Objective 1.1
Reduce behavioral and other factors that contribute to the development of chronic diseases

Constraints (e.g., economic) that limit individual and family ability to adopt and maintain a healthy diet and exercise program

Promote adoption of family-friendly workplaces; work with Department of Education to encourage schools to further increase proportion of schools that provide access to physical activity spaces and facilities for people, outside of normal school hours

Work with USDA to promote healthy school food choices, and with restaurant and fast food industry to promote healthy food portions and choices

Patient reluctance concerning cancer screening tests and other preventive health care services

Some people may not receive tests that can help detect health issues early and prevent them from becoming more severe

Conduct education campaigns to raise awareness of the benefits of screening tests and preventive services and to reduce patient misconceptions or reluctance to be tested

Inhibited access to drugs and other therapies to prevent and treat chronic disease

Inability to afford medications and supplies, such as insulin for diabetes or inhalers for asthma, that are needed to treat chronic disease

Support and promote model approaches, such as disease management programs, that improve access to medically necessary medications and supplies

Limitations on practitioners’ understanding of the complex interaction of environmental, genetic, social, and behavioral factors that cause and contribute to chronic disease and its complications

It is not always completely clear what strategies will be the most effective or cost-effective to reduce the incidence and consequences of chronic disease

Continue to support and carry out research on the causes of disease and the most effective strategies to prevent and treat chronic disease

Objective 1.2
Reduce the incidence of sexually transmitted diseases and unintended pregnancies

Objective 1.3
Increase immunization rates among adults and children

Lack of stability in the production of essential vaccines

Limited or delayed production of critical vaccines, such as flu vaccine and vaccines that protect against potentially fatal childhood illnesses, compromises the ability of health care providers to deliver essential vaccines in a timely fashion

Continue to work with vaccine manufacturers to assure availability of essential vaccines; continue to support research to improve vaccine production

Decreasing public confidence in the safety of vaccines

Adverse publicity focused on real and perceived risk of vaccines erodes public confidence and reduces public willingness to accept the risk-benefit profile of vaccines

Continue/increase vaccine injury compensation program; continue efforts to improve the safety of vaccines; continue public education about the value of vaccines in preventing death and disability

Objective 1.4
Reduce substance abuse

Increase in size of the 12 to 20 population cohort

Increase in number of people in most vulnerable age group for initiation of drug use

Increase prevention efforts for 12 to 20 age group

Unforeseen emergence of new “designer” drugs that are initially seen as benign

New epidemics could emerge and increase the level of drug use

Maintain surveillance systems and react quickly to proscribe and publicize dangers and consequences of new drugs

Objective 1.5
Reduce tobacco use, especially among youth

Increased advertising and other media promoting use of tobacco products

Smoking among youth and adults increases

Increase HHS counter-media events/advertising

Objective 1.6
Reduce the incidence and consequences of injuries and violence

Demographic and economic trends

Higher rates of violence are associated with economic distress and the size of the population below age 25

Expand effective youth development programs; maintain safety net programs

Increases or decreases of violence  in the media

Violent behaviors influenced by media exposure may increase or decrease with level of violence shown in the media

Encourage media to reduce display/ presentation of violence

Trends in requirements for the use of occupational and recreational safety equipment (e.g., safety helmets)

Safety equipment reduces amount and extent of injuries

Promote increased collaboration and sharing of information between public safety interest groups and all levels of government to strengthen safety requirements

Objective 2.1
Build the capacity of the health care system to respond to public health threats in a more timely and effective manner, especially bioterrorism threats

New threats emerge that outpace capacity

Inadequate preparation for all threats

Attempt to improve capacity to identify new strains of pathogenic microorganisms

Lack of communication between public health sector and hospital/health care sector

Duplication of resources, inadequate communications links in emergency situations

Public Health Preparedness enhancements to improve state/local capabilities; HHS-sponsored meetings to address communications issues; joint training exercises at state and local levels between the public health and hospital sectors

Objective 2.2
Improve the safety of food, drugs, biological products, and medical devices

