Establishing national health goals and standards

Four statements of national health goals and standards were proclaimed from the U.S. Department of Health and Human Services during the 1970s. Two were based on statutory mandates--the National Guidelines for Health Planning and the Model Standards for Community Preventive Health Services. Two were the results of administrative initiatives--the Forward Plans for Health and the complementary publications "Healthy People" and "Promoting Health/Preventing Disease". These efforts present a variety of approaches and experiences and can provide direction and lessons for future endeavors along these lines. The four issuances include guidance on national priorities, resource standards, and accessibility to care. They also offer goals and objectives for local services and health status. They address a multiplicity of issues, ranging from hospital bed supply and recommended uses of specialized medical equipment to infant mortality and proposed reductions in death and disability. Almost all urge further actions to prevent illness and promote health. The development of statements of national health goals and standards has been advocated by some experts and questioned by others. Advocates believe that these materials can help clarify purposes and priorities for health programs, resulting in more effective and efficient uses of resources and greater accountability. Critics are particularly concerned about deleterious impacts on creativity and local initiatives. Among the major lessons identifiable from these undertakings is the importance of committed leadership, broad-based consultation, and reliable data. Implementation inevitably encounters the complexities of the health system and depends upon available resources. In influencing the agenda of deliberation and debate, the symbolic value of these statements may often be more significant than the specific details. The continuing interest in these approaches suggests that future efforts along these lines are likely.