OFFICE OF PUBLIC HEALTH AND SCIENCE

FY 2003 PERFORMANCE PLAN

The Office of Public Health and Science (OPHS) provides leadership to the Nation on public health and science issues that are important to the American people. OPHS policy, program and operational components make it unique among the Staff Divisions in the Department of Health and Human Services (HHS). OPHS is led by the Assistant Secretary for Health (ASH), a key leadership position in HHS whose chief interests are promoting, protecting, and improving the Nation's health. The ASH provides senior professional leadership on population-based public health and clinical preventive services, directs thirteen program offices housing a variety of essential public health activities, provides senior professional leadership across HHS on White House and special Secretarial initiatives involving public health and science, and guides and provides technical assistance to the ten Regional Health Administrators.

OPHS consists of the Immediate Office of the ASH, the Office of the Surgeon General (OSG), the Office of HIV/AIDS Policy (OHAP), the Office of Population Affairs (OPA), the Office of Disease Prevention and Health Promotion (ODPHP), the President's Council on Physical Fitness and Sports (PCPFS), the Office of Minority Health (OMH), the Office on Women's Health (OWH), the Office of Emergency Preparedness (OEP), the Office for Human Research Protections (OHRP), the Office of Global Health Affairs (OGHA), the Office of Research Integrity (ORI), the Office of Military Liaison and Veterans Affairs (OMLVA), and the National Vaccine Program Office (NVPO). These offices are actively engaged in a broad array of activities that support and facilitate the work of many of the Department's Operating Divisions.

OPHS Theme/Priorities

OPHS has developed a theme, priorities, enabling objectives, and common strategies based upon the 5-year HHS Strategic Plan, ASH priorities, and special annual initiatives. The theme of OPHS is Healthy People in Healthy Communities through Public Health and Science. By applying sound science to public health policies and programs, and by educating people and communities about prevention, health, and the health care system, OPHS will stimulate research, policies, and interventions that will improve the Nation's health. OPHS will focus its efforts on three health priorities:

1. Move toward establishing a balanced community health system

a. Assure every child the opportunity for a healthy start in life;

b. Promote healthy lifestyles and behaviors;

c. Enhance mental health for all; and

d. Strengthen the health sciences research enterprise.

2. Maintain a global approach to public health

a. Increase awareness of and attention to global health concerns and their effects on the domestic issues; and

b. Ensure a safe food and blood supply and prepare for and respond to terrorism threats.

3. Eliminate racial/ethnic disparities in health

OPHS will achieve success with these three priorities by employing the following cross-cutting strategies:

Strengthen the science base for decision-making by fostering research integrity, protection of human research participants, demonstration projects, and evaluations;

Improve the policies, programs and practices required to achieve priority objectives;

• Increase the number of effective networks, coalitions, and partnerships addressing priority objectives; and
• Improve communications with various audiences to increase awareness and understanding of the major health problems confronting Americans.

OPHS values collaboration and works in partnership with other HHS components, as well as a variety of other Federal agencies (including the Departments of Education, Justice, Labor, Agriculture, Defense, State, Transportation, Commerce, Energy, Housing and Urban Development, and Veterans Affairs; the Environmental Protection Agency; the Federal Emergency Management Agency; and the US Consumer Product Safety Commission), tribal, State and local governments, health departments and agencies, the academic community, health providers, national professional associations, tribal, national and international health-related organizations, community-based organizations, minority community-based organizations, faith-based institutions, the media, advocacy groups, the business community, foundations, the public, Congress, and others. Through its program offices, OPHS has established close ties with stakeholders who are critical to addressing significant public health and science issues in the Nation and around the world.

OPHS Role and Contributions

OPHS' essential role in achieving each priority is to provide leadership, assess national health trends and problems, stimulate serious debate, engender creative ideas, and give critical visibility to health problems, needs, and solutions. Investments in programs and activities that are effective pay off heavily in the improved health and productivity of the American people and our global partners. The results - better health for individuals and longer life spans - are highly valued by the public. Of the strategies utilized by HHS and OPHS, most include a combination of research, prevention, public health programs, public education services, and regulation. OPHS contributes by:

Building a Stronger Science Base

• OPHS promotes the collection of health data and the strengthening of data infrastructures to monitor the health of all Americans, to measure the effects of initiatives and interventions aimed at improving health, and ultimately to provide a sound basis for decision-making.
• OPHS fosters service demonstration projects, evaluations, and other studies of interventions aimed at improving health and the health care system to strengthen and expand the science base for decision-making, determine model approaches and best practices, and identify and overcome barriers to health, as well as program and intervention effectiveness.
• OPHS protects the integrity of the research underlying public health policy and clinical treatments by ensuring that all institutions that conduct research supported by the Public Health Service have an understanding and commitment to research integrity and an administrative process for responding to allegations of scientific misconduct, by conducting oversight review of institutional investigations into alleged misconduct in science, and by monitoring institutional efforts to promote the responsible conduct of research. OPHS helps to instill confidence by the public and others in research involving human subjects by working to ensure the protection of human research participants in accordance with U.S. laws and regulations.

Influencing and Improving National Policy

• OPHS influences and affects policies, programs, and practices through review, analysis, and advice on existing policy-related efforts as well as development, coordination, and implementation of new initiatives and activities. Recent hallmarks of OPHS's activities in this area are Healthy People 2010 and the Leading Health Indicators, the HHS Initiative to Eliminate Racial and Ethnic Disparities in Health, the Surgeon General's Report on Mental Health, the Surgeon General's Report on Oral Health, the Dietary Guidelines for Americans 2000, the HHS Blueprint for Action on Breastfeeding, The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior, The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity, and a variety of reports which translate state-of-the-art science into documents that are extensively read by legislators, the media, professionals and the public.
• OPHS facilitates the translation of health data and research findings into budgetary and program expressions.

Promoting Effective Partnership Activities

• OPHS establishes and strengthens effective networks, coalitions, and partnerships to identify and solve public health concerns and to stimulate and undertake innovative projects that address them. OPHS reaches out to professional groups, advocacy groups, international partners, nongovernmental organizations, and colleagues in Federal, State, tribal and local governments, engaging in collaborative work to assist in the identification of health concerns and problems and development of creative solutions.

Engaging in Strategic Communication

• OPHS increases public awareness and understanding of the major public health concerns and health systems through strategic communications and a wide range of informational and educational efforts aimed at decision makers, health professionals, those serving racial/ethnic minority communities, and the general public to spur responsive policy and programmatic action. OPHS prepares reports, background papers, legislative proposals, Congressional testimony, journal articles, speeches, Internet sites, and a myriad of other documents related to the communication of science and its impacts on public health. Through the ASH and her designees, OPHS communicates directly with the American people and other decision- and opinion-makers through speaking engagements, conferences, and publications, thereby serving as a catalyst for sustained attention to health and promotion of the health of the Nation.

