About 10 years ago the government set some lofty health goals for the nation to reach by 2010.
So how did we do? By many measures, not so hot. There are more obese Americans than a decade ago, not fewer. We eat more salt and fat, not less. More of us have high blood pressure. More of our children have untreated tooth decay.
But the nation has made at least some progress on many other goals. Vaccination rates improved. Most workplace injuries are down. And deaths rates from stroke, cancer and heart disease are all dropping.
As we move into a new decade, the government is analyzing how well the nation met the 2010 goals and drawing up a new set of goals for 2020 expected to be more numerous and _ perhaps _ less ambitious.
"We need to strike a balance of setting targets that are achievable and also ask the country to reach," said Dr. Howard Koh, the federal health official who oversees the Healthy People project. "That's a balance that's sometimes a challenge to strike."
The Healthy People objectives were first created in the late 1970s to set an agenda for getting Americans to live longer, healthier lives. It was also an attempt to involve the public and emphasize that many health problems are preventable.
Every 10 years, the U.S. Department of Health and Human Services reassesses the goals, and reports on progress made in the previous decade.
Many call the effort a success. The report has been imitated by states and other nations. Because of its importance within public health circles, interest groups jockey to add their goals to the document, which is expanding to more than 1,000 targets. And health agency workers have Healthy People goals memorized.
"It is something that we think about all the time," said Dr. Lance Rodewald, a vaccination expert at the U.S. Centers for Disease Control and Prevention.
But after more than 30 years, the goals aren't well known to the public and only a modest number have been met.
About 41 percent of the 1990 measurable goals were achieved. For the 2000 goals, it was just 24 percent.
As for the 2010 goals, data is still being collected, and a final report is not due out until 2011. But it looks like the results will be in the neighborhood of 20 percent, according to a preliminary analysis by the CDC's National Center for Health Statistics.
The CDC analysis done this fall found that just 18 percent of those goals have been met so far. Worse, the nation actually retreated from about 23 percent of the goals.
One example: Healthy People 2010 called for the percentage of adults who are obese to drop to 15 percent. That goal was set at a time when nearly a quarter of all adults were obese. Now, about 34 percent of adults are obese, according to the latest federal statistics.
Some other backslides:
_An estimated 28 percent of adults had high blood pressure in 2000. The goal was to reduce that to 16 percent. But the most recent government data say the proportion has risen to 29 percent.
_About 16 percent of young children had untreated tooth decay in 2000. The target was 9 percent. The latest statistic is about 20 percent.
_The proportion of births by cesarean section increased despite a 2010 goal of lowering them, and the percentage of infants born very small and fragile also increased.
The nation has had better luck raising childhood vaccination rates, lowering cancer death rates, increasing smoking laws and reducing most types of work injuries.
To many health officials, simply making progress is a victory. An analysis of 635 of the nearly 1,000 targets for the past decade shows only 117 goals have been met. But progress was made toward another 332. In other words, there was improvement in 70 percent of the measures.
"That's evidence of a healthier nation," Koh said.
The Healthy People effort could be better if it included more information about how to reach the goals, and how much it would cost, said David Holtgrave, a health policy expert at Johns Hopkins University.
The program lays out the goals, but looks to others _ and the public _ to find ways to achieve them. Healthy People does not provide funding to meet the goals, either.
"It's all carrot and no stick," said Dr. Richard Riegelman, founding dean of the George Washington University School of Public Health, who has been part of the Healthy People planning.
Right now, health officials are developing goals for 2020. The details are far from settled, but an advisory panel of experts has recommended that the new goals be more realistic. They also hope to make it more inviting to the public.
In the past, Healthy People reports have been released as a book the size of a James Michener epic.
"They have a lot of good information. They can also give you a backache," said Dr. Jonathan Fielding, director of the Los Angeles County Department of Public Health who heads a committee working on the new goals.
He and others are pushing for Healthy People 2020 to be an online document that links to Web sites and sources for nutrition and exercise advice and other ways people can improve their own health.
"We want to make 2020 a blueprint everyone can rally behind," Fielding said.
On the Net:
Healthy People: http://www.healthypeople.gov/