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National Health Mission - Major Initiatives and Successes

National Health Mission was launched by the Government of India with the objective of addressing India’s malnutrition crisis. This mission subsumed 2 other malnutrition missions that already existed with the aim of targeting rural population and urban population. This mission was launched in the year 2013 and is implemented by the Ministry of Health and Family Welfare. This article covers the 4 main components of the mission, major objectives, goals, major initiatives and some of the successes of the National Health Mission.

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National Health Mission – 4 Components of the Mission

• National Rural Health Mission
• National Urban Health Mission
• Tertiary Care Programmes
• Human Resources for Health and Medical Education

National Health Mission – Major Objectives

• The mission targets to move beyond earlier missions focus on reproductive and child health
• Tackle 2 categories of diseases – Communicable and Non-Communicable
• To give a major impetus to health infrastructure facilities at District and Sub-District levels.

National Health Mission – Goals

Some of the major goals of the National Health Mission are given below.

• Total Fertility Rate (TFR) – Reduce it to 2.1
• Infant Mortality Rate (IMR) – Reduce it to 25 per 1000 live births
• Maternal Mortality Rate (MMR) – Reduce it to 1 per 1000 live births
• Bring down the malaria cases to less than 1 per 1000 population.
• Prevent and reduce anaemia in women in the age bracket of 15 years to 49 years.
• Bring down cases and mortality due to tuberculosis by half.

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National Health Mission – Major Initiatives

There are around 24 major initiatives under the National Health Mission.

Below table gives details of 10 Major initiatives under National Health Mission

National Health Mission – Some Major Successes

• Mission Indradhanush – It helped in increasing immunization cover by over 5% in just 1 year.
• Kayakalp Initiative – This was launched with the plan to inculcate hygiene, sanitation, effective waste management, and infection control in public health facilities. This initiative has introduced awards which resulted in significant improvement in sanitation standards.

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FAQ about National Health Mission

When was the national health mission launched, what is the aim of national health mission.

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National Health Mission (NHM)

Last updated on October 22, 2022 by ClearIAS Team

To ensure that health services are properly distributed to the underprivileged, the Ministry of Health and Family Welfare established the National Health Mission in 2013. The NHM has had a great impact on the health services in the country since its implementation. Read here to know in detail about the mission.

The National Health Mission (NHM) encompasses two Sub-Missions:

• The National Rural Health Mission (NRHM) (2005)
• The National Urban Health Mission (NUHM) (2013)

The main programmatic components include:

• Health System Strengthening
• Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A)
• Communicable and Non-Communicable Diseases.

The NHM envisages the achievement of universal access to equitable, affordable & quality healthcare services that are accountable and responsive to people’s needs.

Table of Contents

The goals for NHM have been set specific for states-

• State-specific innovations would be encouraged.
• Process and outcome indicators will be developed to reflect equity, quality, efficiency, and responsiveness.
• Targets for communicable and non-communicable diseases will be set at the state level based on local epidemiological patterns and taking into account the financing available for each of these conditions.

The aim is to achieve the following indicators:

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• Reduce Maternal Mortality Rate to 1/1000 live births
• Reduce Infant Mortality Rate to 25/1000 live births
• Reduce Total Fertility Rate to 2.1
• Prevention and reduction of anemia in women aged 15–49 years
• Prevent and reduce mortality & morbidity from communicable, and non-communicable; injuries and emerging diseases
• Reduce household out-of-pocket expenditure on total healthcare expenditure
• Reduce annual incidence and mortality from Tuberculosis by half
• Reduce the prevalence of Leprosy to <1/10000 population and incidence to zero in all districts
• Annual Malaria Incidence to be <1/1000
• Less than 1 percent microfilaria prevalence in all districts
• Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks

NHM support is also provided for the provision of a range of free services related to maternal health, child health, adolescent health, family planning, universal immunization program , and for major diseases such as Tuberculosis, vector-borne diseases like Malaria, Dengue and Kala Azar, Leprosy, etc.

National Rural Health Mission (NRHM)

The National Rural Health Mission (NRHM) was launched in 2005.

It aims to provide accessible, affordable, and quality health care to the rural population, especially vulnerable groups.

Under the NRHM, the Empowered Action Group (EAG) States, as well as the North Eastern States, Jammu, Kashmir, and Himachal Pradesh, have been given special focus.

The thrust of the mission is on establishing a fully functional, community-owned, decentralized health delivery system with inter-sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, and social and gender equality.

Institutional integration within the fragmented health sector was expected to provide a focus on outcomes, measured against Indian Public Health Standards for all health facilities.

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The key features of the mission:

• making the public health delivery system fully functional and accountable to the community, human resources management
• community involvement, decentralization, rigorous monitoring & evaluation against standards
• the convergence of health and related programs from the village level upwards
• innovations and flexible financing and interventions for improving health indicators.

Mobile Medical Units (MMUs) & Teleconsultation services are also being implemented to improve access to healthcare, particularly in rural areas.

At the National level, the NHM has a Mission Steering Group (MSG) headed by the Union Minister for Health & Family Welfare and an Empowered Programme Committee (EPC) headed by the Union Secretary for Health & FW. The EPC will implement the Mission under the overall guidance of the MSG.

National Urban Health Mission (NUHM)

The National Urban Health Mission (NUHM) as a sub-mission of the National Health Mission (NHM) was approved in 2013.

NUHM envisages meeting the healthcare needs of the urban population with a focus on the urban poor , by making available to them essential primary healthcare services and reducing their out-of-pocket expenses for treatment.

This will be achieved by strengthening the:

• existing health care service delivery system
• targeting the people living in slums
• converging with various schemes relating to wider determinants of health like drinking water, sanitation, school education, etc. implemented by the Ministries of Urban Development, Housing & Urban Poverty Alleviation, Human Resource Development, and Women & Child Development.

The goals of the NUHM are:

• Need-based city-specific urban health care system to meet the diverse health care needs of the urban poor and other vulnerable sections.
• Institutional mechanisms and management systems to meet the health-related challenges of a rapidly growing urban population.
• Partnership with the community and local bodies for more proactive involvement in the planning, implementation, and monitoring of health activities.
• Availability of resources for providing essential primary health care to urban poor.
• Partnerships with NGOs, for-profit and not-for-profit health service providers, and other stakeholders.