External Factors

OPHS is committed to assuring sustained progress and improved health outcomes within each priority through coordinated public and private efforts. The effectiveness of OPHS's activities are essential to the achievement of this ambitious goal, but its programs and activities alone cannot assure success. The problems underlying OPHS's priorities are complex and reach beyond the control and responsibility of any one arena or effort. Achievement is dependent on various health programs and providers, all levels of government, and the efforts of the private sector as well as individual contributions. While external factors beyond the control of OPHS may affect outcomes (including factors such as legislative and court decisions; education and social services; availability of resources; and shifts in the economy and demographics), OPHS's essential role in achieving each priority is to provide leadership, assess national health trends and problems, stimulate serious debate, engender creative ideas, and give critical visibility to health problems, needs, and solutions. OPHS continues to strive to better measure and communicate the ways in which its contributions improve the health of the US population.

Where data for FY 2001 reporting is unavailable, we have indicated estimated dates for receipt of final data where possible. In assessing achievement of goals, it is appropriate to note that OPHS activities are but some of the many public and private contributions necessary to achieving the goals and priorities set out in this plan.

Target Setting, Data Sources and Validation for Performance Measurement

Most performance measures in this plan were selected from among the nationally-recognized health objectives of Healthy People- the state-of-the-art for consensus on population-based health status outcomes. Healthy People objectives contain decade-long targets. OPHS based its performance measures for FYs 1999 and 2000 on objectives from Healthy People 2000 (launched in 1990 with health targets for the year 2000), and performance measures for FY 2001, 2002, and 2003 on Healthy People 2010 (final edition released November 2000 with health targets for the year 2010).

The targets for the 317 objectives in Healthy People 2000 were challenging. Although 60 percent of the objectives were either met or are moving in the right direction, there are areas where progress is not so clear. For the purposes of this performance report, OPHS has selected targets consistent with Healthy People 2010, the nation's health agenda for the first decade of the twenty-first century. It contains two goals, 467 objectives, and 28 focus areas. Each year, the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention publishes the most recent data on progress towards the Healthy People targets. The data produced by NCHS are compiled from State and local public agencies, Federal surveys and other data sources. The data are used for a wide variety of purposes by Federal, State and local officials; researchers; legislators; the media; the public; and others. The validity of these data has been subjected to internal and external scrutiny.(1) [Note: Healthy People 2010 was released in January 2000 as a conference edition. New data were added and the final edition was released in November 2000. Baselines drawn from Healthy People 2010 were updated to be consistent with the updated document, as appropriate.]

OPHS proposes to use the most recently published NCHS data as its primary source for performance measurement whenever possible. For performance measures that are not included in Healthy People, and therefore not monitored by NCHS, other data sources have been identified. OPHS's use of NCHS data provides many benefits. For example, the data have been subjected to intense review and are regarded as the "gold-standard" for health information. Without NCHS data, OPHS could not include health outcomes - of the utmost importance to Congress and the American public - as performance measures. In addition, OPHS will not need to invest significant resources in the development of monitoring systems for its performance measures. These factors are consistent with Congress's intent for GPRA. One problematic aspect of relying on NCHS data is that there will be a lag in reporting on the performance measures. For the measures based on mortality or death rates, the lag time will be 1 to 2 years; for measures based on behaviors and morbidity, the lag time is likely to be 2 to 3 years. On balance, OPHS considers the strengths of the data to outweigh the weaknesses.

For those performance measures based on Healthy People 2010 objectives, whenever more recent and more complete baseline or actual performance data are available from the Data 2010 database (http://wonder.cdc.gov/data2010/obj.htm), such data are now used in the performance plan and report. If more recent and more complete baseline or actual performance data are not available from Data 2010, then data are obtained from the specific data source for the objective in question (e.g., National Vital Statistics System, HIV/AIDS Surveillance System).

Measuring OPHS Progress

The three priorities of OPHS are presented in the following sections. Each section presents a list of OPHS offices that contribute to goal achievement, a brief description of significant OPHS contributions and context for performance, a performance summary of past fiscal year activities, a listing of performance measures with baselines and targets for performance and the latest actual performance data available, and links of OPHS measures with the HHS strategic plan.

OPHS PRIORITY 1: MOVE TOWARD ESTABLISHING A BALANCED COMMUNITY HEALTH SYSTEM

This balanced community health system must include health promotion, disease prevention, early diagnosis, and universal access to quality care. It must be grounded at the community level, calling on the serious involvement of civic and other local groups, community schools, and faith-based organizations to work in concert with the health system both public and private. And, finally, it must be supported by a strong and balanced research agenda.

1(a) Assure every child the opportunity for a healthy start in life

The type of start a child experiences plays a major part in determining that child's future. A healthy start involves several things - the health of the parents and whether they are experiencing a planned pregnancy, and whether either or both of them are teenagers. It relates to the health of the mother, including whether she has access to quality prenatal care. And it involves the health concerns of the baby in utero, ranging from reducing the risk of having HIV transferred from mother to child to avoiding exposure to tobacco, alcohol, and crack cocaine in utero. We also must focus on issues affecting the newborn, including breast feeding and nutritional habits and the sleeping position the parents select for the baby. A healthy start also means looking at a child's environment and making sure that it is safe and nurturing, offers protection from infectious disease through access to immunizations, and is free from toxins, violence and abuse, as well as unintentional injury. We know that children develop best in supportive environments where there are loving, caring adults who will take the time to read to them and stimulate their senses.

OPHS Contributing Offices

The Office of Population Affairs, Office of Disease Prevention and Health Promotion, Office of HIV/AIDS Policy, Office of the Surgeon General, Office of Minority Health, Office on Women's Health, National Vaccine Program Office, and Office of Research Integrity.

OPHS Role and Contributions

OPHS's essential role in achieving each priority is to provide leadership, assess national health trends and problems, stimulate serious debate, engender creative ideas, and give critical visibility to health problems, needs, and solutions. OPHS - together with HHS agencies and other partners - invests in programs and activities that are effective in providing a healthy start for children. Some examples of the direct contributions of OPHS include:

Building a Stronger Science Base

• OPHS collaborates with various HHS agencies in several research efforts, including funding support for the collection and analysis of data from national surveys such as the National Survey of Family Growth (NSFG) and the Adolescent Health Survey.
• The national Title X Family Planning program supports research to improve the delivery of family planning services, as well as research other selected topics in family planning such as male involvement.
• The President's Task Force on Environmental Health Risks and Safety Risks to Children, managed by OPHS (with the Environmental Protection Agency), addresses specific environmental-related risks to children's health and safety - asthma, unintentional injuries, cancer, and developmental disorders. This initiative, which reaches across the Federal government, recognizes the growing body of scientific information demonstrating that America's children suffer disproportionately from environmental health risks and safety risks. The Secretary co-chairs the Task Force with the Administrator of the Environmental Protection Agency. In addition to HHS agencies, other active collaborators include the Department of Housing and Urban Development, Department of Justice, US Consumer Product Safety Commission, and the EPA.
• The Adolescent Family Life (AFL) program supports demonstration projects to develop models aimed at (1) promoting abstinence from sexual intercourse as a means of preventing adolescent pregnancy and sexually transmitted diseases, including HIV, and (2) assisting pregnant and parenting adolescents, their children and their families. The program also funds research projects examining the causes and consequences of adolescent premarital relations, adolescent pregnancy and adolescent parenting.
• OPHS, through the National Vaccine Program Office (NVPO) facilitates and coordinates HHS agency activities to ensure the development of the safest and most effective vaccines possible for the children of the United States.