Increasing importation of foods and products from around the world

There is an increased risk of foodborne illness appearing or unsafe products being marketed, due to varying foreign standards

Develop increased international cooperation and standards

Technological advances create greater product complexity and diversity

Increasingly more complex products may slow review process and delay market approvals; health professionals may have insufficient skills and resources to maintain safety at current levels

Improve skills and training and early involvement and communications with scientific community in development of new products

Objective 3.1
Encourage the development of new, affordable health insurance options

Economic conditions

Economic variables affect business decisions to provide employee health insurance and decreasing family income and job loss cause increases in the uninsured; decisions by state insurance regulators also affect insurance coverage

Focus on outreach to enroll eligible persons in insurance programs; monitor trends in coverage and propose legislative or regulatory changes where needed

Objective 3.2
Strengthen and expand the health care safety net

Economic conditions

An economic downturn can increase demand for health care services from safety net providers and strain the ability of current safety net providers to meet the demand for careDecreased state revenue leads to restrictions on Medicaid funding

Monitor trends in access to care among uninsured and low-income individuals and propose legislative or regulatory changes where needed.

Objective 3.4
Eliminate racial and ethnic health disparities

Economic conditions

Objective 3.5
Expand access to health care services for targeted populations with special health care needs

Cost of anti-retroviral therapies for HIV and treatment may increase and/or insurance companies may drop coverage

Access to therapies and treatment could be restricted if costs escalate

Develop better purchasing agreements with drug manufacturers; support for program expansions to subsidize purchases and monitoring of Medicaid coverage

Shifting demographics of HIV-related disease and affected populations

Affected populations expand and become harder to reach and serve, or longer life expectancy greatly increases the number of persons being treated

Develop improved surveillance and outreach strategies; provide assistance to service providers in planning and capacity building to meet sudden demographic shifts

Fragmentation, expensive, and/or incomplete public transportation infrastructure

Access to service sites, training, or employment would be impeded

Develop coordination strategies for transportation planning and service provision

Objective 3.6
Increase access to health services for American Indians and Alaska Natives

Continued poor economic conditions in American Indian/Alaska Native (AI/AN) communities

Because poverty is correlated with poor health status, making significant progress in improving the health status of AI/AN people is likely to be limited in the face of extreme and persistent poverty

expand the development of preventive technologies that are less dependent on individual compliance and refractory to the negative effects of poverty

Objective 4.1
Advance the understanding of basic biomedical and behavioral science and how to prevent, diagnose, and treat disease and disability

The uncertainties and risks intrinsic to the process of research

The pace of progress in scientific research is intrinsically unpredictable; history demonstrates the benefits of sustained research effort, but at any given time it is difficult to predict how/from where the next important advance will emerge

Broaden the research portfolio; carry out sound management of the research enterprise; encourage the flexibility to respond to changing scientific opportunities and willingness to take risks

The public’s willingness to continue to broadly support the biomedical research enterprise is an important factor to the extent to which the frontier of knowledge can be pushed forward in biology and related sciences; among other issues, advances in medical technology and breakthroughs in medical research have created a new set of challenges regarding ethical and moral considerations that are associated with the pursuit of these scientific advances and their incorporation into medical practice

Find additional ways to communicate with the public about new scientific achievements and their important implications for health; institute processes to involve the public in dialogue about these important issues

Same as for basic research

Objective 4.2
Accelerate private sector development of new drugs, biologic therapies, and medical technology

Objective 4.3
Strengthen and diversify the pool of qualified health and behavioral science researchers

Strength of job market for research scientists; extent of opportunities for both new and seasoned researchers; remuneration

Realities and the perceptions about potential candidates, as well as candidates’ perceptions of job opportunities, salary levels, etc. affect recruitment

Encourage successful basic and applied research programs, which continue to yield new scientific knowledge and opportunities, and continuing public support for the biomedical research enterprise provide the greatest leverage in sustaining demand for well qualified and creative researchers; promote career messages

Level of resources available to support agency programs for training and career development