NUHM would cover all State capitals, district headquarters, and cities/towns with a population of more than 50000.

It would primarily focus on slum dwellers and other marginalized groups like rickshaw pullers, street vendors, railway and bus station coolies, homeless people, street children, and construction site workers.

Funding scheme: The center-state funding pattern will be 75:25 for all the States except North-Eastern states including Sikkim and other special category states of Jammu & Kashmir, Himachal Pradesh, and Uttarakhand, for whom the center-state funding pattern will be 90:10 .

The Programme Implementation Plans (PIPs) sent the by the states are apprised and approved by the Ministry.

Other initiatives under NHM

• Janani Shishu Suraksha Karyakram (JSSK): Under which free drugs, free diagnostics, free blood and diet, and free transport from home to institution, between facilities in case of a referral and drop back home is provided.
• Rashtriya Bal Swasthya Karyakram (RBSK) : It provides newborn and child health screening and early intervention services free of cost for birth defects, diseases, deficiencies, and developmental delays to improve the quality of survival.
• Implementation of Free Drugs and Free Diagnostics Service Initiatives
• PM National Dialysis Programme
• Implementation of National Quality Assurance Framework in all public health facilities including in rural areas.

As part of Ayushman Bharat, the States are supporting the establishment of 1.5 lakh Health and Wellness Centres across the country by December 2022 for the provision of comprehensive primary care that includes preventive healthcare and health promotion at the community level with a continuum of care approach.

Further Ayushman Bharat , Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides health coverage up to Rs 5 Lakh per family per year to around 1074 crore poor and vulnerable families as per Socio-Economic Caste Census (SECC) .

Achievements of NHM

In the years of implementation, the NHM has enabled the achievement of the Millennium Development Goals (MDGs) for health.

It has also led to significant improvements in maternal, new-born, and child health indicators, particularly for maternal mortality ratio, and infant and under-five mortality rates, wherein the rates of decline in India are much higher than the global averages and these declines have accelerated during the period of implementation of NHM.

• Improved core health outcomes and increased access to health services
• Growth in public health facilities
• There was also a sustained focus on the health of tribal populations, those in Left Wing Extremism areas, and the urban poor.
• National Ambulance services for providing “free pick up and drop back” facilities to pregnant women and sick infants.
• Human Resource Augmentation: NHM supports states for engaging service delivery HR such as doctors, nurses, and health workers and also implements the world’s largest community health volunteer program through the ASHAs.
• The National Health Mission enabled the design and implementation of reforms specifically related to Governance and Technology
• Addressing high Out-of-Pocket Expenditure (OOPE)

NHM-supported health system reforms have resulted in the development of resilient health systems, albeit at different stages of maturity.

It has enabled the successful scaling up of existing interventions and the addition of newer reforms given the rapid transitions from rural to urban, gradual demographic transition to aging populations, increasing burden of chronic diseases, and the emergence of newer infectious diseases.

-Article written by Swathi Satish

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National Rural Health Mission: Turning into Reality

Deoki nandan.

Director, NIHFW, New Delhi, India. moc.oohay@15nadnand

On 12 April 2005, the Government of India took a major welfare initiative by launching National Rural Health Mission (NRHM) in 18 states with weak public health indicators and infrastructure and extended it across the entire country. What constituted the conceptual build-up to this mission was a spectrum of systemic deficiencies in the health system. These included lack of holistic approach, absence of linkages with collateral health determinants, gross shortage of infrastructure and human resources, lack of community ownership and accountability, non-integration of vertical disease control programs, non-responsiveness and lack of financial resources.

The NRHM employed five main approaches while addressing these issues – communitization, flexible financing, improved management through capacity building, monitoring progress against standards, and innovations in human resource management, which became the mainstay. What helped immensely in communitizing the health care was the ongoing process of decentralization with concomitant convergence. Development of village health plan through Village Health and Sanitation Committee (VHSC) and its integration into the district plan, which in turn has been made the main instrument for planning, inter-sectoral convergence, implementation and monitoring, was instituted as the fulcrum of decentralization (till date more than 451,000 VHSCs are functional).( 1 ) Convergence of all programs is being ensured at village and facility level. Effective integration of health concerns with other health determinants like sanitation and hygiene, nutrition and safe drinking water through district health plan is being made. Panchayat Raj Institutions (PRIs), self-help groups, and health, nutrition and sanitation committees have been activated to seek local accountability in the delivery of programs.

On the other hand, untied funds are making things somewhat easier for the peripheral health facilities, while overcoming small day-to-day problems. Each sub-center is provided with Rs. 10,000 to facilitate urgent activities needing relatively small sums of money. Funds are kept in the joint bank account of ANM and Village Pradhan and are used only for common good, e.g. purchase of consumables such as bandages in sub-center or purchase of bleaching powder and disinfectants for use in common areas of the village. Barring the case of referral and transport in emergency situations, the untied fund is not utilized for individual clients. Sub-centers are encouraged to use the untied funds for minor modifications and repairs of sub-center; ad-hoc payments for cleaning up sub-center; transport of samples during epidemics; labor and supplies for environmental sanitation, such as clearing or larvicidal measures for stagnant water. This can also be used to reward volunteers for certain identified activities, but not to meet the expenses of the Gram Panchayat . An annual maintenance grant is also available to Primary and Community Health Centres (PHCs and CHCs). There are certain special financial provisions too which may be underscored as NRHM innovation for upgrading CHCs, district hospitals, etc. to Indian Public Health Standards; corpus grant for Rogi Kalyan Samitis (RKS); and grant for Mobile Medical Unit (MMU) per district (there are currently 29,223 RKS operational and 1031 MMUs in different states).( 1 ) Needless to say, NRHM has succeeded in making resources available at the level of facilities, which were earlier starved of the needed resources.

