management systems comprising sound strategic planning, management, administrative systems, and an emphasis on total are reflected in senior management performance appraisals and incentive plans. Mr. Chairman, these responses confirm the results of other including discussions with officials of other research - A national governments as well as state and local governments. capsulized conclusion is that performance measurement, by itself, is not a cure-all. Performance measurement is an immensely powerful tool when used as an integral part of a comprehensive management system that is led by strategic planning and based on the principles of employee empowerment, customer involvement, and continuous improvement. Mr. Chairman, thank you for giving me the opportunity to discuss the Financial Management Service's efforts in the very important area of program performance. I shall be happy to answer any questions the Committee may have. Thank you, Mr. Chairman. I am Dr. Michael McGinnis, Deputy Assistant Secretary for Health and Director of the Office of Disease Prevention and Health Promotion in the Office of the Assistant Secretary for Health, Public Health Service (PHS), Department of Health and Human Services (HHS). It is a pleasure to be here today to describe for this Committee the process which we use to define the national health promotion and disease prevention agenda and the implications of that process for agency accountability within the Public Health Service. Title XVII of the Public Health Service Act directs the Secretary of Health and Human Services to establish national goals for prevention of disease and promotion of health and strategies for achieving these goals. It also establishes the Office of Disease Prevention and Health Promotion to coordinate prevention policies and programs within the Department that support achievement of these goals and implementation of the strategies. To carry out this legislative mandate, we have developed national goals and supporting measurable, time-limited objectives for tenyear periods. With the publication of Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention in 1979, national goals were promulgated for achievement by 1990 calling for reductions in death rates for age groups from birth to age 65 and reduction of days of disability for those over 65. In 1980, these broad goals were followed by publication of Promoting Health/ Preventing Disease: Objectives for the Nation, a set of 226 objectives, with targets set for achievement by 1990. The objectives were organized in 15 separate priority areas, each assigned to the lead responsibility of one or another of our PHS agencies. I would like to submit a list of the priority areas and assignments as an appendix to this testimony (Figure 1). Objectives addressed: improvements in health status; reduction of risks to health; increases in public and professional awareness; improvements and expansion of health services and protective measures, and enhancements of surveillance measures and research efforts. Lead agencies were tasked with reporting regularly on how we were doing in moving toward the objectives. One might describe our experience in the 1980s of using goals and objectives to set a national prevention agenda and to track progress toward achievement of clearly defined targets as a decade-long experiment in using a form of management-byobjectives to make improvements in public health. A review of the accomplishments from the decade of the 80s indicates that the broad mortality-based goals established for infants, children, adolescents, and adults were substantially achieved by the year 1990 (Figure 2). Data available for the 226 health objectives show that 32 percent of those objectives have been accomplished and another 34 percent showed progress toward the established targets. Only 11 percent of the objectives did not show any progress or moved in the wrong direction. The other 23 percent had inadequate data by which to make a valid determination of progress. In many ways, however, what we have learned from the experience of pursuing numerical targets has not been as important as what we have learned from the process of setting and tracking these measurable objectives. The objectives have proved useful in giving us a realistic sense of what ought to be able to be achieved over a finite period of time by the public health community, given effective application of available resources. This has helped us to chronicle our successes, ask questions when it looked as if we were heading off the mark, and hold ourselves accountable if we fail. The last point is of particular importance. For example, when, despite good progress toward society's overall goal of reduced infant mortality, we fail to close the gap between whites and blacks, it is important that this failure be held up for examination. We also learned that having numerical targets can help recruit participants. By involving groups and individuals in the setting of targets, they are more likely to become committed to their attainment. This has helped not only to unify the public health community around agreed upon priorities but also to recruit participants from non-traditional sectors. For example, one of the most vigorous proponents of the targets for injury control has been the transportation sector. Similarly, the agriculture community is rallying behind the nutrition targets. Another use for the objectives is the provision of a national reference point for activities at the State and community levels. The notion of a national target for improving prenatal care may be a useful tool for a local or State program official needing to make a case before a Governor, State legislature, or city council. Finally, we learned that having the targets was a useful means of helping us to focus on needs for improving our data systems at Federal, State, and local levels. Although at the end of the decade, still 23 percent of the objectives had inadequate data for tracking, that number was down from about 35 percent at the beginning of |