Strategic Objective 2.3: Enhance promotion of healthy behaviors to reduce occurrence of and disparities in preventable injury, illness, and death

HHS supports strategies to promote healthy behaviors to reduce the occurrence of and disparities in preventable injury, illness, and death.  The Department develops, communicates, and disseminates information to improve health literacy about the benefits of healthy behaviors.  HHS leverages resources, partnerships, and collaborations to support healthy behaviors that improve health conditions and reduce disparities in health outcomes.  HHS also advances and applies research and data insights to inform evidence-based prevention, intervention, and policy approaches to address disparities in preventable injury, illness, and death.

Objectives represent the changes, outcomes and impact the HHS Strategic Plan is trying to achieve.  This objective is informed by data and evidence, including the information below.

• Consuming a nutritious diet adequate in fruits, vegetables, and whole grains while limiting saturated fat, sodium, and calories from added sugars can help people achieve and maintain a healthy body weight and reduce their risk of developing certain chronic diseases.  However, many Americans don’t follow this dietary advice.  From 2013 to 2016, Americans consumed an average of 3,604 milligrams of sodium per day, exceeding daily recommendations by more than 1,000 milligrams.  (Source: Healthy People 2030: Nutrition and Weight Status Workgroup)
• Most Americans do not eat a healthful diet and are not physically active at levels needed to maintain proper health.  Adults in the United States consume fruit about 1.1 times per day and vegetables about 1.6 times per day; adolescents showed even lower intake.  Across age and gender, Americans' average daily fruit and vegetable consumption does not meet intake recommendations.  Compounding this is the fact that a majority of adults (81.6 percent) and adolescents (81.8 percent) do not get the recommended amount of physical activity.  (Source: Physical Activity Guidelines for Americans)  Despite modest increases over time, only 25.4 percent of adults report in meeting federal guidelines for aerobic and muscle-strengthening physical activity in 2018.  Rates among low-income and low-education groups of any race were well below the Healthy People 2030 target of 28.4 percent.  (Source: Online Summary of Trends in US Cancer Control Measures)
• Children in the United States with very low food security often don’t have enough to eat.  This is linked to negative health outcomes and may cause children to have trouble in school.  (Source: Healthy People 2030: Eliminate very low food security in children—NWS‑02)
• Obesity rates among children increased substantially in the first months of the COVID-19 pandemic.  Increases in obesity rates were more pronounced among patients age five to nine and among patients who were Hispanic/Latino, non-Hispanic Black, publicly insured, or from lower-income neighborhoods.  (Source: COVID-19 and Changes in Child Obesity)
• Nearly 25 percent of Hispanic/Latino or non-Hispanic Black child patients seen during the pandemic were obese, compared with 11.3 percent of non-Hispanic White patients.  Before the pandemic, differences by race or ethnicity had been about 10 percent to 11 percent.  (Source: COVID-19 and Changes in Child Obesity)
• Obesity is a chronic disease that increases the risk of heart disease, type 2 diabetes, and many types of cancer.  (Source: Health Equity)
• More than four in 10 American adults have high blood pressure and that number increases to about six in 10 for non-Hispanic Black adults (Source: NCHS Data Brief 2020).  Diagnosed diabetes prevalence is higher among American Indians and Alaska Natives than other racial and ethnic minority groups.  (Source: Hypertension Prevalence Among Adults Aged 18 and Over: United States, 2017–2018)
• The leading causes of death include heart disease, cancer, COVID-19, unintentional injuries, stroke, and chronic lower respiratory diseases.  COVID-19 became an official cause of death in 2020.  (Source: Mortality in the United States, 2020)  Injuries are the leading cause of death in children ages 19 and younger.  More than 7,000 children and teens age 0–19 died because of unintentional injuries in 2019.  Leading causes of child unintentional injury include motor vehicle crashes, suffocation, drowning, poisoning, fires, and falls.  (Source: Injuries Among Children and Teens)
• Almost 90 percent of adult smokers start smoking by the age of 18, and nearly 1,500 youth aged 12 to 17 smoke their first cigarette every day in the United States.  According to published data from the 2021 National Youth Tobacco Survey (NYTS), approximately 2.06 million U.S. middle and high school students were estimated to be current e-cigarette users in 2021.  Among current youth e-cigarette users, 84.7 percent used flavored e-cigarettes, and disposable e-cigarettes (53.7 percent) were the most commonly used device type.  (Source: Smoking & Tobacco Use)
• More than three out of five U.S. adults who have ever smoked cigarettes have quit.  Although a majority of cigarette smokers make a quit attempt each year, less than one-third use cessation medications approved by the FDA or behavioral counseling to support quit attempts.  (Source: Smoking Cessation: A Report of the Surgeon General – Key Findings)
• Cancer incidence rates for American Indian and Alaska Native (AI/AN) populations compared with White populations living in select urban areas vary by geographic region.  Rates in certain regions, such as Alaska and the Southern Plains are higher in urban AI/AN populations compared with White populations.  (Source: Cancer Incidence Among American Indian and Alaska Native Populations in Urban Indian Health Organization Service Areas, 2008–2017)
• Disparities may be caused by systemic and environmental factors, like lack of access to affordable, nutritious food and safe places to be physically active.  (Source: Health Equity)