In the process of communitization, the role of Non-governmental Organizations (NGOs) is critical for the success of NRHM. Their partnership is being utilized under the disease control programs, reproductive and child health, routine immunization and special immunization activities (SIAs). To this effect, a highly imaginative Janani Suraksha Yojana (JSY) is already making use of partnerships of various NGOs. Efforts are being made to involve NGOs at all levels of the health delivery system and more infrastructures in training of Accredited Social Health Activists (ASHAs) (300 mother NGOs are involved in ASHA training).( 1 ) This involves entering into partnership arrangement with the private sector (including individuals) for the improvement of support services such as cleaning services, laundry services, diagnostic facilities and ambulatory services. Some of the other innovative actions in this domain are about developing/leasing out vacant land in the premises of the hospital for commercial purposes, with a view to improve financial position of the health societies, encouraging community participation in the maintenance and upkeep of the hospital, promoting measures for resource conservation through adoption of wards by institutions or individuals, and adopting sustainable and environmental friendly measures for the day-to-day management of the hospital, e.g. scientific hospital waste disposal system, solar lighting systems, solar refrigeration systems, water harvesting and water recharging systems.

Half a decade back, when the NRHM was launched, certain concerns were placed on record and debated. It was said, and rightly so, that the success of this mission would heavily depend on PRIs for effective utilization of resources and providing micro-level leadership - while the state governments were yet to empower PRIs in most parts, with real devolution of power.( 2 ) NRHM gains are being registered at an accelerated pace in states where the PRIs are in full command. States will have to invest in capacity building of PRIs, so that locally designed initiatives are responsive to needs of local community and equity related issues are addressed. Social audit is gradually being accepted as one of the important mechanisms to ensure that intended benefits reach target groups. There are immense political commitments to promote social audit in schemes like Mahatma Gandhi National Rual Employment Guarantee Act (MNREGA). A similar target has to be given to evolving a framework of social audit of NRHM, engaging different stakeholders additionally. Unlike all other programmes in the past, NRHM has clearly laid down the guidelines of operationalization of decentralization and implementation of the strategy which undoubtedly ensures the greater participation of the community.( 3 )

One of the success stories being attributed to NRHM is a huge increase in institutional deliveries. ASHAs (around 7.5 lakh in number)( 1 ) at grassroot level have done a phenomenal job in mobilizing women from valuable community to come to institutions (the number of beneficiaries under JSY had increased from 7 lakhs in 2005-2006 to over 86 lakhs in 2008-2009).( 1 ) It is critical to ensure that there is corresponding increase in inputs available at the facilities, so that health outcomes for mother and baby are ensured. There definitely have been gains as shown by statistics - infant mortality rate has come down to 53/1000 live births, maternal mortality rate has come down to 254/1000 live births and total fertility rate is now 2.7.( 1 )

What the future holds for NRHM should be seen through the lens of similar challenges ahead. Complexities in attaining inter-sectoral convergence; multidimensional strategy at district, block and village levels; cross-linkages with the issues of poverty, illiteracy, and social inertia; governance issues, including ongoing empowerment of PRIs; vibrant VHSC including safe water management; impediments in release of funds; and assured availability of incremental outlays for mission period are going to test the endurance of NRHM. The inherent riddles in public-private partnership will continue to examine the pro-people character of NRHM for a very long period. There is also a need to explore linkages with the ongoing programs like MNREGA, added with the deployment of rich repository of human resource of elderly men and women, who could be used for community mobilization. Social audit for community action is the call of the day to ensure that dreams of Mahatma Gandhi for Swaraj come true.

Let communitization be our path finder during such testing times.

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National Health Mission (NHM)

For the purpose of health systems strengthening in urban and rural areas, the Indian government launched the National Health Mission (NHM) in 2013. NHM encompasses two sub-missions, namely National Rural Health Mission and National Urban Health Mission. The government extended it in March 2018, to continue until March 2020.

( Note: Information listed in this page has been sourced from the website of National Health Mission.)

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Types of National Health Mission

National rural health mission (nrhm).

Launched in April 2005, the National Rural Health Mission focuses on providing accessible, affordable and quality healthcare to the rural population, particularly the vulnerable groups. Under the National Rural Health Mission , the Empowered Action Group States and the North Eastern States, Jammu and Kashmir and Himachal Pradesh are given special focus. The mission aims to establish a fully functional, community-owned, decentralized health delivery system, with inter-sectoral convergence at every level. This has been undertaken to ensure simultaneous action on a range of determinants of health, like water, sanitation, nutrition, education, social and gender equality.

National Urban Health Mission (NUHM)

NUHM seeks to improve the health status of the urban population, especially slum dwellers and other vulnerable sections, by providing them access to quality primary healthcare. National Urban Health Mission covers all district headquarters, state capital and other cities whose population is over 50,000 (as per census 2011) in a phased manner. Cities and towns whose population is less than 50,000 are covered under NRHM.

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Features Benefits Of National Health Mission (NHM)

Features of National Health Mission

The features of National Health Mission are as follows:

• It encompasses the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM).
• It aims to provide equitable, affordable & quality healthcare services
• ASHA, Rogi Kalyan Samiti/Hospital Management Society, Janani Suraksha Yojana (JSY) and The Village Health Sanitation and Nutrition Committee (VHSNC) are some of the major initiatives under National Health Mission.
• Web-based monitoring system Health Management Information System has been put in place by the Ministry for monitoring health programmes under National Health Mission

Benefits of National Health Mission

The benefits of National Health Mission are as follows:

• It provides affordable and quality healthcare to the rural population.
• It has strengthened the healthcare infrastructure.
• It has brought down maternal mortality among the poor pregnant women.
• The prevalence of tobacco use and number of tobacco users have reduced.
• The Janani Shishu Suraksha Karyakram entitles pregnant women to give birth in public health institutions at no expense.

Components of National Health Mission (NHM)

Rmnch+a - reproductive, maternal, newborn, child and adolescent health.

Improving the health of mothers and their children as well as ensuring their survival are vital to the achievement of national health goals under the NHM. SDG Goal 3 focuses on bringing down maternal, new-born and child mortality. Innovative strategies have evolved under the national programme to deliver evidence-based interventions to different population groups.

Following the “Call to Action (CAT) Summit” in February, 2013, the Ministry of Health & Family Welfare introduced Reproductive, Maternal, Newborn Child plus Adolescent Health (RMNCH+A) to influence the key interventions for reducing maternal and child morbidity and mortality.