The year-to-year level of budget authority directly affects an agency’s ability to maintain existing programs and to expand to address new needs

Maintain strong support for training and career development programs with public budget decision makers, with relevant sectors of private industry, and with the general public

Providers and the general public receive a lot of information resulting from health research; some information may be conflicting, difficult to understand, or impractical to apply

Health care practices may be slow to change

Further improve internal coordination of release of research results and other health information by HHS

Continue to develop partnerships with non-federal entities, including provider associations, non-profit organizations, and industry to disseminate health information and facilitate behavior change on the part of providers and the general public

Support further research on effective ways to disseminate research findings and to determine the best ways to increase application of new knowledge by providers and the public

Objective 4.5
Strengthen the mechanisms for ensuring the protection of human subjects and the integrity of the research process

Expansion of private research and pressure to move research from the laboratory to market more quickly to recoup costs

Patient protections may erode as competition for volunteers increases; quality of study may decrease under time pressures

Expand oversight where authority exists

Objective 5.1
Reduce medical errors

Increasing complexity of healthcare delivery and/or technologies

Greater propensity for error

Intensified and improved training; promote the use of standardized electronic systems for prescribing; promote electronic health records accessible across plans and providers to ensure availability of key personal health information at the point of prescribing

Changing demographics: aging population, increasing numbers of non-English speaking and/or low literacy populations

Older populations use multiple medications and have heightened risk of adverse reactions

Elderly and non-English speaking/low literacy people have added difficulties in understanding prescription and other instructions

Recruitment efforts of additional health care and/or support personnel with competence in other languages and cultural/ethnic groups; increased creative incentives for people to enter health care delivery field

Objective 5.2
Increase the appropriate use of effective health care services by medical providers

Continue building evidence base for the delivery of health care and focus on fostering the implementation of evidence-based research findings into health care practice and making information available to consumers

Increasing complexity of health care system

 Consumers are unsure about what quality indicators mean and how to use them

Volume and complexity of quality information hinders consumers’ and patients’ ability to interpret data

Promote consensus on core quality measures and consumer information

Objective 5.4
Improve consumer and patient protections

Increasing complexity of the system through which health care is delivered

Business decisions by employers about offering employee health insurance can impact the type of coverage and therefore protections; decisions by state insurance regulators also can affect insurance coverage

Continue to develop outreach and education materials for the public

Objective 5.5
Accelerate the development and use of an electronic health information infrastructure

Lack of widely accepted content and interoperability standards

Proprietary systems and applications do not support information exchange; the complexity of health information and the multitude of existing incompatible information systems contributes to the difficulty of agreeing upon standards for the content and format of health information, which has been widely identified as the major barrier to improvements in the national health information infrastructure

Enhanced HHS leadership and support of efforts to promote the development and voluntary adoption of format and content standards for health information

Enhanced use of e-Gov CHI initiative; HHS participation in various standards development efforts

Adequate national protection of the confidentiality of health information

Real and perceived threats to privacy of health information have a negative impact on the likelihood of public acceptance of improved health information infrastructure

Enhanced public education on the national standards to protect the privacy of personally identifiable health information.

Lack of resources for providers and public health agencies to acquire and implement standards-based systems

Providers and public health agencies make individual IT purchasing decisions that do not support information exchange

HHS grants to public health agencies require standards-based systems for bioterrorism

Lack of incentives for health care providers to share patient health information

Clinics and hospitals consider core information, such as patient allergies and family health history, to be proprietary

Collaborate on identifying a minimum set of non-proprietary personal health information

Lack of consensus on policies and practices for privacy, security, and confidentiality protections

Hesitation by providers and consumers to embrace electronic health information solutions

Implement privacy regulations; identify and promote best practices for privacy, security, and confidentiality protections

Lack of consensus on the content of a personal health record

Missed opportunities for consumers to have continuous access to their own personal health information or that of their children/families

Collaborate on identifying a minimum set of non-proprietary personal health information; work with consumer/patient advocacy organizations to identify preferred approaches; work with other stakeholders on consensus approach

