Example Of Healthy People 2020 II-D 8 Objective Research Paper
Type of paper: Research Paper
Topic: Vaccination, Health, Medicine, Immunization, Family, Objective, Children, Public
Healthy people 2020, HP 2020, is an initiative of the United States government, together with other private organizations and agencies, to promote the health of the US citizens. A subsequent of Healthy people 2010, the HP 2020 has its foundation on specific objectives with a 10 year time frame for achievement. To achieve their objectives, the initiative recognizes the need for collaboration with other organizations and the community, the empowerment of individuals in making informed decisions about their health, and a way of measuring the impact of these objectives in prevention of diseases and health promotion. This paper will, therefore, discuss a HP 2020 topic of Immunization and Infectious disease, whose goal is to “increase immunization rates and reduce preventable infectious diseases” (HP 2020, 2015). The paper will further discuss the achievement of failure of this objective, provide a literature review on the topic, discuss agencies that contribute to this objective, and also discuss the implications of nursing practice and support groups towards the achievement of this objective.
History of the HP2020 II-D 8 Objective
The healthy People 2020 initiative has its foundation on the accomplishment of four other previous initiatives: 1979 initiative, 1990 initiative, the 2000 initiative and the recently ended 2010 initiative. Each of the objectives of the HP 2020 is built upon its previous accomplishment or failure, although there has been new objectives introduced as well. According to Diekema (2012), immunization has played a significant role in the prevention of diseases and promotion of health. Immunizations have contributed to a reduction in the development of infectious diseases, their spread, and mortality associated with the infectious diseases. Immunizations and vaccines have been recognized as the most cost-effective measures of prevention of infectious diseases and reduction of mortality caused by these diseases. Fu, et. al. (2012) indicates that with immunizations, 330,000 lives are saved, 14 million cases of diseases are prevented, and consequently, 9.9 billion dollars worth of healthcare costs are saved. However, the process of immunization has been met with various challenges, including access and availability, and rejection by some part of the public. As a result of the unmet goals of this topic, the goal to increase immunization rates and reduce preventable infectious diseases was developed.
There are many provisions and objectives under this topic, but this paper will focus on objective IID-8, which seeks to increase the percentage of children aged 19 to 35 months who receive the recommended doses of DTaP, polio, MMR, Hib, hepatitis B, varicella and pneumococcal conjugate vaccine (PCV)” (HP 2020, 2015). This objective stems from HP 2010 topic of immunization and infectious diseases, and its predecessor as well. The target for this objective is to achieve an 80% immunization against the mentioned diseases among the targeted population. This objective wasn’t achieved with the HP2010 initiative, and the HP 2020 initiative seeks to endeavor in its quest to reach the required target percentage in achieving the objective. To achieve this objective, the government must remain consistent with the policies, regulations, and national programs that guide the HP 2020 initiative (HP 2020, 2015)
Reasons for Failure/Success
According to the HP 2020 data fact sheet, the objective to Increase the percentage of children aged 19 to 35 months who receive the recommended doses of DTaP, polio, MMR, Hib, hepatitis B, varicella and pneumococcal conjugate vaccine hasn’t been achieved yet.. The initiative targets to reach 80%, although by 2009, statistics indicated that only 44.3 % had been achieved. However, the objective seems to be receiving recognition as the percentage of immunization has been on the rise from 44.3% in 2009 to 56.6% in 2010 to 68.5% n 2011 and 68.4 in 2012 (CDC, 2015). While the objective received an increase between 2009 and 2011, there was a 0.1 decrease in its achievement in 2012. According to Grepin (2009), this can be attributed to the recent uproar in the public about the right to informed consent during immunizations, which has led to many people thinking twice before receiving immunizations or before taking their children for immunizations. There also misconceptions about development of certain conditions, like autism, and immunization, specifically the measles-mumps-rubella. Relating vaccinations to such adverse events have thwarted the Healthy people initiatives in reaching its targeted percentage for immunizations and vaccines due to the fears that inhabit parents’ minds towards the development of adverse effects in their children.