Health Systems Strengthening

Quality standards have been prescribed for clinical protocols, administrative and management processes and support services. Skill sets and standard treatment protocols for providing quality RCH services and training packages have been designed. Additionally, the creation of a hospital management society with untied funds, enabling public participation, has contributed to improved quality of care.

Non-Communicable Disease Control Programmes

Non-communicable diseases are one of the leading causes of mortality and morbidity. The government has initiated a number of national programs for their prevention and control. These include:

• National Programme for prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & stroke (NPCDCS)
• National Programe For Control Of Blindness & Visual Impairment (NPCBVI)
• National Oral Health Programme (NOHP)
• National Programme for Palliative care (NPPC)
• National Programme for Prevention & Management of Burn Injuries (NPPMBI)
• National Mental Health Programme (NMHP)
• National Programme for healthcare of Elderly (NPHCE)
• National Programme for the Prevention & Control of Deafness (NPPCD)
• National Tobacco Control Programme (NTCP)
• Other Non-Communicable disease Control Programmes

Communicable Disease Control Programme

With a view to limit instances of communicable diseases, the government has initiated the following programs:

• National Vector Borne Disease Control Programme (NVBDCP)
• Revised National Tuberculosis Control Programme (RNTCP)
• National Leprosy Eradication Programme (NLEP)
• Integrated Disease Surveillance Programme (IDSP)

Infrastructure Maintenance

Releases to State Health & FW Society Infrastructure Maintenance for 2014-15, 2015-16, 2016-17, 2017-18 and 2018-19 are listed on the website of National Health Mission.

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Initiatives for Community Participation Under NHM

Some of the initiatives for community participation under National Health Mission are as follows:

Rogi Kalyan Samiti: This committee is a registered society whose members act as trustees, managing the hospital affairs. It is responsible for maintaining the facilities and ensuring provision of better facilities for the patients in the hospital. Financial assistance through untied fund is provided for the purpose of undertaking activities for patient welfare. 31,763 Rogi Kalyan Samitis have been established, involving the members of the community in nearly all District Hospitals (DHs), Sub-District Hospitals (SDHs), Community Health Centres (CHCs) and Primary Health Centres (PHCs).

Accredited Social Health Activist (ASHA): Over 9.15 lakh ASHAs are in place across the nation. They serve as facilitators, mobilizers and providers of community level care. ASHA is the first port of call in the community, particularly for marginalized sections of the population, with a focus on women and children.

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Objectives achievements of national health mission (nhm), objectives of national health mission.

National Health Mission endeavours to:

• Bring down MMR to 1/1000 live births
• Bring down IMR to 25/1000 live births
• Bring down TFR to 2.1
• Prevention and reduction of anaemia in women from the ages 15 to 49 years
• Prevent and reduce mortality & morbidity from communicable, noncommunicable; emerging ailments and injuries.
• Bring down household out-of-pocket expenses on overall health care expenditure
• Bring down annual incidence and mortality from Tuberculosis by half
• Bring down prevalence of leprosy to <1/10000 population and incidence to zero in all districts
• Annual malaria incidence to be <1/1000 10
• Less than 1% microfilaria prevalence in all districts
• Kala-azar elimination by 2015, <1 case per 10000 population in all blocks

Achievements of National Health Mission

• National Tobacco Control Programme is in-force in around 612 districts in all States/UTs.
• Tobacco use has gone down by 6 percentage points from 34.6% to 28.6% from 2009-10 to 2016-17. Tobacco users have come down by around 81 lakhs
• The National Tobacco Cessation Quitline Services was launched.
• 'mCessation' initiative introduced to help tobacco users quit through text-messaging via mobile phones.
• Regulating the use of cigarettes and other tobacco products in TV programmes and films.
• Established the ‘Global Knowledge Hub for Smokeless Tobacco’.
• Acceded to the Protocol to Eliminate Illicit Trade in Tobacco Products under Article 15 of the WHO Framework Convention on Tobacco Control.
• Issued an advisory to ban Electronic Nicotine Delivery System, including Heat-Not-Burn devices, e-Cigarettes, Vape, e-Sheesha, e-Nicotine Flavoured Hookah, and similar devices that allow nicotine delivery besides other than for the purpose and to the extent, as may be approved under the Drugs and Cosmetics Act, 1940 and Rules made thereunder.
• Three national tobacco testing laboratories have been set up.

National Health Mission - Janani Suraksha Yojana

Janani Suraksha Yojana is a safe motherhood intervention whose objective is to reduce the mortality rate of mothers and new-born babies by promoting institutional delivery. The scheme aims to encourage poor pregnant women to give birth in registered health institutions, where medical staff are on-hand, in case something goes wrong. Janani Suraksha Yojana integrates cash assistance along with delivery and post-delivery care. The success of the scheme can be determined by the increase in institutional delivery among the poor families.

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The NHM was introduced with the aim to provide universal access to equitable, affordable and quality healthcare services that are responsive to the needs of the country's citizens. Many states have shown improved progress in healthcare facilities as well as the health of the individuals following the implementation of various initiatives under NHM. The mission, launched by the government in 2013, is set to continue until March 2020.

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Healthy People 2030 Questions & Answers

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• How does Healthy People 2030 address social determinants of health?

How were health disparities and health equity incorporated into the selection process for Healthy People 2030 objectives and Leading Health Indicators?

Are there any additional features coming in the future.

Healthy People 2030 is the nation’s 10-year plan for addressing our most critical public health priorities and challenges.  

In 1980, the U.S. Department of Health and Human Services (HHS) released the first set of Healthy People 10-year objectives. Healthy People 2030 is the fifth iteration of the Healthy People initiative.

Healthy People helps individuals, organizations, and communities committed to improving health and well-being address public health priorities. Healthy People 2030 includes hundreds of measurable objectives with ambitious but achievable national targets. Objectives are associated with a variety of resources that can be used to help achieve these targets.  

Healthy People 2030 was created with the successes and lessons learned from previous iterations of the Healthy People initiative in mind. Subject matter experts across several disciplines developed the Healthy People 2030 framework and objectives, and stakeholders from several sectors provided their input through public comments on the new objectives and framework for Healthy People. The Healthy People 2030 framework outlines the vision, mission, foundational principles, plan of action, and overarching goals of the initiative’s current iteration. Check out the Healthy People 2030 framework .