Influencing and Improving National Policy

• OPHS staff provide policy analysis and perspective in the Department-wide implementation process of the Title XXI State Child Health Insurance Program (S-CHIP) and Child Health Initiative.
• Reports from the Surgeon General provide the science underpinning for actions to reduce tobacco use and address other health issues related to children. The report Reducing Tobacco: A Report of the Surgeon General, was released in August 2000; the report Women and Smoking: A Report of the Surgeon General was released in March 2001. The latter report provides an update of the 1980 first Surgeon General's report on women and tobacco, including issues related to maternal smoking. The FY 2000 report, Oral Health in America: A Report of the Surgeon General, and subsequent Surgeon General's Conference on Children and Oral Health have guided actions to maintain and improve oral health for all Americans and remove barriers that stand between adults and children and oral health services. The HHS Blueprint for Action on Breastfeeding released by the Surgeon General in FY 2000, in conjunction with the Office on Women's Health, establishes a comprehensive policy for the nation to improve children's health by promoting the benefits of breastfeeding through the family and community, workplaces, and the healthcare system.
• NVPO, through its National Vaccine Advisory Committee, helps develops immunization policy aimed at ensuring that vaccine research, development, and delivery contribute in the most effective ways to the reduction of vaccine preventable disease in the United States.

Engaging in Strategic Communication

• The national Title X Family Planning program supports information dissemination and community-based education and outreach activities.
• The AFL program develops model strategies for promoting abstinence from sexual intercourse as a means of preventing adolescent pregnancy and sexually transmitted disease. The Title X (Family Planning) program also stresses abstinence in both education and counseling sessions with adolescents. All adolescents requesting services are counseled about the benefits of abstinence in relation to prevention of both pregnancy and STDs.
• NVPO, through its HHS Interagency Vaccine Communications Group, develops effective communication messages regarding the benefits and risks of vaccines to ensure an informed public.
• The OPHS Office on Women's Health National Centers of Excellence in Women's Health have developed programs targeting adolescent girls on reducing risk-taking behaviors and general physical, mental and social health through bilingual teen web sites and volunteer mentor programs. Hispanics, Native Americans, and pregnant teens are among the groups reached through these efforts.

Promoting Effective Partnership Activities

• The national Title X Family Planning program provides family planning and related gynecological health care services to nearly 4.5 million individuals each year to assist them in planning the timing and spacing of their children. The program also supports training for family planning clinic personnel.
• OPHS has initiated several efforts to increase male involvement in family planning and reproductive health. Each HHS region has been given the opportunity to fund demonstration projects designed to employ adolescent males in clinic settings and provide them with family planning and reproductive health education.
• The National Centers of Excellence in Women's Health, sponsored by the OPHS Office on Women's Health, partner with a variety of groups within their own academic institutions and with outside agencies and organizations to reach and serve minority and economically disadvantaged pregnant teens and other middle and high school students on nutrition, exercise, decision-making and negotiation skills, sexuality, drug and smoking prevention, sexually transmitted diseases and pregnancy prevention. Bilingual services are provided in Spanish, Vietnamese, and Somali, and other languages. Local public health departments and WIC programs, departments of education, state medical assistance programs, and pharmaceutical companies are examples of partners.

FY 2001 Performance Summary

OPHS is committed to assuring sustained progress and improved health outcomes within each priority through coordinated public and private efforts. The effectiveness of OPHS's activities are essential to the achievement of this ambitious goal, but the problems underlying OPHS's priorities are complex and reach beyond the control and responsibility of any one arena or effort. Achievement is dependent on various health programs and providers, all levels of government, and the efforts of the private sector as well as individual contributions.

In FY 2001, OPHS continued to move toward assuring every child the opportunity for a healthy start in life, through building a stronger science base, influencing national policy, promoting effective partnerships, and engaging in strategic communications.

The birth rate for teenagers continued its steady decline since the early 1990s - between 1991 and 2000 (the latest year for which data are available) there was a 29 percent drop in the birth rate for teenagers 15-17. The percent of women who began prenatal care in the first trimester of pregnancy was 83.2 percent for 2000, the same as the level reported for 1999. The proportion of women with timely prenatal care had improved steadily between 1989 and 1999, rising from 75.5 percent. This measure has shown steady progress during the 1990s, with the most notable increase being among black and Hispanic women, with an increase of approximately 25 percent over the last decade.

Among the factors accounting for the overall falling birth rate among teenagers are decreased sexual activity, increases in condom use, and the adoption of injectable and implant contraceptives. Within the larger public health framework, OPHS's Office of Population Affairs and the programs it administers (the AFL program and the Family Planning Program) play a central role in assuring a healthy start for every child by preventing unintended and adolescent pregnancies, providing abstinence education for adolescents, and providing related preventive health care and counseling.

In an effort to promote effective partnerships to reduce adolescent pregnancy, the AFL prevention projects continue to focus on abstinence as the most effective method of preventing adolescent pregnancy and sexually transmitted infections. In 2001, the program supported 73 prevention projects focusing on encouraging adolescents to remain abstinent and served an estimated 91,000 adolescents. The program also supports care projects which work with pregnant and parenting adolescents to assure healthy outcomes for themselves and their children. In 2001, the program funded 37 care projects providing almost 22,000 pregnant and parenting adolescents, their families and infants with access to health (including prenatal care) and social services.

In 2001, the family planning program, the primary provider of subsidized family planning services for low-income individuals, provided funding for service delivery grants to 91 public and private organizations supporting a nationwide network of more than 4,500 family planning clinics. Title X provide reproductive health services to approximately 4.4 million persons each year, enabling women to avoid unintended pregnancies. Pregnancy testing is a common and frequent reason for women coming to visit a clinic, and family planning is often an access point for women entering early prenatal care. The program also plays an important role in adolescent pregnancy prevention. Approximately 30 percent of those receiving services are under 20 years of age. In addition to clinical services, outreach and education (including counseling to encourage continued postponement of sexual activity for adolescent clients who are not yet sexually active) are important components of family planning services for adolescents.

The reduction of new perinatally acquired HIV infections has also been a high priority for the Department since the definition of effective treatment options that reduce the risk of transmission from mother to child. OPHS has coordinated a Department-wide effort across the research, prevention and treatment arenas to maximize opportunities to reduce the incidence of new perinatal HIV infections. HRSA, CDC and SAMHSA all have extensive program efforts in place to reach and offer pregnant women with HIV infection effective treatment for their own illness and to reduce the risk of perinatal transmission. The U.S. has seen dramatic reductions in perinatal HIV transmission rates in the past decade; these initiatives have been successful in dropping the number of new perinatal AIDS cases diagnosed each year, with 102 cases diagnosed in FY 2000 compared to a target level of 203 cases, well exceeding the target set. Surveillance data reported through December 2000 show sharply declining trends in perinatal AIDS cases, showing a reduction of 69 cases from the FY 1999 level of 171 cases (to 102 cases in FY 2000), or a 40 percent reduction; this decline was strongly associated with increasing zidovudine (ZDV) use in pregnant women who were aware of their HIV status, at delivery, and in treatment of the infant after birth. More recently, improved treatment also likely delayed onset of AIDS for HIV-infected children. These declines also reflect the success of widespread implementation of PHS recommendations for routine counseling and voluntary HIV testing of pregnant women. With efforts to maximally reduce perinatal HIV transmission and increase treatment of those infected, declines are likely to continue but may be affected by treatment failures and missed opportunities to prevent transmission.