Objective 6.1
Increase the proportion of low-income individuals and families including those receiving welfare who improve their economic condition

Economic conditions

Historically, when negative economic conditions occur, welfare recipients, low income minorities, and persons with disabilities are more vulnerable to unemployment.  This may offset efforts to move from welfare to work.  Conversely, when positive economic conditions exist, there are increased employment opportunities and local resources

Require states and tribes to engage all families on welfare in work and constructive activities

Provide states greater flexibility to accomplish TANF purposes

Consider use of waivers to enhance states’ capacity to coordinate a broad range of services

Provide adequate support for child care services and parental choice

Ensure families moving into work remain connected to other safety net programs for which they are eligible

Increase the involvement and financial support of non-custodial parents

Conduct research, provide TA, and identify best practices that focus on elimination of barriers for the hard-to-employ and cost-effective service delivery

Objective 6.2
Increase the proportion of older Americans who stay active and healthy

Rapidly aging population and increasing life expectancy

As the population grows older, there will be increasing numbers of older adults to serve; additionally, older adults are living longer lives and as a result experience longer periods of frailty, making staying active and healthy a challenge

Conduct research to identify effective approaches to targeting health promotion and long-term care services to specific populations of older adults, including ethnic and racial minorities, as well as cost-effective models to support increasingly frail older adults in their homes

Decreasing availability of time, safe environments, and other resources to adopt and maintain an exercise program and a healthy diet

Some older Americans may find it difficult to exercise regularly or eat nutritious meals

Promote more simple ways people can improve exercise and diet

Objective 6.3
Increase the independence and quality of life of persons with disabilities, including those with long-term care needs

Economic conditions

Putting qualified working-age adults with disabilities to work calls for job availability; decreases in state and local budgets could result in a reduction in funding for home and community-based placements for individuals with disabilities; changes in national and state economies and budgets have a direct effect on the availability of a quality long-term care workforce

Increase monitoring and training of long-term care service delivery personnel; coordinate extensively with other agencies and departments

Success of efforts to make medical  insurance available to disabled persons who work

Disabled individuals rely on continuing medical insurance to maintain employment; the success of efforts to protect access to affordable insurance will affect decisions of disabled persons to move from dependency to work

Monitor recent changes in access to medical insurance to see if further modification to existing legislation is needed

Issues related to long-term care coverage: individual perceptions of the need for coverage, affordability of insurance, fear of product instability, lapses in coverage, and limited availability of financing options

Individuals may not plan adequately for their long-term care needs, which may result in divestiture of assets, increased reliance on state Medicaid programs, and reduction in quality of life

Enhanced education of the public to raise awareness of long-term care coverage, thereby stimulating the market and creating more choices for consumers

Objective 6.4
Improve the economic and social development of distressed communities

The nation’s overall economic condition as well as that of particular geographic regions 

The availability of state and local resources

Economic decline and limited state and local resources are correlated with fewer jobs and lack of economic development, and conversely, economic prosperity and adequate state and local resources are associated with increased employment and economic development

Facilitate job creation through partnerships with state and local governments, private employers, and community based groups

Provide financial resources, training and technical assistance to state and local government and private agencies for job creation and supportive services that help residents excel in their jobs

Assist community action agencies, community development corporations and other community groups in leveraging federal, state, local and philanthropic resources to strengthen neighborhoods

Build social capital by developing community leadership and strengthening community-based organizations

Support asset development projects for residents of distressed communities

Objective 6.5
Expand community and faith-based partnerships

Legislative, regulatory, and programmatic barriers to participation of faith-based and community organizations in federal programs

Faith and community-based organizations may have difficulty accessing federal programs

Improve communication and provide TA on how to participate in federal programs

Develop and disseminate best practices

Objective 7.1
Promote family formation and healthy marriages

Public attitudes toward cohabiting, unwed childbearing, no-fault divorce; tax penalties and other policies that discourage marriage

May provide cultural disincentives that discourage long-term commitments and marriage

Further increase awareness of economic, social, and health benefits through research, educational campaigns, conferences, and summits