The HHS Office of Disease Prevention and Health Promotion manages Healthy People and led the development of Healthy People 2030. The  National Center for Health Statistics (NCHS)  at the Centers for Disease Control and Prevention (CDC) provides statistical expertise for Healthy People’s data.

The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030, a federal advisory committee composed of nationally and internationally recognized non-federal subject matter experts, provided recommendations on the framework, objective and data selection criteria, and more. Learn more about the Secretary’s Advisory Committee .

The Healthy People Federal Interagency Workgroup (FIW)  — along with individual workgroups of federal subject matter experts representing more than 20 federal agencies — developed the Healthy People 2030 objectives and selected targets and will help review data and resources associated with the objectives throughout the decade. Learn about the Healthy People 2030 workgroups .

Stakeholders, organizations, and members of the public contributed to Healthy People 2030’s development via multiple public comment periods.

Healthy People 2030 has many different types of resources that can support your work. Check out our How to Use Healthy People 2030 graphic to get tips your community, state, or organization can use to achieve your goals, improve health and well-being, and contribute to national public health goals. You can also use our promotional toolkit to help spread the word about Healthy People 2030 to your networks.

Use Healthy People 2030’s search tool to easily find information relevant to your work. You can filter information based on your interests to find topics, objectives with baseline data and targets, and evidence-based resources. In addition, you can  use our new Custom List tool  to build a list of objectives that are relevant to your work — and track them over the decade. 

Additional data and resources are coming soon —  check out our timeline for more information . 

Healthy People 2030 includes 3 types of objectives:

• 359  core , or measurable, objectives, which are associated with targets for the decade and evidence-based resources and have valid, reliable, nationally representative data
• 111  developmental objectives, which are associated with evidence-based interventions but don’t yet have reliable baseline data
• 40  research objectives, which aren’t associated with evidence-based interventions

Some developmental and research objectives may evolve throughout the decade to become core objectives. Learn more about the Healthy People 2030 objectives .

In response to stakeholder feedback and user surveys, we reduced the total number of measurable objectives from over 1,000 for Healthy People 2020 to 359 for Healthy People 2030. Objectives were chosen using rigorous selection criteria recommended by  the Secretary’s Advisory Committee and made available for public comment. As a result, the objectives focus on the country’s highest-priority public health issues, avoid overlap, and use higher data standards than previous decades. 

On the Healthy People 2030 website, the objectives are organized into more intuitive topics — and we developed a tool to help you see which Healthy People 2020 objectives have been modified, removed, or retained for Healthy People 2030.

A new decade means new opportunities to improve health and well-being across the nation. This decade, Healthy People 2030 features a smaller set of objectives with: 

• More rigorous data standards
• New objectives related to e-cigarettes, flavored tobacco use in adolescents, and opioid use disorder
• Resources for adapting Healthy People to emerging health issues like COVID-19

For the first time, Healthy People 2030 also sets 10-year targets for objectives related to social determinants of health. And we’ve updated our health literacy definition for the first time in 20 years to emphasize how both individuals and organizations can help improve health literacy. 

In addition, Healthy People 2030 features 8 Overall Health and Well-Being Measures (OHMs) . Called Foundation Health Measures in Healthy People 2020, the Healthy People 2030 OHMs include a new measure on well-being.

Healthy People 2030 also features 23 Leading Health Indicators (LHIs) . LHIs are a small subset of high-priority core objectives that highlight critical public health issues across different life stages. Together, LHIs and OHMs will help individuals, organizations, and communities committed to improving health and well-being set priorities, track nationwide progress toward improving health and well-being, and assess progress toward achieving Healthy People 2030’s vision.  

We also have an improved website, with an application programming interface (API) to support faster data deployment, a tool for building custom lists of objectives, a more sophisticated search tool, and more intuitive navigation. 

The definitions of health disparities and health equity haven’t changed since Healthy People 2020.  

Healthy People defines health equity as “the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.” 

Healthy People defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.” 

Learn more about Healthy People’s health equity and health disparities definitions .  

Health disparities and health equity have been an important focus of Healthy People for over 30 years. Similar to Healthy People 2020, one of Healthy People 2030’s overarching goals is to “eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.” To help stakeholders work toward this goal, Healthy People: 

• Provides data monitoring tools 
• Highlights evidence-based resources and practices 
• Promotes multisector collaboration  

Each decade, Healthy People tracks progress toward meeting the national disease prevention and health promotion goals and objectives, and it monitors differences across population subgroups. Healthy People data tools summarize and display changes in health disparities to help identify priority populations.  

Healthy People 2030 also features evidence-based resources focused on strategies that are proven to improve health. These resources include interventions to address public health issues among specific population groups and improve the health of all people.  

In addition, Healthy People collects stories that highlight how states, communities, and organizations address health disparities, advance health equity, and improve health by: 

• Using evidence-based interventions and strategies 
• Evaluating interventions 
• Forming multisector collaborations   

Read the facts and watch a video about how Healthy People 2030 promotes health equity. 

How does Healthy People 2030 address social determinants of health?

We brought national attention to social determinants of health (SDOH) when we incorporated them into the Healthy People 2020 prevention framework. Since then, the impact of social determinants has become even more clear — the fact is, the conditions in the environments where people are born, live, learn, work, play, worship, and age significantly influence their health. That’s why Healthy People 2030 continues to focus on SDOH. 

More than a dozen workgroups of subject matter experts with diverse backgrounds worked to develop a range of Healthy People 2030 objectives related to SDOH. For the first time in the initiative’s history, the Healthy People 2030 SDOH objectives also have 10-year targets. (In Healthy People 2020, the SDOH objectives were informational, meaning there was no set target.)    

In addition to objectives, the Healthy People definition for SDOH was adopted in early 2020 as the official HHS definition, meaning that all HHS agencies will approach SDOH using the Healthy People framework. Learn more about Healthy People 2030's focus on SDOH .  

Healthy People SDOH literature summaries provide a snapshot of the latest research on SDOH. These summaries explore a range of key SDOH — such as discrimination, social cohesion, access to health services, and poverty — and examine how these issues can impact health outcomes and health disparities.  Explore Healthy People 2030's SDOH literature summaries and find infographics on key SDOH . 