In 2001, the Adolescent Family Life program took several steps to promote effective partnerships between the grantee, their staff and the clients they serve. The program initiated a training program for its prevention grantees and the front-line staff who work with adolescents. The training focused on providing front-line staff members with an opportunity to improve their skills in communicating and working with youth. In 2002, the program will continue to conduct another series of training workshops for staff in prevention and care projects.

The OPHS Office of Population Affairs also contributes to building a stronger science base through funding support for national surveys such as the National Survey of Family Growth, a periodic survey of a national sample of women 15-44 years of age which collects data on factors affecting pregnancy and women's health in the United States. The survey collects data on a wide range of topics including: pregnancy and birth, marriage, divorce, cohabitation, sexual intercourse, contraception, infertility, use of family planning and other medical services, health conditions and behavior. OPA is providing an estimated $4 million over the period FY 1998 - 2002 to support the development, testing and implementation of the next survey cycle, which will include a sample of men for the first time. In 2001, the OPA worked with the National Center for Health Statistics and other funding partners to ensure that there will be reliable national data focusing on marriage and cohabitation, sexual behavior and reproductive health, including risks related to the transmission of HIV or STDs.

Finally, in the area of influencing national policy, OPHS's Office on Women's Health led the development and publication of the HHS Blueprint for Action on Breastfeeding released by the Surgeon General. The Blueprint establishes a comprehensive policy for the nation to improve children's health by promoting the benefits of breastfeeding through the family and community, workplaces, and the healthcare system. Over 70,000 copies of the Blueprint have been distributed. In addition, collaborations have been formed with the American Association of Health Plans, American College of Obstetricians and Gynecologists, and the African American Breastfeeding Association. A National Breastfeeding Media Campaign and community outreach will be launched in FY 2002.

In addition, Surgeon General reports released in 2001 addressed the health needs of children and adolescents, including the Report of the Surgeon General's Conference on Children's Mental Health: A National Action Plan, Youth Violence: A Report of the Surgeon General, and The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity.

Performance Measures

Related HHS Strategic Goals

• Reduce the major threats to health and productivity of all Americans
• Improve the economic and social well-being of individuals, families and communities in the United States
• Improve access to health services and ensure the integrity of the Nation's health entitlement and safety net programs
• Improve the quality of health care and human services

1(b) Promote healthy lifestyles and behaviors

Promoting healthy lifestyles means paying greater attention to physical activity. We have found that if we can get people who are sedentary up and moving for 30 minutes a day five days a week, we could greatly enhance the health of the nation. It also means allotting greater attention to nutrition by encouraging people to follow the Dietary Guidelines for Americans, including eating at least five servings of fruits and vegetables each day. It means encouraging people to avoid toxins, like tobacco, excessive alcohol and illicit substances. And it means educating people so that they commit to responsible sexual behavior.

By reducing tobacco use, we will improve health outcomes in the areas of cancer, cardiovascular disease, lung disease, and low birth weight and other problems of infancy. Diet and activity behaviors are associated with chronic health problems such as heart disease, hypertension, diabetes, osteoporosis, obesity, and certain types of cancers. Abuse of alcohol and illicit drugs results in motor vehicle fatalities, violence, and other deleterious health, social and economic consequences. Unsafe sexual practices are associated with sexually transmitted diseases, including HIV/AIDS, and hepatitis, as well as unintended pregnancies. Oral health is also an important component of healthy lifestyles.

OPHS Contributing Offices

Office of the Surgeon General, Office of Disease Prevention and Health Promotion, President's Council on Physical Fitness and Sports, Office of HIV/AIDS Policy, Office of Minority Health, Office on Women's Health, Office of Population Affairs, Office of Global Health Affairs, and Office of Research Integrity.

OPHS Role and Contributions

OPHS's essential role in achieving each priority is to provide leadership, assess national health trends and problems, stimulate serious debate, engender creative ideas, and give critical visibility to health problems, needs, and solutions. To reduce the number of premature deaths, OPHS - together with HHS agencies and other partners - invests in programs and activities that are effective in reducing or eliminating behavioral threats, resulting in improved health and productivity of the American people. Some examples of the direct contributions of the Office of Public Health and Science include:

Building a Stronger Science Base

• OPHS works with the National Center for Health Statistics (at the Centers for Disease Control and Prevention) to collect and analyze national data on health status and health behaviors.
• Through staff liaisons, the OPHS is involved in supporting the development of a guide to community preventive services. Under the auspices of the US Public Health Service, a Task Force on Community Preventive Services, a 15-member non-Federal panel, is developing a Guide to Community Preventive Services. The guide will summarize what is known about the effectiveness of population-based interventions for prevention and control, providing recommendations on these interventions and the methods of their delivery, as well as identifying gaps in the evidence to develop a prevention research agenda.
• In the area of women's health, OPHS works with the National Women's Law Center, the University of Pennsylvania Center for Excellence in Women's Health, and The Lewin Group to produce national and State-by-State annual "report cards" on women's health, titled Making the Grade on Women's Health.

Influencing and Improving National Policy

• A hallmark of OPHS's activities in this area is management of Healthy People, which includes tracking and publicly reporting on meeting the national health goals and objectives for the year 2000, and now, for 2010. About 100 objectives (30%) in Healthy People 2010 focus on health behaviors and promote healthy lifestyles. For the first time, Healthy People includes the Leading Health Indicators (LHIs). The LHIs represent ten priority areas for the nation's public health over the next decade. OPHS is committed to the development of national action plans that address each of these ten LHIs and to report to the American public on the status of our efforts to make progress in these areas. The development of health goals for the year 2010 involved an extensive national process, involving Federal, tribal, State, local and non-governmental organizations, to examine the structure and content of health improvement activities, and to determine national health objectives for the Year 2010. This initiative drives health policy making in many states, communities, and businesses.
• OPHS manages preparation of the Dietary Guidelines for Americans, jointly published with USDA every five years since 1980. The 5th edition was released in May 2000 at the National Nutrition Summit. This statutorily required publication is the policy basis for all Federal nutrition education activities. Similarly, OPHS leads efforts to support the Institute of Medicine's multi-year scientific evaluation and development of Dietary Reference Intakes - the consumer's gold standard for recommended intakes of nutrients and a basis for nutrition label values and food assistance program standards.
• In the area of physical activity/fitness, OPHS participates in national policy-making bodies such as the National Coalition for Promoting Physical Activity, Joint Commission on Sports Medicine and Science, and the National Task Force on the Prevention and Treatment of Obesity to promote science-based policy decisions. Additionally, the President's Council on Physical Fitness and Sports is collaborating with federal and non-federal groups on the development of an implementation plan and strategies to promote physical activity/fitness and sports participation among young people following the release of the DHHS report "Promoting Better Health for Young People through Physical Activity and Sports" and the recent Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity.

