I. Overview of the Centers for Disease Control and Prevention

FY 2000 Performance Plan - Revised Final FY 1999 Performance Plan

The Centers for Disease Control and Prevention (CDC) is the lead federal agency responsible for promoting health and quality of life by preventing and controlling disease, injury, and disability. CDC accomplishes its mission by working with partners throughout the nation and the world to monitor health, detect and investigate health problems, conduct research to enhance prevention, develop and advocate sound health policies, implement prevention strategies, promote healthy behaviors, foster safe and healthy environments, and provide public health leadership and training.

A unique and critical aspect of CDC's leadership role is embodied by its National Center for Health Statistics (NCHS). NCHS provides STRONGleadership in monitoring the health of the American people and is an unparalleled resource for health information. NCHS performs several key roles including providing a solid information base for designing and tracking prevention programs, identifying health problems and risk factors that affect the population, and monitoring the dramatic changes taking place in our nation's health care system. NCHS represents an investment in broad-based, fundamental public health and health policy statistics that meets the needs of a wide range of users within the public health community, the Department, other Federal Agencies, research institutions, and health care practitioners.

CDC's reliance upon and access to existing data is exemplified by its approach to public health problems. In order to address these problems, CDC uses a reliable, proven, flexible four-step process that adapts to the wide variety of problems that are subjects of CDC programs: infectious diseases, environmental and occupational health, injuries, and chronic diseases. This public health approach consists of detecting and defining a problem through surveillance, determining the causes, developing and testing potential strategies for handling the problem, and implementing nationwide prevention programs. The approach is supported by science, and is reflected in CDC's programs, as well as its evaluation of programs. Prevention effectiveness has been institutionalized as a public health science at CDC. Since 1992, CDC has substantially increased its ability to scientifically assess the prevention effectiveness of its programs and strategies. More than ever, CDC is able to prove that prevention is a sound and solid investment. Yet, even as the U.S. health care budget approaches $1 trillion, only 1 percent of health expenditures support population-based prevention.

CDC's distinguished history of success in disease prevention has spanned 51 years, beginning with the first national disease-elimination strategy used against malaria in 1947. Some well-known accomplishments of the Nation's prevention agency resulting from the more than 3,000 investigations of disease outbreaks include identifying Legionnaires' disease and toxic shock syndrome, Reye's Syndrome, Ebola, hantavirus, and many foodborne and waterborne diseases. CDC's "Disease Detectives" are renowned worldwide for their ability to work with local authorities responding to urgent health threats by aggressively investigating outbreaks of disease or injury, identifying ways to stop transmission, and preventing further occurrence. Each year CDC is instrumental in accurately tracking influenza strains around the globe, and as a World Health Organization Collaborating Center, using sophisticated techniques to provide scientific data essential for vaccine development. As part of a global partnership, CDC played a major role in the worldwide eradication of smallpox in 1977 and, as a partner in massive immunization campaigns, is on the verge of globally eradicating polio. In addition, CDC is making steady progress toward eliminating measles. In this country, vaccine-preventable childhood diseases such as measles, mumps, rubella, pertussis, and diphtheria occur at the lowest rates ever seen. CDC's sentinel surveillance permitted early identification of the AIDS epidemic, thus allowing prevention strategies to be formulated and applied to curtail the frightening growth of this epidemic. Today, CDC works with state, community, national, and international campaigns to prevent and control human immunodeficiency virus infection (HIV), sexually transmitted diseases, and tuberculosis (TB).

As the Nation approaches the 21st century, CDC has embarked on a mission of preventing and controlling the Nation's new leading killers, adapting the epidemiologic and laboratory techniques that have proved successful with infectious diseases, while continuing to battle emerging and re-emerging infectious diseases. Chronic diseases, including heart disease, cancer, and diabetes, now cause more than 70 percent of the deaths in the United States (U.S.), a dramatic shift from the beginning of the 20th century when infectious diseases caused most premature deaths. Early diagnosis saves money as well as lives, and research documents that healthy behavioral choices in diet and physical activity can significantly reduce the incidence of many chronic diseases. For this reason, many of CDC's programs approach prevention by targeting the underlying causes of disease, disability, and injury. These underlying factors have been termed the "actual causes of death" and their toll on the health of Americans is significant.

For example, CDC's chronic disease prevention strategy is based upon behavioral interventions designed to reduce the underlying causes of chronic diseases. These programs incorporate behavior modification and education to assist the public in efforts to stop smoking, follow a healthier diet, and increase their level of physical activity. Similarly, injury prevention programs rely upon the adoption of prevention practices--the use of seat belts and bicycle helmets, for example. Health promotion and behavior modification are also central to CDC's HIV and sexually transmitted disease programs. Reductions in HIV and sexually transmitted diseases are being achieved through drug education and promotion of safe sex practices, including abstinence. CDC's programs have been strategically grouped into appropriate Centers, Institute, and Offices (CIOs) to more effectively address these factors.

Environmental and occupational health threats also have increased, and CDC's role includes addressing the public health aspects of toxic exposures and occupational diseases, injuries and disabilities. CDC's vision of "Healthy People In a Healthy World Through Prevention" means working with partners to prevent the leading health threats confronting Americans.

A key partner in these efforts is the Agency for Toxic Substances and Disease Registry (ATSDR). In 1983, the Secretary of the Department of Health and Human Services (DHHS) established, by Administrative Order, ATSDR as an agency within the Public Health Service located at the CDC headquarters in Atlanta, Georgia. ATSDR was created to address the health related sections of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), or what is more commonly known as "Superfund" legislation. In June 1985, ATSDR was formally organized as an independent agency. By implementing the programs that support its mission, ATSDR forms a critical link among environmental public health, research, and regulatory organizations.

ATSDR, in concert with CDC, the Environmental Protection Agency (EPA), and the National Institute of Environmental Health Sciences (NIEHS), supports CERCLA, one of the most challenging and innovative environmental laws relating to public health. The coordination and collaboration among these environmental public health organizations strengthen the Nation's capacity to understand and respond to environmental public health concerns.

Because ATSDR carries out a unique mission, separate and distinct from CDC's, a performance plan specific to ATSDR's programs and activities has been created and submitted separately from this plan.

Public health and CDC contribute significantly to Americans' ability to lead longer, healthier lives. An infant born today in the United States has 30 more years of life expectancy than in 1900. Twenty-five of these years are directly related to public health efforts. Many public health efforts result in considerable financial savings; others carry a net cost but represent an important investment--and the saving of lives. Clear evidence, for instance, shows that comprehensive health education in schools is effective in reducing risk behaviors among youth, which account for most of the health problems among young people that will follow them into adulthood if not prevented or solved. Such education is also cost-effective: for every $1 spent on tobacco, drug, alcohol, and sexuality education, $14 are saved in avoided health care costs. The signature feature of CDC's public health programs is that they achieve results and cost savings through the promotion of health and quality of life by preventing disease, disability, and injury.

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