Contributing OpDivs and StaffDivs

AHRQ, ACF, ACL, ASFR, CDC, CMS, FDA, HRSA, IHS, NIH, OASH, and SAMHSA work to achieve this objective.

HHS OpDivs and StaffDivs engage and work with a broad range of partners and stakeholders to implement the strategies and achieve this Objective.  They include: the Disease, Disability, and Injury Prevention and Control Special Emphasis Panel, Injury Prevention in AI/AN Communities, Interagency Committee on Smoking and Health, National Center for Injury Prevention and Control Board of Scientific Counselors, National Organizations of State and Local Officials Cooperative Agreement, National Youth Tobacco Survey (NYTS), Native American Research Centers for Health (NARCH), Population Assessment of Tobacco and Health (PATH), and Tobacco Regulatory Science Program (TRSP).

Strategies

Develop, communicate, and disseminate information to improve health literacy about the benefits of healthy behaviors

• Enhance maternal, infant, and child health through promotion of healthy dietary and physical activity patterns and guidelines while reducing exposure to contaminants and environmental risks, including foodborne pathogens and toxic elements in foods, during pregnancy and in early childhood, particularly in underserved populations.
• Continue to develop targeted public awareness and education for youth and adults about the risks and dangers posed by tobacco products, including e-cigarettes and other electronic nicotine delivery systems, and alcohol, to discourage use, while promoting the availability of cessation programs and supports to minimize harm.
• Expand public awareness and education of mental and behavioral health services including the availability of services for prevention of, treatment of, and recovery support for substance use disorders.
• Support and improve the dissemination and accessibility of information and interventions related to physical activity, healthy eating, food deserts, food insecurity, nutrition, and nutrition labeling to reduce the incidence of related health conditions and chronic diseases.
• Educate the public on best practices and approaches for mitigating and reducing preventable injury in sports and other physical activities, such as concussions and related injuries, including preventable injury in children and youth sports.
• Ensure the public is informed and understands the prevalence, causes, consequences, and risk of social, environmental, behavioral and biological conditions, including related impacts on healthcare costs among underserved populations.

Leverage resources, partnerships, and collaborations to support healthy behaviors that improve health conditions and reduce disparities in health outcomes