Engaging in Strategic Communication

• Some well-known communication activities involve the President's Council on Physical Fitness and Sports, which is responsible for Flexing the Nation's Muscle: Presidents, Physical Fitness, and Sports in the American Century - A Traveling Exhibition.
• OPHS disseminates a wide range of information about health behaviors. For example, a quarterly Research Digest that synthesizes knowledge about fitness and exercise topics is distributed by the President's Council on Physical Fitness and Sports. Through healthfinder™ and the National Women's Health Information Center - the Federal government-wide Internet gateways to health information - and the Office of Minority Health Resource Center, OPHS provides nation-wide access to information and referral services for both health professionals and consumers. The Office of Minority Health Resource Center has recently enhanced its abilities to provide a wide range of information and technical assistance on HIV/AIDS. The Office of HIV/AIDS Policy coordinates specific activities that target communities of color including The Leadership Campaign on AIDS (TLCA). TLCA works with local and national leaders in communities of color, government officials, and community-based organizations from the business, media, faith, civic and social service sectors to create opportunities to reduce stigma and discrimination related to HIV/AIDS.
• The National Women's Health Information Center (NWHIC) and healthfinder® web sites and toll-free numbers provide improved access to reliable and up-to-date health information. Both sites feature targeted information tailored for specific populations such as kids, professionals, pregnant women, and women with disabilities. These sub-sections present a carefully selected and organized set of resources supporting these population groups. As examples, the new smoking cessation section on NWHIC - "A Breath of Fresh Air!" - empowers women to gain independence from smoking by using carefully selected resources and the section serves to promote the Surgeon General's Report on Women and Smoking. As another example, the newly developed healthfinderKIDS section presents a carefully selected and organized set of resources for children aged 8 to 12. As part of the launch, the Regional Women's Health Coordinators attracted media coverage by major Hispanic TV stations and provided community-based organizations and clinics with posters and pocket planners in both English and Spanish.
• OPHS contributes to the quality and effectiveness of the health information available to consumers and professionals and works to achieve increased access to technological advances in health for the underserved. These include the Science Panel on Interactive Communication and Health, activities related to the quality of health Web sites, and activities to measure and promote health literacy.
• The BodyWise Eating Disorders Educational Campaign sponsored by the Office on Women's Health is a program to increase awareness and knowledge of eating disorders, including their signs and symptoms, steps to take when concerned about students, and ways to promote healthy eating and reduce preoccupation with body weight and size. The program targets middle school educators and health care providers.

Promoting Effective Partnership Activities

• The Healthy People Consortium, led by OPHS, links all HHS agencies; private, voluntary and community organizations; and State public health, mental health, substance abuse, and environmental agencies. OPHS communicates with the Consortium through regular mailings and annual meetings. The members participated in the development of health goals for the nation every decade and are engaged in the follow-up activities that lead to achievement of the goals. To increase Healthy People's usefulness in improving health, OPHS is undertaking a variety of outreach activities, including formalizing new partnerships with external organizations, reaching out to new nontraditional partners, working toward development of an annual report on the health of the nation using the Leading Health Indicators, collaborating on a national action plan on overweight and obesity, and developing a communication strategy for the Leading Health Indicators.
• Over the last decade, the Title X national family planning program has been working in collaboration with the CDC to implement effective prevention strategies designed to reduce the prevalence of chlamydia and its debilitating complications. CDC estimates that every dollar spent on early detection can save an estimated $12 in complication-associated costs. The chlamydia prevention partnership, begun in 1987 as a demonstration project in PHS Region X, has now been expanded to all ten PHS regions. The success of this approach has been demonstrated by the fact that chlamydia prevalence rates decreased by as much as 69 percent in Region X, where the program has been in place for more than ten years.
• To prevent the abuse of tobacco, alcohol and other drugs by youth, OPHS promotes partnerships with parents and other caregivers, teachers, coaches, clergy, health professionals, and business and community leaders. Through the Smoke-Free Kids partnership with US Soccer, OPHS coordinates the dissemination of a national program promoting participation of adolescents in soccer as a way to reduce risk of tobacco use. OPHS assists in the development of community coalitions and programs to prevent drug abuse and underage alcohol and tobacco use, supports and disseminates scientific research and data on the consequences of legalizing drugs, and promotes other similar activities.
• The Task Force on Environmental Health Risks and Safety Risks to Children comprises nine Cabinet-level officials and seven White House Office Directors. The Task Force, chaired by the Secretary of HHS and the Administrator of EPA, is an enormously successful inter-agency collaboration that is charged to explore environmental factors, both risk and protective, that influence growth and developmental processes. OPHS provides staff support to the Secretary of HHS in his role as co-chair of the Task Force.
• In partnership with SAMHSA/CSAP and ASPA, OPHS jointly leads the HHS Girl Power! campaign targeted at 9-14 year-old girls and the adults who care about them, including parents, extended family members, teachers, coaches, youth workers, and mentors. The campaign creates PSAs, programs, and activities to assist girls in realizing their full potential. A Girl Power! Community Education Kit has been designed to help those who work with girls to create programs with messages that girls have the right to be the best that they can be - confident, fulfilled, and true to themselves. Girl Power! uses interactive educational materials to help girls develop the skills they need to resist unhealthy influences and to make positive decisions in their lives. The Steering Committee is chaired by the Office on Women's Health; other HHS agencies currently involved are the Office of the Secretary, ACF, CDC, FDA, HRSA, NIH and SAMHSA.

FY 2001 Performance Summary

OPHS is committed to assuring sustained progress and improved health outcomes within each priority through coordinated public and private efforts. The effectiveness of OPHS's activities are essential to the achievement of this ambitious goal, but the problems underlying OPHS's priorities are complex and reach beyond the control and responsibility of any one arena or effort. Achievement is dependent on various health programs and providers, all levels of government, and the efforts of the private sector as well as individual contributions.

In FY 2001, OPHS continued to promote healthy lifestyles and behaviors through building a stronger science base, influencing national policy, promoting effective partnerships, and engaging in strategic communications.

Through the Office of Population Affairs, OPHS contributes to departmental efforts to reduce the incidence of sexually transmitted diseases, specifically those addressed in measures 1.10, 1.11 and 1.12. Related to performance measure 1.10, in 2000 (the latest year for which data is available), the median chlamydia test positivity among 15-24 year old women who were screened during visits to selected family planning clinics in all states and the outlying areas was 5.9 percent. After adjusting trends in chlamydia positivity to account for changes in laboratory test methods and associated increases in test sensitivity, chlamydia test positivity decreased in four of ten PHS regions from 1999 to 2000 and increased in six regions. Although chlamydia positivity had declined in the past year in some regions, most likely due to the effectiveness of screening and treating women, continued expansion of screening programs to populations with higher disease prevalence may have contributed to the increases in positivity seen in other regions. With regard to the incidence of gonorrhea (performance measure 1.11), following a 72 percent decline in the reported rate of gonorrhea from 1975 to 1997, in 2000 the gonorrhea rate remained fairly steady as compared to the 1999 rate, which had reflected an increase for the second year in a row. Although increased screening (usually associated with simultaneous testing for chlamydia infection), use of more sensitive diagnostic tests, and improved reporting may account for a portion of the recent increase, true increases in disease in some populations and geographic areas also appear to have occurred. Finally, in reference to performance measure 1.12, between 1999 and 2000, the national rate of congenital syphilis decreased by 7.6 percent from 14.5 to 13.4 cases per 100,000 live births. The continuing reduction in congenital syphilis rates, evident since the early 1990s, reflects the substantial reduction in the rate of primary and secondary syphilis among women over the same period.