Objective 7.2
Improve the healthy development and learning readiness of preschool children

Economic and demographic conditions

Can lead to greater disadvantage for families and children

Conduct research to identify effective approaches in changing conditions and for different populations

Enhance effectiveness of programs through application of science-based knowledge

Objective 7.3
Increase the involvement and financial support of non-custodial parents in the lives of their children

Many noncustodial parents have low educational attainment, poor work histories, and few job skills which make them more vulnerable to economic downturns

Non-custodial parents may lose jobs/income resulting in fluctuations in income support ability

Increase efforts to achieve more emotional involvement of non-custodial parents with their children, encourage job retention or greater efforts to find employment during economic downturns, and coordinate child support enforcement with opportunities for job training and supported work activities

Work/time demands on parents

Work stress and parental difficulty in finding time for involvement with children may result in high levels of family conflict and family discord; children may grow up without parental role models

Identify access and visitation safe practices that encourage non-custodial parents to be more involved in their children’s lives

Objective 7.4

Economic conditions

Family stress is greater as economic situations deteriorate leading to increased potential for violence  and family breakup

Maintain integrity of safety net programs

Impact of welfare reform

Welfare reform has not had the deleterious effects on the safety of children that some had feared. We need to continue to be alert to potential future economic and social conditions that will have an effect on children's safety and well-being

Share with states successful strategies to use TANF, child welfare, and other funding streams to serve families in an effective manner

Objective 8.1
Create a unified HHS committed to functioning as one Department

None

Objective 8.2
Improve the strategic management of human capital

Possible administrative and/or budget imperatives

Various alternative possible requirements and actions of OPM could affect management of human capital

Integrate new imperatives into current approaches with smooth transition; maximize information flow to all affected groups and individuals throughout HHS.

Objective 8.3
Enhance the efficiency and effectiveness of competitive sourcing

Possible administrative and/or budget imperatives; changes in the private market (pricing and/or quality of service)

Changes in the relative value of external sourcing could affect the overall efficiency and effectiveness of competitive sourcing

Attempt to re-adjust the balance of internal vs. external work as needed with minimum disruption to service delivery

Objective 8.4
Improve financial management    

Commercial-off-the-shelf (COTS) software applications may not meet HHS requirements

Can increase costs and lead to implementation delays as COTS software products are modified to meet specific HHS requirements

Utilize to the extent possible existing COTS applications, limiting the number of specific enhancements that need to be developed and implemented

Objective 8.5
Enhance the use of electronic commerce in service delivery and record keeping

Availability of technology and communications

HHS could be behind the state of the art technology if technology advances faster than it can be adopted or acquired by HHS.

Assess, monitor, and adopt technology in cost effective ways

Commercial-off-the-shelf (COTS) software applications may not meet HHS requirements

Can increase costs and lead to implementation delays as COTS software products are modified to meet specific HHS requirements

Utilize to the extent possible existing COTS applications, limiting the number of specific enhancements that need to be developed and implemented

Lack of federal granting agency participation or delay in integration of partners into the current technology

Can limit success of E-Grants initiative and can delay targeted implementation and roll-out

Effective outreach to maintain federal agency support, as well as involvement of federal agencies early in the process

Lack of adoption of CHI standards across federal health care enterprise

Failure to adopt a portfolio of health data interoperability standards for all federal agencies that would allow all relevant agencies to “speak the same language”

Promote collaboration and participation in the establishment of the standards, as well as processes and procedures

Objective 8.6
Achieve integration of budget and performance information       

None identified

Objective 8.7
Reduce regulatory burden on providers and consumers of HHS services

The changing nature and complexity of health care, rapid changes in health care technology, and the pace and scope of legislative changes may influence regulatory requirements

The complexity and costs of complying with regulations can influence provider participation in Departmental programs and may hinder access to some health care services and products

Seek even greater regular and open consultation with stakeholders to streamline and clarify regulatory standards so that physicians and providers can spend more time providing patient care and consumers have access to the latest proven medical technologies