• Maximize partnerships with states, community-based organizations, and healthcare organizations to improve safe opioid prescribing and reduce harm by leveraging naloxone distribution, syringe services programs, and integrated service delivery for co-occurring conditions.
• Collaborate with states, tribes, and community-based organizations to develop and implement tailored prevention and intervention efforts aimed at addressing substance use challenges faced by adults and youth through evidence-based education and programs.
• Enhance collaborative efforts with states and community and faith-based organizations to raise awareness of mental health and substance use disorders and reduce barriers and increase access to effective prevention programs and treatments, including telemedicine, healthcare integration, and community- and school-based care.
• Support partnerships and collaborations to enhance the promotion of interpersonal and emotional skills among children, youth, and adolescents and to prevent adverse childhood experiences, suicide, substance use, and youth violence in communities by supporting the implementation and evaluation of evidence-based programs, including interventions related to health promotion, socioemotional learning, and teen pregnancy.
• Partner with states, tribes, local, and territorial communities, including private and non-profit organizations, to expand tailored prevention education and interventions to reduce health disparities, focusing efforts in addressing disparities in injury, substance use and misuse, illness, morbidity, and mortality rates in underserved populations.
• Engage state level, regional, tribal, territorial, and local providers, programs, and organizations—including medical practitioners, Breastfeeding Coalitions, the Supplemental Nutritional Assistance Program (SNAP), and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)—to develop cultural competence training and education materials for healthcare providers who provide services to maternal, perinatal, and postpartum populations, and groups that have been economically and socially marginalized.
• Coordinate federal interagency efforts and target resources aimed at increasing the utilization of the Dietary Guidelines for Americans to inform federal nutrition programs and initiatives, including the development of science-based nutrition education initiatives, with a particular focus on efforts that address disparities in health and food access.

Apply research and data insights to inform evidence-based prevention, intervention, and policy approaches to address disparities in preventable injury, illness, and death

• Support, enhance, and coordinate research and surveillance efforts to improve identification of key trends and disparities in preventable injury, illness, and death at the national and sub-national levels to inform evidence-based interventions aimed at reducing health disparities.
• Advance health equity through regulatory efforts, where appropriate, and research efforts that utilize implementation science concepts and methods to better integrate effective, evidence-based interventions and actions to reduce substance use, tobacco use, obesity, and promote nutrition, blood pressure control, and physical activity across all populations.
• Support interdisciplinary and innovative research to enhance our understanding of how social, built, and natural environments affect the social determinants of health and inform culturally appropriate evidence-based treatments and supports to improve healthy behaviors in community settings for populations with health disparities.
• Leverage and promote partnerships and collaborations, including public-private partnerships, to support implementation science and research application in the development and implementation of prevention and intervention approaches.
• Promote research to effectively characterize and understand the interactions among the demographic, behavioral, lifestyle, social, cultural, economic, occupational, and environmental factors that influence healthy eating choices in diverse population groups.

Performance Goals

The HHS Annual Performance Plan provides information on the Department’s measures of progress towards achieving the goals and objectives described in the HHS Strategic Plan for FY 2022–2026.  Below are the related performance measures for this Objective.

• Reduce the annual adult per-capita combustible tobacco consumption in the United States
• Increase the proportion of adults (age 18 and older) that engage in leisure-time physical activity
• Percentage of adult health center patients with diagnosed hypertension whose blood pressure is under adequate control
• Percentage of adult health center patients with type 1 or 2 diabetes with most recent hemoglobin A1c (HbA1c) under control (less than or equal to nine percent)