One example of OPHS's use of partnerships to promote healthy lifestyles and behaviors is the Title X Family Planning program's continued collaboration with the CDC to implement effective prevention strategies designed to reduce the prevalence of chlamydia and its debilitating complications. The effectiveness of large-scale screening programs in reducing chlamydia prevalence has been well documented in areas where this intervention has been in place for several years. CDC estimates that every dollar spent on early detection can save an estimated $12 in complications-associated costs. The chlamydia prevention partnership, begun in 1987 as a demonstration project in PHS Region X, has now been expanded to all ten PHS regions. The success of this approach had been demonstrated by the fact that the chlamydia prevalence rate decreased by as much as 69 percent in Region X, where the program has been in place for more than ten years.

Family planning clinics provide a broad spectrum of preventive health services in an effort to promote healthy lifestyles and behaviors. Title X clinics provide services to a population that matches the demographics of the population of women most at risk for sexually transmitted diseases (STDs) and HIV infection - primarily young (60 percent under the age of 25), low-income (65 percent under 100 percent of the federal poverty level), and minority (40 percent). Most clients are sexually active and in conjunction with contraceptive services, Title X-supported clinics have helped numerous women detect and obtain early treatment for a range of medical conditions, including sexually transmitted infections and HIV, as well as breast and cervical cancer. In 2000 (the latest year for which data are available), Title X clinics provided 2.9 million pap tests and 2.8 million breast examinations to family planning clients - seven pap tests and over six breast exams for every ten female family planning users. The program also provided almost 366,000 HIV tests to clients - about one HIV test for every twelve users.

OPHS's President's Council on Physical Fitness and Sports (PCPFS) is involved in activities directly related to achieving performance measure 1.8, which addresses increasing physical activity among adults aged 18-74. In conjunction with the Healthy People 2010 objectives, PCPFS continues to work with schools and outside organizational components to promote regular physical activities/fitness and non-competitive sports as positive, healthy behavioral patterns. To improve health behaviors related to physical activity and fitness, PCPFS coordinates activities through its long-standing signature programs, the President's Challenge Physical Activity and Fitness Awards Program (for school and community-based achievement) and the Presidential Sports Award (for ages six to adult). During FY 2001, materials were distributed to more than 190,000 schools and organizations; more than five million young people participated in the President's Challenge in FY 2000. Following the recommendations of a President's Challenge special workgroup, comprised of PCPFS members, fitness professionals (representing such groups as the American Alliance for Health, Physical Education, Recreation, and Dance and the American College of Sports Medicine), the American Academy of Pediatrics, and individuals from academia noted for their expertise in exercise science and kinesiology, the PCPFS launched in the fall of 2001 the Presidential Active Lifestyles Awards Program to further enhance the adoption and maintenance of regular physical activity. This workgroup was instrumental in initiating an enhanced physical activity component which will empower and engage individuals to change behavior as well as address societal goals and objectives outlined in Healthy People 2010. This concept will be expanded to all adults in the Fall of 2002. During FY 2001, more than 400,000 brochures regarding the Presidential Sports Award program were mailed to the general public and sports organizations and groups. In response to goals established by the HHS Initiative to Eliminate Racial and Ethnic Disparities in Health, PCPFS translated materials on these two programs into Spanish and collaborated with the OMH clearinghouse for appropriate dissemination to Hispanic leaders, schools, and others. Efforts to build and strengthen coalitions and partnerships with minority organizations to enhance outreach to minority communities and youth will be addressed with the incoming administration's Council members.

PCPFS promotes physical activity/fitness and sports through numerous partnerships and collaborative projects with Federal agencies and offices, as well as non-Federal organizations. PCPFS publishes a quarterly periodical, the PCPFS Research Digest, a synthesis of the latest scientific information presented in lay format, which is intended for use primarily by fitness, physical education, and allied health professionals. Otherwise, the PCPFS web site and publications are designed primarily for use by the general public. Using these two modes of communication, PCPFS received more than 50,000 inquiries during FY 2001 and also responded to a high volume of requests received by telephone and mail. The PCPFS staff functions in an advisory capacity to provide technical advice and assistance to individuals seeking funding, referrals to appropriate organizations, and other resource material about physical activity/fitness and sports. PCPFS has a well-deserved national reputation as a credible voice calling for increased physical activity/fitness and sports by Americans of all ages and is in a unique position to address cross-cutting issues, policies, and programs at Federal, state, and local levels.

Also, the fifth edition of the Dietary Guidelines for Americans issued in May 2000 greatly expanded emphasis on the vital importance of physical activity to health. The guidelines advise adults to accumulate at least 30 minutes of moderate physical activity each day and recommend 60 minutes for children. These guidelines are promoted by all Federal nutrition education activities and are coordinated with HHS by the Office of Disease Prevention and Health Promotion (ODPHP), in collaboration with USDA. In addition, to alert the American public to the critical nature of the epidemic of overweight and obesity, one of the ten Leading Health Indicators of Healthy People 2010, and to mobilize national collaborative efforts to address it, The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity was released on December 13, 2001 in Washington, D.C.

Further, OPHS (ODPHP) led the creation of the Leading Health Indicators (LHIs) which contribute to meeting performance measures 1.7, 1.8, and 1.9, relating to tobacco use, physical activity, and drug/alcohol abuse, respectively. These LHIs are a special subset of measures based on objectives in Healthy People 2010. Promotion of the LHIs indirectly contributes to meeting these performance measures by promoting awareness and driving action nationally about ways we can improve and assess the nation's health. ODPHP is currently preparing the first annual report on the status of the Leading Health Indicators, expected for release in 2002. The report will provide the latest data used to monitor the LHIs on a national and state level. During FY 2001, ODPHP complete development of a communications plan for the LHIs. A contract to begin implementation of the plan will be awarded in February 2002.

Through ODPHP, OPHS is also engaged in overarching efforts that more generally promote the health of the nation. Two of these efforts are Healthy People 2010 and healthfinder®. Healthy People 2010 is a compilation of the Nation's health objectives for the first decade of the 21st century. Released by the Department on January 25, 2000, it reflects the thinking of a broad cross-section of the nation's public health scientists and planners. Central to Healthy People 2010 are its two overarching goals: (1) increase quality and years of healthy life, and (2) eliminate health disparities. To monitor the Nation's progress in attaining these goals, Healthy People 2010 identifies 467 specific objectives covering a comprehensive array of health issues. Each objective has a target for specific improvements to be achieved by 2010. The objectives are organized into 28 focus areas and were developed by work groups of experts with broad public input.

