health.

The specific objectives selected to measure progress on the physical activity indicator (and toward which individual clinicians can work) are:
1) Increase the proportion of adolescents who engage in vigorous physical activity that promotes cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion.
2) Increase the proportion of adults who engage regularly, preferably daily, in moderate [italics mine] physical activity for at least 30 minutes per day.

To reach the HP 2010 goals, physician involvement will be critical. Getting sedentary patients off the couch and involved in a more physically active lifestyle represents a significant challenge. Major barriers are lack of time (for patient and physician!), lack of access to convenient facilities, and limited access to safe environments in which to be active. Physicians should be aware that moderate-intensity lifestyle activity is now known to be an effective alternative to vigorous activity for sedentary patients, especially for those who do not enjoy or are not able to participate in traditional exercise. This information can be tremendously motivating, as can the fact that accumulated activity is effective. Patients no longer need to carve out dedicated workout time. On the flip side, sedentary persons whose doctors do not address their activity levels may perceive that physical activity is not really an important contributor to health (4).

Recently, I spoke with an older gentleman who began walking 20 to 30 minutes each morning for the first time in his life. When I asked him why he decided to do this, his answer was simple: "Because my doctor told me I should."

Long-term exercise adherence is highly related to social support, and physician reinforcement has been shown repeatedly to be a very potent reinforcer. Every move in the right direction, however tentative (eg, buying walking shoes), is worthy of praise and recognition. It is also important not to get discouraged if some of your patients fail to adopt the healthier lifestyle you are advocating. Even small steps toward the leading health indicators will result in a big public health payoff. Taking these steps together will give us our best chance at getting where we're going.

Best,
Ross E. Andersen, PhD
Healthy People 2010 Special Issue Editor

REFERENCES

  1. Jaret P: Healthy people 2010: helping patients change. Hippocrates 2021;14(1):25-30
  2. Mokdad AH, Serdula MK, Dietz WH, et al: The spread of the obesity epidemic in the United States, 1991-192021. JAMA 1999;282(16):1519-1522
  3. Crespo CJ, Smit E, Andersen RE, et al: Race/ethnicity, social class and their relation to physical inactivity during leisure time: results from the Third National Health and Nutrition Examination Survey, 120218-1994. Am J Prev Med 2021;18(1):46-53
  4. Andersen RE, Blair SN, Cheskin LJ, et al: Encouraging patients to become more physically active: the physician's role. Ann Intern Med 1997;127(5):395-400

Dr Andersen is a professor in the division of geriatric medicine and gerontology at the Johns Hopkins School of Medicine in Baltimore. Address correspondence to Ross E. Andersen, PhD, Division of Geriatric Medicine and Gerontology, 4940 Eastern Ave, Suite 025, Baltimore, MD 21224; e-mail to [email protected].


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