HHS considered health equity and health disparities throughout the Healthy People 2030 objective development process. To select core objectives, subject matter experts applied specific criteria, including considering how each objective would address health disparities and advance health equity. In addition, the selection criteria for Healthy People 2030 Leading Health Indicators — a subset of high-priority core objectives — required that the indicators address social determinants of health, health disparities, and health equity.

Yes! More tools and resources — like disparities data, evidence-based resources, and state-based resources — will be released throughout the decade. Check out our timeline to see when you can expect them.

And be sure to visit the Healthy People 2020 website and check out “Healthy People 2020: An End of Decade Snapshot” to find data from the last decade of Healthy People and read about progress made over the decade.

Please stay tuned for updates and additions to Healthy People 2030!

The Office of Disease Prevention and Health Promotion (ODPHP) cannot attest to the accuracy of a non-federal website.

Linking to a non-federal website does not constitute an endorsement by ODPHP or any of its employees of the sponsors or the information and products presented on the website.

You will be subject to the destination website's privacy policy when you follow the link.

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How the GRU spy agency targets the west, from cyberspace to Salisbury

Accusations mount against the Russian army’s main intelligence directorate

In Russia’s shadow war with the west, one intelligence agency keeps making headlines.

The GRU, or main intelligence directorate, of the Russian army, has been accused of spearheading several of Russia’s most notorious operations in recent years. They include the 2014 seizure of Crimea using undercover soldiers called “little green men”, the hacking theft of emails from the Democratic National Committee and Hillary Clinton, and even the planning of a failed coup in Montenegro .

A British security source told the Guardian on Monday that the nerve agent attack on the former double agent Sergei Skripal was also ordered by the intelligence agency. The British government is poised to submit an extradition request to Moscow for two Russians suspected of carrying out the Salisbury attack that left one person dead and three injured, including Skripal and his daughter.

One of the three main Russian intelligence agencies, less has been written about the GRU (now officially called the GU, or Main Directorate of the General Staff of the Russian Armed Forces) than its sister agencies, particularly the Soviet-era KGB or its modern successor the FSB, the spy agency once headed by Vladimir Putin .

Known for operating under a wartime mentality and a willingness to take risks, experts say the culture of the GRU has been influenced by its inclusion of Spetsnaz special forces and experience in war zones, including Syria and Ukraine .

Open source researchers have claimed that a GRU officer supervised the transport of anti-aircraft weapons to eastern Ukraine when the Malaysian jetliner flight MH17 was shot down there, killing 298 people.

“The GRU regards itself as a war-fighting instrument. Yes, it gathers conventional intelligence … but its culture is much more military,” said Mark Galeotti, an expert on Russian security issues and the country’s intelligence agencies . “Although only a minority of GRU officers are Spetsnaz, it has an impact when part of your service are commandos.”

Besides special forces, the spy agency manages more traditional intelligence-gathering operations around the world, as well as signals intelligence.

Vladimir Rezun, a GRU officer who defected to the UK in the 1970s, wrote in his history of the agency (written under the pen name Viktor Suvorov) that it was largely tasked with preventing the collapse of the Soviet Union from without, as opposed to the KGB, which had a prominent role in thwarting internal threats.

While the KGB became notorious, the GRU largely operated in obscurity. “In the people’s consciousness, everything that is dark, underground and secret is connected with the KGB but not at all with the GRU,” he wrote.

Traditionally, Galeotti noted, the GRU answered for “uncontrolled spaces”. While in the past that has meant areas like civil wars, it may also apply to zones like cyberspace now.

Several Russian intelligence agencies were involved in hacking operations before the 2016 US presidential elections, but only the GRU was identified in an 11-count indictment released last month by the United States special counsel Robert Mueller’s investigation. The hack was perpetrated by staff employees of several Moscow-based units traditionally tied to signal intelligence.

The interests of Russia’s intelligence agencies regularly overlap, as have their methods. As Christopher Andrew wrote in The Mitrokhin Archive: The KGB in Europe and the West, his study of notes on KGB files smuggled out of Russia, the agency “offered its allies lethal nerve toxins and poisons which were fatal on contact with the skin for use during ‘special actions’”.

While the GRU has largely been shrouded in secrecy, there have been occasional contacts with the west.

Peter Zwack, a retired US army brigadier general, wrote about a series of meetings before the Sochi Olympics with the head of the GRU, Igor Sergun, who died unexpectedly of a heart attack in January 2016. “I found him soft-spoken, unassuming, complex, erudite and nuanced,” he said of their meetings, which largely focused on counter-terrorism efforts.

“I learned that even as Sergun relentlessly directed global intelligence operations against our interests, he — paradoxically — also viewed constant confrontation with the US and west as not in Russia’s best long-term interest,” Zwack wrote.

Those meetings ended after Russia’s invasion of Ukraine.

• Trump-Russia investigation
• Sergei Skripal
• Robert Mueller

More on this story

Baltic states no longer a bridge between east and west, says Latvia

Russian at Oslo IT conference held on suspicion of spying

Russia to hold biggest war games since 1981

Russia could cut off internet to Nato countries, British military chief warns

Vladimir Putin watches display of Russian firepower near EU border

Nato accuses Russia of blocking observation of massive war game

Dispute along cold war lines led to collapse of UN cyberwarfare talks

West failing to tackle Russian hacking and fake news, says Latvia

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Preview: Valencia Basket vs. Khimki Moscow Region 22 december 2020

On Wednesday, December 23, 2020 Khimki Moscow Region will face Valencia Basket, Spain in a EuroLeague round 16 game. The game will be played in Valencia at La Fonteta. Tip-off at 23:00 msk.