Learn More About HHS Work in this Objective

• Adverse Childhood Experiences (ACEs): CDC is committed to preventing, identifying, and responding to adverse childhood experiences at the community, state, and national level so that all people can achieve lifelong health and well-being.  Our goal is to create the conditions for strong, thriving families and communities where children and youth are free from harm.
• Cannabis and Cannabis-Derived Products, including Cannabidiol (CBD): FDA is reviewing all available science, legislation, and regulatory structures to determine the suitability for cannabis and cannabis-derived products, including CBD in conventional foods and dietary supplements.
• Closer to Zero: Identifies actions the FDA will take to reduce exposure to toxic elements from foods eaten by babies and young children.
• Colorectal Cancer Control Program: The purpose of CDC’s Colorectal Cancer Control Program (CRCCP) is to increase colorectal cancer screening rates among people between 45 and 75 years of age by implementing evidence based interventions and other supporting strategies in partnership with health systems and providing follow-up services for a limited number of program-eligible people.  Currently, the CRCCP funds 35 award recipients: 20 states, eight universities, two tribal organizations, and five other organizations.
• Comprehensive public education campaigns: These FDA campaigns work in concert with regulatory actions to reduce the use of tobacco products and improve the public health.  FDA's public education campaigns have helped educate the public—especially youth—about the dangers of regulated tobacco products.  During the first two years of “The Real Cost” smoking prevention campaign, FDA realized a cost savings of $180 for every dollar of the nearly $250 million invested when measured by future healthcare costs avoided.
• Dietary Guidelines for Americans: Together with USDA, HHS provides advice on what to eat and drink to meet nutrient needs, promote health, and prevent disease.  HHS and USDA partner in the development of the Dietary Guidelines, and HHS is the lead agency for the 2025–2030 edition.
• FDA Center for Tobacco Products (CTP) Strategic Priorities: The CTP takes action to protect American families by prioritizing product standards, comprehensive FDA nicotine regulatory policy, pre- and post-market controls, compliance and enforcement, and public education.
• FDA Tobacco Product Review: Tobacco products are inherently dangerous.  FDA’s authority to regulate tobacco products includes premarket review of new tobacco products, including electronic nicotine delivery systems.
• Foodsafety.gov: The gateway to food safety information provided by the U.S. Department of Agriculture, FDA, and CDC.
• Good Health and Wellness in Indian Country (GWIC): GHWIC is the CDC's largest investment to improve American Indian and Alaskan Native (AI/AN) tribal health, focused on health promotion and chronic disease prevention.  GHWIC continues to support healthy behaviors for AI/AN and emphasize strategies to reduce risk factors in Native communities to attain long-term goals.
• Healthy People 2030: Through this department-wide program, HHS provides science-based, 10-year national objectives for improving the health of all Americans at all stages of life, underpins HHS priorities and strategic initiatives, and provides a framework for prevention and wellness programs for a diverse array of stakeholders.
• Healthy Tribes Program: CDC's Healthy Tribes Program partners with AI/AN communities to promote health, prevent disease, and strengthen cultural connections to improve health and promote wellness.  This occurs in four action areas: epidemiology and surveillance; environmental approaches; healthcare system interventions; and community programs linked to clinical services.
• Integrated Care for Kids (InCK) Model: A child-centered local service delivery and state payment model that aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid through prevention, early identification, and treatment of behavioral and physical health needs.
• Leading Health Indicators (LHI): This subset of high-priority Health People 2030 objectives reflect the most critical public health challenges facing the nation.  The LHI data, broken out by demographic characteristics, will help identify health disparities and areas needing targeted resources for program and policy development.
• Medicaid Improvement Initiative: Reducing Obesity: Medicaid and the Children's Health Insurance Program (CHIP) can play a role in reducing the rate of obesity in the United States by improving access to health care services that support healthy weight.  For children enrolled in Medicaid, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit covers all medically necessary services which can include obesity-related services.
• Move Your Way Campaign: This OASH campaign and associated community pilot program increase public awareness of the Physical Activity Guidelines for Americans and encourages people to add more activity into their daily lives.
• National Plan to Address Alzheimer’s Disease: 2021 Update: The National Plan establishes six ambitious goals to both prevent future cases of Alzheimer's disease and related dementias (AD/ADRD), and to better meet the needs of the millions of American families currently facing this disease.
• Nutrition Initiative: FDA is committed to finding new ways to reduce the burden of chronic disease and advance health equity across generations through improved nutrition, especially for racial and ethnic subgroups who experience higher rates of nutrition-related chronic diseases.  To help create an overall healthier food supply, FDA encourages industry to produce healthier foods and empowers consumers to choose a healthy diet through labeling and education.
• OASH’s Reproductive Health National Training Center (RHNTC): The RHNTC exists to ensure that personnel working in family planning and adolescent sexual and reproductive health have the knowledge, skills, and attitudes necessary to deliver high-quality services and programs and prevent maternal mortality through increased fertility awareness and improved preconception health.
• Physical Activity Guidelines for Americans: Together with USDA, HHS provides evidence-based recommendations for the amounts and types of physical activity people need to promote health and reduce the risk of chronic disease.
• Smokefree.gov: An NIH resource created as part of HHS efforts to reduce smoking rates in the United States, particularly among certain populations, providing tools and information to help smokers and tobacco users quit.
• Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities: This Call to Action aims to get Americans walking and wheelchair rolling for the physical activity needed to help prevent and reduce their risk of chronic diseases and premature death.  It also supports positive mental health and healthy aging.
• Surgeon General’s Call to Action to Support Breastfeeding: This Call to Action describes specific steps people can take to participate in a society-wide approach to support mothers and babies who are breastfeeding.