The U.S. healthy people initiative: its genesis and its sustainability

Unlike most government initiatives in health, the Healthy People initiative of the U.S. federal government was crafted and sustained not as a federal initiative, but as a "national initiative" eliciting participation from nongovernmental national organizations, state health agencies, professional associations, multiple agencies of the U.S. Department of Health and Human Services, and other federal agencies, such as Agriculture, and increasingly engaging academia and state and local stakeholders in adapting the objectives for their own efforts to enact and evaluate state and local policies and programs. The quantified objectives at the center of the initiative were a product of continuous balancing of changing science and political or social concerns and priorities along with national and state or special population needs. The evolution from the first decade's objectives to each subsequent set of objectives reflected changing societal concerns, evidence-based technologies, theories, and discourses of those decades. Such accommodations changed the contours of the initiative over time in attempts to make it more relevant to specific partners and other stakeholders.