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Midwest tornadoes flatten homes in Nebraska suburbs and leave trails of damage in Iowa

A tornado plowed through suburban Omaha, Nebraska, on Friday afternoon. (AP video by Margery Beck)

Two women help carry a friend’s belongings out of their damaged home after a tornado passed through the area in Bennington, Neb., Friday, April 26, 2024. (AP Photo/Josh Funk)

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Gopala Penmetsa walks past his house after it was leveled by a tornado near Omaha, Neb., on Friday, April 26, 2024. (Chris Machian/Omaha World-Herald via AP)

A tornado is seen near north of Waverly, Neb., on Friday, April 26, 2024. (Chris Machian/Omaha World-Herald via AP)

Homeowners assess damage after a tornado caused extensive damage in their neighborhood northwest of Omaha in Bennington, Neb., Friday, April 26, 2024. (AP Photo/Josh Funk)

Damaged houses are seen after a tornado passed through the area near Omaha, Neb., on Friday, April 26, 2024. (Chris Machian/Omaha World-Herald via AP)

Damage is seen to houses after a tornado passed through the area near Omaha, Neb., on Friday, April 26, 2024. (Chris Machian/Omaha World-Herald via AP)

From left; Ally Mercer, Gabe Sedlacek Kaleb Andersen and Austin Young watch a tornado from a seventh floor parking garage on Friday, April 26, 2024, in Lincoln, Neb. (Kenneth Ferriera/Lincoln Journal Star via AP)

Firefighters work to clear a home damaged by a tornado northwest of Omaha, Neb., on Friday, April 26, 2024. (AP Photo/Margery A. Beck)

A tornado begings touch down near U.S. Route 275 near the Platte river near Omaha, Neb., on Friday, April 26, 2024. (Chris Machian/Omaha World-Herald via AP)

Debris is seen from a destroyed home northwest of Omaha, Neb., after a storm tore through the area on Friday, April 26, 2024. (AP Photo/Margery A. Beck)

A tornado touches down on Friday, April 26, 2024, in Lincoln, Neb. (Kenneth Ferriera/Lincoln Journal Star via AP)

A destroyed home is seen northwest of Omaha, Neb., after a storm tore through the area on Friday, April 26, 2024. (AP Photo/Margery A. Beck)

A tornado moves through suburbs northwest of Omaha on Friday, April 26, 2024, as seen from Bennington, Neb. (Chris Gannon via AP)

Severe weather damage to Eppley Airfield in Omaha, Neb., can be seen from the Lewis and Clark Monument in Council Bluffs, Iowa, Friday, April 26, 2024. (Anna Reed/Omaha World-Herald via AP)

A tornado touches down north of Lincoln, Neb., on Friday, April 26, 2024. (Kenneth Ferriera/Lincoln Journal Star via AP)

A destroyed house is seen northwest of Omaha, Neb., after storms swept through the area on Friday, April 26, 2024. (AP Photo/Margery A. Beck)

A piece of wood is embedded in the ground as firefighters assess the damages to houses after a tornado passed through the area near Omaha, Neb., on Friday, April 26, 2024. (Chris Machian/Omaha World-Herald via AP)

Damage is seen to a home after a tornado passed through the area near Bennington, Neb., Friday, April 26, 2024. (AP Photo/Josh Funk)

Gopala Penmetsa walks past a damaged house after a tornado passed through the area near Omaha, Neb., on Friday, April 26, 2024. His house was leveled by the tornado. (Chris Machian/Omaha World-Herald via AP)

Firefighters assess the damage to houses after a tornado passed through the area near Omaha, Neb., on Friday, April 26, 2024. (Chris Machian/Omaha World-Herald via AP)

Linda Kolhof, 66, looks over damage outside her home after a severe storm in Council Bluffs, Iowa, on Friday, April 26, 2024. (Anna Reed/Omaha World-Herald via AP)

Robert Keesee helps his father, Randy Keesee, up a ladder to access roof damage to their home after a severe storm hit the neighborhood in Council Bluffs, Iowa, on Friday, April 26, 2024. (Anna Reed/Omaha World-Herald via AP)

Harold Huff, 83, looks over damage after a severe storm in Council Bluffs, Iowa, on Friday, April 26, 2024. (Anna Reed/Omaha World-Herald via AP)

Jim Huff, 53, breaks down fallen trees after a severe storm hit his neighborhood in Council Bluffs, Iowa, on Friday, April 26, 2024. (Anna Reed/Omaha World-Herald via AP)

Damage is seen to Justin and Amanda Putnam’s bedroom after a severe storm damaged their neighborhood in Council Bluffs, Iowa, on Friday, April 26, 2024. (Anna Reed/Omaha World-Herald via AP)

Neighbors help clean up Justin and Amanda Putnam’s home after a severe storm blew through the area in Council Bluffs, Iowa, on Friday, April 26, 2024. (Anna Reed/Omaha World-Herald via AP)

OMAHA, Neb. (AP) — A tornado plowed through suburban Omaha, Nebraska, on Friday, damaging hundreds of homes and other structures as it tore for miles along farmland and into subdivisions. Some injuries were reported but there were no immediate reports that anyone was killed.

Multiple tornadoes were reported in Nebraska and Iowa on Friday, but the most destructive storm moved from a largely rural area into suburbs northwest of Omaha, a city of 485,000 people. Photos on social media showed the small city of Minden, Iowa, about 30 miles (48.3 kilometers) northeast of Omaha also sustained heavy damage.

Three people were injured in Nebraska’s Lancaster County when a tornado hit an industrial building, causing it to collapse with 70 people inside. Several were trapped, but everyone was evacuated and the injuries were not life-threatening, authorities said.

Hundreds of houses sustained damage in Omaha, mostly in the Elkhorn area in the western part of the city, Omaha police Lt. Neal Bonacci said. Police and firefighters moved door-to-door to help people. Crews went to the “hardest hit area” and had a plan to search anywhere someone could be trapped, Omaha Fire Chief Kathy Bossman said.

“They’re going to be putting together a strategic plan for a detailed search of the area, starting with the properties with most damage,” Bossman said. “We’ll be looking throughout properties in debris piles, we’ll be looking in basements, trying to find any victims and make sure everybody is rescued who needs assistance.”

Bonacci said many homes were destroyed or severely damaged.

“You definitely see the path of the tornado,” Bonacci said.

AP AUDIO: Midwest tornadoes flatten homes in Nebraska suburbs and leave trails of damage in Iowa.

Omaha resident Pat Woods says they saw the tornado and took cover.

In one area of Elkhorn, dozens of newly built, large homes were damaged. At least six were wrecked, including one that was leveled, while others had the top half ripped off. There were dozens of emergency vehicles in the area.