To stimulate local, community-level activity that supports the national health goals of Healthy People 2010, ODPHP launched the Healthy People 2010 Community Implementation Program in FY 2001. ODPHP developed a Request for Proposals (RFP) for the new pilot program and issued it in July 2001; over 85 applications were received for two cooperative agreements. FY 2001 awards totaling $1.1 million were made to two intermediary organizations to conduct pilot projects to study the efficacy of microfinance to support Healthy People 2010 implementation activities by community-based organizations. The intermediaries will administer microgrants (of up to $2010 each) to local community-based organizations in their areas to focus on health promotion and disease prevention activities that link to Healthy People 2010 objectives and/or Leading Health Indicators.

healthfinder® is the first Federal health information portal to provide easy public access to resources from Federal, State, and local agencies, voluntary and professional organizations and other reliable non-commercial sources. healthfinder® was the first to organize content by topics and audiences rather than by agencies or organizations. healthfinder® now links to over 4,500 carefully reviewed resources from almost 1,900 selected organizations. Its easy-to-use searches direct users efficiently to specific resources across the country. Statistical measures of increased access confirm the site's success: the number of visits to the site has increased from 1.6 million in its first full year of operation (April 1997-March 1998) to 3.8 million in 2001, or a 138 percent increase. healthfinder.gov has increased the total number of resources and organizations reviewed and linked from 1,600 to 6,400, or a 300 percent increase. In addition, more citizens are accessing a wider range of quality information every month. In 2001, healthfinder® was redesigned and a new Spanish-language version of the site was released, along with one especially for children 8 to 12. In 2002, new sections targeting additional under-served populations are planned. As for its goal of improving access to Federal health information specifically, healthfinder.gov now directs users to other Federal health web sites an average of 200,000 times each month.

In addition to healthfinder®, many other OPHS activities target strategic communications to highlight the importance of health lifestyles and behaviors. For example, OWH has launched "Pick Your Path To Health," a community-based health education campaign targeting women of color. More than 100,000 booklets containing action tips were distributed nationwide through over 20 local and national conferences, regional offices, the National Centers of Excellence, community groups, media outlets, and national partners in the communities. Partnerships have been developed with more than fifty private sector groups that actively promote the campaign, its themes and weekly action steps to a healthier lifestyle. Weekly news articles on how to improve healthy lifestyles are placed with a news syndicate reaching more than 200 community papers, including 26 news articles reaching African American community newspapers and two news articles in Spanish-language newspapers reaching Latinas.

In September 2001, OPHS initiated a new partnership with the ABC Radio Networks and ABC Radio's Urban Advantage Network to inform minority communities on ways to achieve better health and close the health gaps between them and the rest of the U.S. population. This partnership aims to inform and educate African Americans about the health gap and empower individuals to adopt healthier lifestyles through a health information and education campaign entitled "Closing the Health Gap: Reducing Health Disparities Affecting African Americans." In FY 2002, in collaboration with OASPA, this new partnership is being expanded and strengthened.

In December 2001, OWH released the second "report card" on women's health, Making the Grade on Women's Health, which included a special chapter on women and cardiovascular health. The "report card" is designed to provide policy makers, heath care planners and providers, educators, researchers, advocates and the public with a comprehensive assessment of women's health and to establish a framework to measure progress.

Also, the HHS GirlPower! Campaign targeted at 9-14 year-old girls and the adults who care about them creates PSAs, programs, and activities to assist girls in realizing their full potential. A GirlPower! Community Education Kit has been designed to help those who work with girls to create programs with messages that girls have the right to be the best that they can be - confident, fulfilled, and true to themselves. GirlPower! uses interactive educational materials to help girls develop the skills they need to resist unhealthy influences and to make positive decisions in their lives. Topics covered include eating disorders, illicit drug and tobacco use, chronic illness and disability, and science careers. In FY 2000, there were 60 National Endorsers and 9,000 local programs using Girl Power! materials, and approximately 2 million hits per month on the web site.

Finally, the BodyWise evaluation was conducted in FY 2001 to assess whether school nurses report a shift in school practices and exhibit changes in behaviors, attitudes, and knowledge after exposure to BodyWise, an OWH program to increase awareness and knowledge of eating disorders. Not only did results indicate positive trends in each of theses areas, nurses also exhibited increased awareness about how eating disorders and related issues are handled in their schools.

Performance Measures

Related HHS Strategic Goals

• Reduce the major threats to health and productivity of all Americans

1(c) Enhance mental health for all

OPHS will work to enhance mental health and mental illness services for all Americans. OPHS efforts will be focused on reducing the stigma of mental illness, finding effective mental health promotion and mental illness prevention strategies, detecting mental health problems early and assuring that mental health/mental illness services are utilized for cure and care. Mental health problems often relate to other serious health problems, including substance abuse, suicide and violence. The first ever Surgeon General's Report on Mental Health has brought the latest science on mental health/mental illness into the domain of all Americans. OPHS must follow that release with outreach, education, and collaboration with mental health advocates to move mental health squarely into the mainstream of health care for all.

OPHS Contributing Offices

Immediate Office of the ASH, Office of Disease Prevention and Health Promotion, Office of Emergency Preparedness, Office of Minority Health, Office of the Surgeon General, Office on Women's Health, President's Council on Physical Fitness and Sports, Office for Human Research Protections and Office of Military Liaison and Veterans Affairs.

OPHS Role and Contributions

OPHS's essential role in achieving each priority is to provide leadership, assess national health trends and problems, stimulate serious debate, engender creative ideas, and give critical visibility to health problems, needs, and solutions. OPHS - together with HHS agencies and other partners - invests in programs to improve the mental health of Americans. Some of the direct contributions of OPHS include:

Building a Stronger Science Base

• The National Centers of Excellence in Women's Health sponsored by the Office on Women's Health are conducting research addressing aspects of gender that are linked via various mechanisms to post-traumatic stress and associated syndromes, the effects of hormone replacement therapy in response to stress, and depression management.
• OHRP, in cooperation with the National Human Research Protections Advisory

Committee (NHRPAC), is addressing the need to assure that individuals who are

decisionally-impaired due to mental illness and who participate as human research

subjects are adequately and appropriately protected

Influencing and Improving National Policy

• The Office of the Surgeon General coordinated the development of a comprehensive report, Mental Health: A Report of the Surgeon General, in FY 2000. Like Surgeon General reports on tobacco use and physical activity, the mental health report includes cutting edge information about the status of mental health and mental illness and new science and research on etiology, treatment and services within the United States. Efforts to influence the provision of mental health services have continued with the January 2001 release of the Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda and other related reports released since then, including the Report of a Surgeon General's Working Meeting on the Integration of Mental Health Services and Primary Health Care and Mental Health: Culture, Race, and Ethnicity - A Supplement to Mental Health: A Report of the Surgeon General. These reports serve as a basis for shaping future mental health policy and program initiatives for State and Federal governments, as well as providing the public with valuable information about mental health issues affecting the Nation.
• The Office of the Surgeon General coordinates the national strategy to combat suicide through The Secretary's Steering Committee for the National Suicide Prevention Strategy, led by the Surgeon General.
• The Office of Emergency Preparedness (OEP) is responsible for coordinating the provision of mental health services in the immediate response phase of natural disasters and domestic terrorism. Working with the Federal Emergency Management Agency and SAMHSA, OEP provides teams of mental health professionals to respond to large-scale declared disasters.

Promoting Effective Partnership Activities

• OPHS is involved with a variety of both governmental and community partners to address the Mental Health For All Initiative. Within HHS, OPHS has close working relationships with SAMHSA, NIH, CDC, HRSA, IHS, and ASPE on a variety of ongoing and evolving projects on mental health.

