Healthy People 2020: Sleep Health New Goal

BY SHARON WORCESTER
Elsevier Global Medical News

The Department of Health and Human Services has launched its Healthy People 2020 goals, and among the objectives set forth in its “ambitious, yet achievable” 10-year agenda for improving the nation’s health are substantial improvements in sleep health, respiratory disease outcomes, and levels of tobacco use.

Sleep Health
Sleep health is a new topic in the Healthy People initiative. The main focus is on increasing public knowledge of how adequate sleep and treatment of sleep disorders improves health, productivity, wellness, quality of life, and safety on the roads and in the workplace.

The public health burden is substantial, and awareness of the problem is lacking; thus, Healthy People 2020 seeks to provide a “well-coordinated strategy to improve sleep-related health.”

Objectives are to:

• Increase the proportion of persons with symptoms of obstructive sleep apnea who seek medical care (from 25.5% to 28%).
• Reduce the rate of vehicular crashes per 100 million miles traveled that are due to drowsy driving (from 2.7 to 2.1).
• Increase the proportion of students in grades 9-12 who get sufficient sleep, defined as 8 hours or more on an average school night (from 30.9% to 33.2%).
• Increase the proportion of adults who get sufficient sleep, defined as 8 or more hours for those aged 18-21 years, and 7 or more hours for those aged 22 years and older (from 69.6% to 70.9%).

Respiratory Disease
The respiratory disease category focuses on asthma and chronic obstructive pulmonary disease, and the main goal is to “promote respiratory health through better prevention, detection, treatment, and education efforts,” according to the report, which states that asthma affects 23 million people in the United States and COPD affects 13.6 million U.S. adults.

The cost to the health care system is high, and society pays through higher health insurance rates and lost productivity and tax dollars. Annual expenditures for asthma alone are estimated at nearly $21 billion.

Healthy People 2020 seeks to reduce asthma-related deaths, hospitalizations, emergency department visits, activity limitations, and missed school or work days, and to increase the proportion of asthma sufferers who receive appropriate care. Improved surveillance at the state level is another goal.

For example, goals for 2020 in regard to asthma-related deaths include reductions from 11.0 to 6.0 deaths per 1 million people aged 35-64 years, and from 43.3 to 22.9 per 1 million people aged 65 and older. Goals regarding annual asthma related hospitalization include a reduction from 41.4 to 18.1 per 10,000 children under age 5, from 11.1 to 8.6 per 10,000 people aged 5-64 years, and from 25.3 to 20.3 per 10,000 adults aged 65 years and older.

Goals regarding appropriate asthma care include improvements in the number of patients who receive written asthma management plans, instructions for inhaler use, education about appropriate response to an asthma episode, and follow-up visits each year.

COPD-related objectives include reducing activity limitations, deaths, hospitalizations, and emergency department visits, and improving diagnosis among adults with abnormal lung function.

Specific goals include a reduction from 23.2 to 18.7 in the percentage of adults with COPD aged 45 years and older with activity limitations from COPD, and a reduction from 112.4 to 98.5 in the number of COPD-related deaths per 10,000 people aged 45 years and older.

Tobacco Use
Tobacco use is not a new topic in the Healthy People initiative, but ongoing efforts to reduce use are needed, according to the report, because tobacco use remains the single most preventable cause of death and disease in the United States. About 443,000 Americans die from tobacco-related illnesses each year, and for every 1 who dies, 20 more suffer with at least one serious tobacco-related illness.

Healthy People 2020 seeks to “provide a framework for action to reduce tobacco use to the point that it is no longer a public health problem for the nation.”

More than 4 decades of evidence has shown that the toll tobacco use takes on families and communities can be significantly reduced by fully funding tobacco control programs, increasing the prices of tobacco products, enacting smoke-free policies, controlling access to products, reducing tobacco advertising and promotion, implementing antitobacco media campaigns, and encouraging and assisting users to quit.

Healthy People 2020 addresses tobacco use prevalence, health system changes, and social and environmental changes. Among the key goals for adults are:

• Reducing the percentage of adult cigarette smokers (from 20.6% to 12.0%).
• Reducing the percentage of adult users of smokeless tobacco (from 2.3% to 0.3%).
• Reducing the percentage of adult cigar smokers (from 2.2% to 0.2%).

In adolescents, goals include reducing the percentage of those who used tobacco in the past month from 26% to 21%, and reducing the percentages who said they used cigarettes, smokeless tobacco, and cigars in the past month from 19.5% to 16%, from 8.9% to 6.9%, and from 14% to 8%, respectively.

Initiation of tobacco use among children, adolescents, and young adults is also addressed, with a goal of reducing it among those aged 12-17 years from 7.7% to 5.7%, and among those aged 18-25 years from 10.8% to 8.8%.

Numerous goals are also set in regard to health system changes, and social and environmental changes.

For example, the report calls for increases in comprehensive Medicaid coverage for nicotine dependency treatment, increased tobacco screening and counseling in health care settings, reductions in the proportion of nonsmokers exposed to secondhand smoke, increases in the proportion of persons covered by worksite policies that prohibit smoking, and increases in tobacco-free environments in school facilities and at school events.

Efforts should be made to eliminate state laws that preempt stronger local tobacco control laws, to reduce illegal sales to minors, and to reduce exposure to tobacco advertising and promotion among 6th-12th graders. Also, federal and state taxes on tobacco products should be increased, the report states.

Healthy People 2020 has been in development since 2007. A panel of health experts drew on input from public and private health officials, preventive medicine experts, representatives from 2,000 health organizations, and thousands of public comments.

The initiative expands upon topics from Healthy People 2010, and will incorporate the Internet and other media in spreading the message. The ultimate goals, according to HHS officials, are to avoid preventable diseases and to promote improved quantity and quality of life.

Dr. Paul A. Selecky, FCCP, comments:
Each of these topics is very important to good health, and often go hand in hand, e.g., COPD and tobacco use. It’s also good news that sleep finally got on the HHS radar. It is the third important pillar of good health, along with regular exercise and a balanced diet. We are a sleep-deprived nation with a “National Sleep Debt,” a term coined by William Dement, a true pioneer in sleep medicine. Sleeping longer on the weekend will not repay that debt.