“We watched it touch down like 200 yards over there and then we took shelter,” said Pat Woods, who lives in Elkhorn. “We could hear it coming through. When we came up our fence was gone and we looked to the northwest and the whole neighborhood’s gone.”

His wife, Kim Woods added, “The whole neighborhood just to the north of us is pretty flattened.”

Three people, including a child, were in the basement of the leveled home when the tornado hit but got out safely, according to Dhaval Naik, who said he works with home’s owner.

KETV-TV video showed one woman being removed from a wrecked home on a stretcher in Blair, a city just north of Omaha.

Bonacci said only two people have been transported for treatment, both with minor injuries.

He said crews are now doing a second search of homes. He said fire crews would work throughout the night to check all the unsafe structures and make sure no one is inside.

“People had warnings of this and that saved lives,” Omaha Police Chief Todd Schmaderer said, of the few serious injuries.

The tornado warning was issued in the Omaha area on Friday afternoon just as children were due to be released from school. Many schools had students shelter in place until the storm passed. Hours later, buses were still transporting students home.

“Was it one long track tornado or was it several tornadoes?” said Becky Kern, the warning coordination meteorologist in the National Weather Service’s Omaha office.

She said the agency planned to send out multiple crews over the next several days to determine the number of tornadoes and their strength, and that it could take up to two weeks to finish the evaluation.

“Some appeared to be violent tornadoes,” she continued. “There were tornadoes in different areas. And so it’s like forensic meteorology, we call it, like piecing together, all the damage indicators.”

Another tornado hit an area on the eastern edge of Omaha, passing directly through parts of Eppley Airfield, the city’s airport. Officials closed the airport to aircraft operations to access damage but then reopened the facility, Omaha Airport Authority Chief Strategy Officer Steve McCoy said.

The passenger terminal wasn’t hit by the tornado but people rushed to storm shelters until the twister passed, McCoy said.

After passing through the airport, the tornado crossed the Missouri River and into Iowa, north of Council Bluffs.

Nebraska Emergency Management Agency spokesperson Katrina Sperl said damage reports were just starting to come in. Taylor Wilson, a spokesperson for the University of Nebraska Medical Center, said they hadn’t seen any injuries yet.

In Lancaster County, where three people were injured when an industrial building collapsed, sheriff’s officials also said they had reports of a tipped-over train near Waverly.

Two people who were injured in the county were being treated at the trauma center at Bryan Medical Center West Campus in Lincoln, the facility said in a news release. The hospital said the patients were in triage and no details were released on their condition.

The Omaha Public Power District reported that nearly 10,000 customers were without power in the Omaha area.

Daniel Fienhold, manager of the Pink Poodle Steakhouse in Crescent, Iowa, said he was outside watching the weather with his daughter and restaurant employees. He said “it looked like a pretty big tornado was forming” northeast of town.

“It started raining, and then it started hailing, and then all the clouds started to kind of swirl and come together, and as soon as the wind started to pick up, that’s when I headed for the basement, but we never saw it,” Fienhold said.

The forecast for Saturday was ominous. The Weather Service also issued tornado watches across parts of Iowa, Kansas, Missouri, Oklahoma and Texas. And forecasters warned that large hail and strong wind gusts were possible.

“It does look like a big outbreak again tomorrow,” Kern said. “Maybe slightly farther south.”

Hollingsworth reported from Mission, Kansas. Associated Press writers Hannah Fingerhut in Des Moines, Iowa, Jack Dura in Bismarck, North Dakota, and Jeff Martin in Atlanta contributed to this report.

Khimki, Moscow Oblast, Russia

Khimki is a city located in Moscow Oblast, Russia, which is situated about 23 kilometers northwest of Moscow. It is one of the most significant industrial centers in the region and has a population of approximately 253,000 inhabitants as of 2021. The city is connected to Moscow by the Moscow-St. Petersburg highway and the Moscow Central Circle railway.

One of the most beautiful areas in Khimki is the historical center, which is known for its well-preserved buildings from the 19th and 20th centuries. The area is home to the City Hall and the City History Museum, as well as several beautiful parks and green spaces. The housing prices in this area are on the higher end due to the historic charm and central location. The average price for a one-bedroom apartment in the historical center is around 50,000 rubles (about $675) per month. The transportation is convenient with several bus and minibus routes connecting the area to the rest of the city. This area is generally safe, with low crime rates.

Another area worth mentioning is the recently developed residential district of Yaroslavsky. It is located in the eastern part of the city and is known for its modern and comfortable living spaces. The area has a large park with several playgrounds, bike paths, and sports fields. The housing prices in this area are more affordable compared to the historical center, with the average rent for a one-bedroom apartment being around 30,000 rubles (about $400) per month. The transportation is also convenient, with several bus routes connecting the area to the rest of the city. The safety of this area is also high, with low crime rates.

The Sokolniki neighborhood is also a popular residential area in Khimki. It is located in the southwestern part of the city and is known for its green spaces, which include several parks and forests. The housing prices in this area are slightly higher than in Yaroslavsky, with the average rent for a one-bedroom apartment being around 35,000 rubles (about $470) per month. The transportation is convenient, with several bus and minibus routes connecting the area to the rest of the city. The safety of this area is also high, with low crime rates.

Khimki is known for its diverse industry, which includes metalworking, chemicals, and construction materials. The city has several large industrial plants, such as the Sheremetyevo International Airport, which is one of the busiest airports in Russia. The city also has several shopping centers and entertainment complexes, such as the MEGA Khimki Mall, which is one of the largest malls in the region.

The people of Khimki are known for their love of sports, with football, ice hockey, and basketball being the most popular. The city has several sports clubs, such as the Khimki Basketball Club, which is one of the most successful basketball teams in Russia. The city also has several well-known public figures, such as the musician and composer Andrey Makarevich, who is known for his work with the band Mashina Vremeni.

Khimki is a beautiful city with a rich history and culture. The city has several outstanding areas, each with its own unique charm and character. The housing prices in the city are generally affordable, and the transportation is convenient, making it a great place to live. The city is known for its diverse industry, sports, and entertainment options, making it a great place to work and play.