• The 1994 Violence Against Women Act (VAWA) established the National Advisory Council on Violence Against Women. The Council is co-chaired by the Secretary of HHS and the Attorney General, and consists of more than 40 key leaders from across the country in the business, sports, media, entertainment, religious, labor, law, and medical fields, as well as domestic violence and sexual assault survivors and advocates. OWH provides staff support to the Secretary of HHS for his role as co-chair of the Council. In October 2000, the Council released an Agenda for the Nation on Violence Against Women which outlines their recommendations for future Federal, State and local efforts, and provides a toolkit for use by people at all levels of exposure to the issue. The Agenda is designed to build on the early successes of VAWA and inform subsequent policy and practice. The Council currently has a new charter and is completing the process for new members.

Engaging in Strategic Communication

• OPHS has a unique opportunity to focus the Nation on the message that mental health is fundamental to health and is everybody's business. In 1999, 2000 and 2001, a series of events (including the White House Conference on Mental Health and the Surgeon General's Workshop on Underage Drinking) and reports (including Mental Health: A Report of the Surgeon General, the Surgeon General's Call to Action to Prevent Suicide, the Surgeon General's Report on Youth Violence, and Mental Health: Culture, Race, and Ethnicity - A Supplement to Mental Health: A Report of the Surgeon General) built OPHS credibility with the Nation. OPHS must continue to have direct communication links with the American public on the topic of mental health. As science is progressing in discovery of the causes of mental illness and its effective treatment, OPHS works to get out this message of hope by working collaboratively to shape a scientifically sound and effective national media campaign to destigmatize mental illness. Using this vehicle, the Surgeon General will positively affect the visibility of mental health and illness and its incorporation into the mainstream of research, services, and parity of benefits in both private and public plans.
• The Office on Women's Health created two specialty sections on its 4woman.gov web site that address mental health issues: "Violence Against Women" and "Women with Disabilities." These sections offer women and their loved ones an easy way to navigate the often complicated and limited options for escape from the terrible threat of violence in their everyday lives or challenges faced by women with disabilities in obtaining preventive care. The Violence Section offers information and resources to women concerning domestic violence, intimate partner violence, sexual assault, and elder abuse. It also provides a useful state-by-state breakdown of resources and where to turn for help. The Disabilities section offers summaries about critical health issues for a variety of disabilities, including physical, neurological, hearing, speech and visual impairment. The web site section will also provide information on mental, learning and developmental disabilities.

FY 2001 Performance Summary

OPHS is committed to assuring sustained progress and improved health outcomes within each priority through coordinated public and private efforts. The effectiveness of OPHS's activities are essential to the achievement of this ambitious goal, but the problems underlying OPHS's priorities are complex and reach beyond the control and responsibility of any one arena or effort. Achievement is dependent on various health programs and providers, all levels of government, and the efforts of the private sector as well as individual contributions.

In FY 2001, OPHS continued to move toward enhancing mental health for all, through building a stronger science base, influencing national policy, promoting effective partnerships, and engaging in strategic communications.

As science is progressing in discovery of the causes of mental illness and its effective treatment, OPHS works to get out a message of hope by working collaboratively to shape a scientifically sound and effective national campaign to destigmatize mental illness. In 1999, 2000 and 2001, a series of OPHS-led events including the White House Conference on Mental Health and the Surgeon General's Workshop on Underage Drinking, and reports, such as Mental Health: A Report of the Surgeon General, the Surgeon General's Call to Action to Prevent Suicide, and the Surgeon General's Report on Youth Violence, focused national attention on enhancing mental health for all Americans. In 2001, the Office of the Surgeon General coordinated the development and release of two additional, comprehensive reports, Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda and Mental Health: Culture, Race, and Ethnicity - A Supplement to Mental Health: A Report of the Surgeon General. These mental health reports include cutting edge information about the status of mental health and mental illness and new science and research on etiology, treatment and services within the United States. As mental health and mental illness become more mainstream and less stigmatized, health insurance coverage is likely to become more universally available with less restrictive benefits. The reports serve as a basis for shaping future mental health policy and program initiatives for State and Federal governments, as well as providing the public with valuable information about mental health issues impacting the Nation.

Several strategies highlighted in the January 2001 report Youth Violence: A Report of the Surgeon General were promoted through a series of community listening sessions held in November and December 2001. The purpose of these sessions was to obtain the direct input and recommendations of organizations, communities, and individuals addressing the problem of youth violence throughout the country, including those with differing viewpoints. In addition, the sessions increased awareness of the models documented in the Report that have been shown to be effective in reducing youth violence. A summary of the input received from these sessions, which were held in Philadelphia, Atlanta, Chicago and Denver, is currently being prepared and is expected to be released in 2002.

Additionally, the Secretary's Steering Committee for the National Suicide Prevention Strategy, led by the Surgeon General, released a comprehensive strategy document in May 2001. The document, entitled Goals and Objectives for Action, contains eleven broad goals with approximately 70 measurable objectives. The product of broad public-private collaboration, these goals and objectives will seek to involve public and private stakeholders within the healthcare, public health, education, justice, faith-based, business, labor, and social service sectors, among others.

OPHS is monitoring the implementation of the recommendations of these Surgeon General's reports across the Department through the activity of the HHS Mental Health Coordinating Committee. In November 2001, OPHS convened a groundbreaking meeting of diverse participants to begin to develop core principles and a direction for a national action strategy for the integration of mental health services and primary health care. Highlights of the meeting and recommendations of the participants were published in December 2001 in the Report of a Surgeon General's Working Meeting on the Integration of Mental Health Services and Primary Health Care.

Additionally, OWH partnered with the American Psychological Association to convene a Summit on Women and Depression in October 2000 - another example of OPHS partnership activity. This summit confirmed that translating the research into practice, community interventions, and policy continues to be difficult. It serves as a prelude to the upcoming meeting "Psychosocial and Behavioral Factors in Women's Health: Enhancing Outcomes in Women's Health" in February 2002. As many as 1,000 participants are expected at this interdisciplinary conference.

Finally, OEP developed a model metropolitan mental health response plan for inclusion in local disaster preparedness systems through an FY 2000 agreement with the Uniformed Services University of the Health Sciences (USUHS)/Department of Defense (DoD). The goal of the agreement was to develop educational materials for public officials on the behavioral and mental health issues most relevant to preparing for and responding to terrorist acts using WMD.

Performance Measures

Related HHS Strategic Goals

• To reduce the major threats to health and productivity of all Americans
• To improve the quality of health care, public health, and human services
• To improve the public health system
• To strengthen the Nation's entitlement and health safety net programs.

1(d) Strengthen the health sciences research enterprise

A strong health sciences research enterprise is required because it expands the knowledge base that underlies clinical treatments, public health policy and further research. OPHS contributes to the strengthening of the health sciences research enterprise by promoting the responsible conduct of research, the effective handling of scientific misconduct, and the expansion of the knowledge base related to the responsible conduct of research and research misconduct, all while protecting research subjects. In making and publicizing 125 findings of scientific misconduct since its establishment in 1992, the Office of Research Integrity (ORI) actions serve as a deterrent to misconduct and educate the scientific community regarding the importance of research integrity. In initiating 725 investigations since 1990, the Office for Human Research Protections (OHRP) actions serve to provide oversight against non-compliance with research subject protections and educate the scientific community regarding the importance of protecting research subjects.

OPHS Contributing Offices

Office of Research Integrity and Office for Human Research Protections.

OPHS Role and Contributions

OPHS's essential role in achieving each pri