Although measures have been put up to counter this misconception, most parents have already developed a negative attitude towards the vaccinations (Grepin, 2009). Additionally, there are provisions that can allow a person to be exempted from vaccinations on the basis of personal beliefs, religious beliefs, and medical grounds. Although these provisions vary from one State to the other, they hinder the ability of the involved agencies and organizations to effectively carry out their mandated duties in immunizations and vaccinations against these infectious diseases. Availability of immunization services is also another reason that has contributed to the failure of the objective. According to Grepin (2009), the government and other related agencies in immunizations have developed measures to reach out to as many people as possible in regards to the immunizations. This includes the setting up of community support and outreach groups that educate and deliver vaccinations to the public. However, this strategy doesn’t seem to be effective because the targets haven’t been reached yet. Moreover, the United States happens to be home to many immigrants from various walks of life, all of whom have different cultural and social beliefs about immunizations. Therefore, to bridge this gap and reduce disparity, the government has to invest in culturally-sensitive care that addresses the diversified culture of the United States. Another reason is that most of these immigrants who move to the US are undocumented, and due to the fear of being deported, they do not seek social services like healthcare for themselves or for their children. Therefore, children remain unimmunized, posing a challenge to the realization of the objective of increasing the percentage of children aged 19 to 35 months who receive the recommended doses of DTaP, polio, MMR, Hib, hepatitis B, varicella, and the PCV
Review of the Literature
Increasing the percentage of children aged 19 to 35 months who receive the recommended doses of DTaP, polio, MMR, Hib, hepatitis B, varicella, and the PCV has been a focus of the healthcare system for a while now. According to Nair & Nair (2012), the recommended immunizations reduce the mortality caused by the preventive diseases by a significant percentage. However, the achievement of this objective is becoming challenging by the day as information becomes available to the public. According to Hu, Li, Chen, Chen & Qi (2013), a person is bound to make a decision based on the information that they receive from secondary sources. Taking a child for immunization is defined by the parents’ choices since children of this age can’t make their own decisions. As a result, parents seeking secondary information from the internet and other people have had their decisions to take their children for immunizations affected, some positively, and other negatively. To bridge this information gap, the agencies involved in dissemination of vaccines to the public educate the public throughout to ensure that myths are demystified, and facts are embraced by the public.
According to Nair & Nair (2012), educating the public helps change their mindset about a certain issue. Imparting knowledge has been seen to change the attitudes of people regarding immunizations and vaccinations. Since the target population here is children between 19-35 months, the right people to educate would be their parents. Parents can be reached through public forums, antenatal, and postnatal visits to the hospital. However, educating the public is a sensitive subject, because according to Hu, Li, Chen, Chen & Qi (2013), it can either build or break. Approaching a target population requires skills and knowledge of their culture, religious, and social beliefs. The recent improvements towards achievement of the II-D8 objective can be attributed to the numerous campaigns by the government to educate its people on the importance of immunizations and vaccinations to their children (NCSL, 2015).
Strategies to improve coverage of immunizations have also been developed by the government in conjunction with the relevant authorities like the National Immunization Survey, NIS, and the CDC. The NIS carries out immunization surveys to establish the coverage of the practice in the United States. The agency seeks to establish the rate at which children of 19-35 months are receiving immunizations. According to the NIS data (2015), the coverage of immunizations among this target group continues to grow. Although the targeted percentage hasn’t been realized yet, there is hope that it will be accomplished in the near future due to the efforts that have been implemented to ensure that the objective is realized.
Role of Agencies Related to the HP objective
The realization of this objective heavily depends upon the collaboration of various agencies that perform different roles towards its accomplishment. The agencies related to this objective are the US legislature, HIS, CDC, National Center for Immunizations and Respiratory Diseases, NCIRD, the National Center for Health Statistics, and the Advisory Committee on Immunization Practices, ACIP (NCSL, 2015). The US legislature is the body responsible for making the laws. Like any other public issue in the US, immunization requires policies to act as the guiding framework. The Legislature develops and discusses these policies, which when passed, are then signed into a law that all citizens are required to obey. Some of the policies that have been implemented in the United States regarding immunizations include the school entry requirement for immunization, exemptions from immunizations, and financial incentives for immunization of children. The school entry policy requires that a parent present the school with a history of the child’s immunization program before the child is admitted to school. The legislature of various States developed the exemptions to immunization based on medical, personal, and religious grounds of a person. The legislature is also responsible for developing financial incentives for the public, for example the free vaccinations for children (McNeil, et. al, 2013).
The National Immunization Survey carries out surveys from various immunization providers in order to monitor the coverage of immunization programs. The role of the NIS is to provide evidence-based statistics on the coverage and trend of immunization in the US. NCIRD and the NCHS, plays the vital role of sponsoring the NIS by providing the necessary resources for carrying out the surveys on immunizations. The data received by the NIS is used by the NCIRD and the NCHS “to produce timely estimates of vaccination coverage rates for all childhood vaccinations” (Fu, et. al., 2012) The ACIP bears the responsibility developing recommendations on the use of vaccination for disease prevention in the United States (CDC, 2015). Composed of 15 experts, the ACIP makes suggestions on how preventable disease can be avoided through the use of vaccines and immunizations.
