Committed to the Success of Nurse Practitioners

Healthy People 2020: Decreasing Disparity in Cancer Screening

by Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC


On the NP boards, I heard there can be questions on Healthy People 2020. Can you provide insight?

As an important part of your NP role, you are expected to be aware of major health care policy initiatives. An important policy initiative that you should be familiar with, for both the exam and practice, is Healthy People 2020. This initiative is a continuation of the U.S. Department of Health and Human Services’ ongoing Healthy People program, which is now in its fourth decade. Healthy People provides a comprehensive set of national 10-year health promotion and disease prevention objectives aimed at improving the health of all Americans and measures progress toward these objectives over time.

An overarching goal of Healthy People 2020, and the previous 2 Healthy People initiatives, is elimination of health disparities between subgroups of the population. Healthy People’s main tool for addressing disparities is information: the Healthy People 2020 website makes available demographically stratified data, gathered by the National Health Interview Survey (NHIS), on care received and health outcomes related to the Healthy People 2020 objectives. With this information, you can recognize which patients in your practice are most at risk for gaps in health or health care and take steps to help them achieve better health outcomes.

Cancer screening serves as a helpful example of Healthy People 2020 in action. Healthy People 2020 has set national objectives for use of U.S. Preventive Services Task Force (USPSTF)–recommended screening tests for breast, cervical, or colorectal cancer (see Table for the Healthy People 2020 cancer screening recommendations and targets); Healthy People 2000 and Healthy People 2010 set these objectives as well.1 The NHIS’s tracking of progress toward the Healthy People targets has shown that although cancer screening rates are increasing nationally, rates for some subgroups are well below national rates. For example, the proportion of persons not receiving a colorectal cancer screening was 14% to 42% higher for all other racial and ethnic groups than for the white non-Hispanic population.2 For cervical cancer screening, the 2010 rates for Asian Americans, Native American, and Hispanic/ Latino women (75.7%-78.5%) were below the national rate (82.8%) and the rates for black and white women (85% and 83.1%).3 Breast cancer screening rates follow a similar pattern, with rates among black and white women (73.4% and 72.9%) exceeding the national average (72.4%), and rates for other groups below average (Asian, 64.2%; Hispanic/ Latino, 69.9%).


Healthy People 2020 points out that the term “disparities” goes beyond racial or ethnic disparities, defining it as a “particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.”4 As such, disparities can exist based on a wide range of characteristics, including race or ethnicity, sex, gender identity, age, disability status, socioeconomic status, and urban versus rural location, or any other “characteristic linked to discrimination or exclusion.” Healthy People 2020 is assessing health disparities in the U.S. population by tracking rates of illness, death, chronic conditions, and other outcomes in relation to these demographic factors. Data are now available for many of these factors on the Healthy People 2020 website, and you can easily access the data using the DATA2020 search function, giving you a better understanding of where health gaps may exist.

The Healthy People 2020 website also offers tutorials under the Learn and Implement tabs, which you can use to improve health in your practice and community. Through greater involvement in Healthy People 2020, you can help achieve the initiative’s goal of health equity among Americans. ·

References
1. U.S. Preventive Services Task Force. Recommendations for adults: cancer. Rockville, MD: U.S. Preventive Services Task Force; 2011.
http://www.uspreventiveservicestaskforce.org/adultrec.htm. Accessed February 7, 2014.
2. Healthy People website. Clinical Preventive Services.
http://www.healthypeople.gov/2020/LHI/clinicalPreventive.aspx?tab=data. Accessed February 7, 2014.
3. Healthy People website. DATA2020 Interim Results. http://www.healthypeople.gov/2020/data/searchData.aspx. Accessed February 7, 2014.
4. Healthy People website. Disparities.
http://www.healthy people.gov/2020/about/DisparitiesAbout.aspx.

Updated 4.21.14