Implications for Nursing Practice
Increasing the percentage of children aged 19 to 35 months who receive the recommended doses of DTaP, polio, MMR, Hib, hepatitis B, varicella, and pneumococcal conjugate vaccine has several implications for the nursing practice. According to Nair & Nair (2012), immunizations are one of the most cost effective clinical preventative services. Nair & Nair (2013) estimates that a total of 33,000 lives are saved, 14 million cases of disease are prevented, healthcare costs are reduced by $9.9 billion, and $33.4 billion in indirect costs are saved through immunizations in children. Such savings can be directed to other needy medical areas like the terminal illnesses. Also, vaccinations reduce the rates of mortality and disability caused by the preventable diseases, reducing the burden of taking care of such patients for the nursing practice. According to Nair & Nair (2012), the ideal nurse to patient staffing ratio hasn’t been achieved yet, and keeping the incidences of diseases at a low during all times is the only way of ensuring that the nursing staff are not overburdened. This is the main goal of health promotion and disease prevention initiatives like healthy people 2020.
Role of Support Groups
Support groups play a critical role in ensuring the coverage of vaccinations to the general public. The support groups work directly with the nurses to provide information to the public about the vaccinations. According to Hu, Li, Chen, Chen & Qi (2013), there is no vaccines that has a 100% safety guarantee for all individuals. This is because the genetic composition differs among different people, and how one person reacts is not how another does. However, vaccines undergo rigorous testing before they are disseminated for public use, and adverse effects occur rarely. Support groups help parents understand the role of vaccines, as well as effects that may accompany the vaccinations (McNeil, et. al, 2013). On the other hand, the support groups provide the nursing profession with the relevant information from the grass-root levels, since they interact most with the public. Opinions on how the public perceives the immunization and vaccination procedures are vital in developing better strategies of reaching out to the public and increasing coverage. Support groups can also help parents understand what to expect in the event of a vaccination, and how to report any side effects believed to originate from a vaccines. Examples of support groups are the VFC and the Universal Purchase programs.
In conclusion, with vaccinations being some of the most cost effective preventative measures, II-D 8 is an obvious step in achieving the health promotion strategies in the primary care setting. With the increase in the use of APN as primary care providers, Family Nurse Practitioners play a significant role in the II-D 8 objective. The APNs and FNP contribute in bridging the knowledge gap that exists in parents regarding vaccinations. This paper discussed the II-D 8 objective of the healthy people 2020, establishing its achievements, role of agencies involved, as well as its implications on the nursing practice.
CDC. (2014). Advisory Committee on Immunizations Practice, ACIP. Retrieved March 18,
2015, from http://www.cdc.gov/vaccines/acip/about.html
Centers for Disease Control and Prevention, CDC, (2012). Healthy People 2020 Progress
Reviews. Retrieved March 18, 2015, from
Centers for Disease Control and Prevention (CDC. (2011). National and State Vaccination
Coverage among Children aged 19-35 months--United States, 2010. MMWR.
Morbidity and Mortality Weekly Report, 60(34), 1157.
CDC. (2015).National Immunization Survey, NIS. Retrieved March 18, 2015, from
Diekema, D. S. (2012). Improving Childhood Vaccination Rates. New England Journal of
Medicine, 366(5), 391-393.
Fu, L. Y., et. al (2012). Improving the Quality of Immunization Delivery to an At-Risk
Population: A Comprehensive Approach. Pediatrics, 129(2), e496-e503.
Grepin, K. (2009). Practical Challenges to Immunizations Programs. Grepin’s Global Health.
Retrieved March 18, 2015, from Grepin’s Database
Healthy People 2020, HP 2020 (2015). Immunization and Infectious Diseases: IID-8.
Retrieved March 18, 2015, from http://www.healthypeople.gov/2020/data search/Search-the-Data?nid=4722
Healthy People 2010, HP 2010 (2013). Immunization and Infectious Diseases. Retrieved
March 18, 2015 from http://wonder.cdc.gov/data2010/
Hu, Y., Li, Q., Chen, E., Chen, Y., & Qi, X. (2013). Determinants of Childhood
Immunization Uptake among Socio-Economically Disadvantaged Migrants in East
China. International Journal of Environmental Research and Public Health,
McNeil, M. M., et. al. (2013). Who is Unlikely to Report Adverse Events after Vaccinations
Nair, R., & Nair, S. S. (2012). Is behavior Change Communication an Effective Strategy for
Increasing Immunization Coverage. Advance Tropical Medicine and Public Health
International, 2(2), 40-60.
National Conference of State Legislatures, NCSL. (2015). Immunizations Policy Issues
Overview. Retrieved March 18, 2015, from
O’Keefe, C., & Potthoff, M. (2013). Vaccines: Boon or Bane—A Nurse’s Outlook. In
Vaccinophobia and Vaccine Controversies of the 21st Century. New York: Springer