Health Issues and Opportunities at CDC

Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies

Wednesday, March 5, 2008

Statement of:
Julie L. Gerberding, M.D., M.P.H.
Director, Centers for Disease Control and Prevention
U.S. Department of Health and Human Services

Accompanied by
Bill Nichols, MPA, Director, Financial Management Office, CDC
Richard Turman, Deputy Assistant Secretary for Budget, HHS

Good afternoon, Mr. Chairman, Congressman Walsh, and other distinguished Members of the Subcommittee. It is a pleasure to appear before you again as Director of the Centers for Disease Control and Prevention (CDC), the nation′s leading health protection agency and an operating division of the Department of Health and Human Services. Today I would like to focus on the essential contribution the public health system, with CDC′s leadership, is positioned to make in moving our country toward improved health.We need more than improved performance in our health care delivery system and better access to care we need to develop a comprehensive health system that not only delivers care and services, but also protects and promotes good health in all communities.If we do this successfully, America can become one of the world′s healthiest nations.

CDC′s primary focus is on protecting health, rather than treating illness; in doing that through health promotion, prevention and preparedness, rather than disease care; and on creating holistic approaches for improving people′s health across all stages of life.We center our efforts on a set of fundamental Health Protection Goals designed to accelerate health improvement, reduce health disparities, and protect people at home and abroad from current and new health threats.These goals drive our research priorities and our programs and interventions.

Let me begin by describing the role of CDC and our public health partners in protecting health in this country. I will then describe opportunities and investments in health protection, including some of the key priority areas in the President′s fiscal year (FY) 2009 budget request for CDC.I will close by highlighting just a few examples of CDC achievements that illustrate how we contribute to a healthier nation.

The Role of Public Health in the Nation′s Health System
Many of the greatest opportunities today for improving people′s health fall outside the traditional health care system.The public health system aims to enhance quality of life across the lifespan, to prevent costly diseases before they reach the health care system, and to improve economic competitiveness by a safer and healthier workforce.We see lost opportunity at a population level when infant mortality and life expectancy in the United States fall behind that of other developed countries, and when we place our children at risk of having a life expectancy lower than our own. We see lost opportunity at an individual level when practical prevention steps are not taken, and the path toward treatment for disease is the only viable option. We need a focus on protection of health and prevention of disease, injury and disability before the onset of these conditions.When we invest in health protection, we can turn these lost opportunities into public health achievements to realize our long term goal of becoming the healthiest nation.

We must do more than improve our ability to safely and cost-effectively treat diseases; we must create a true health system that measures, values, and rewards health promotion and disease prevention as much or even more than disease care. If we invest in a strong public health system, with programs designed to protect people where they live, work, study and play, and foster linkages to a robust health care system, we can achieve the common objective of better health for all.In this transformed system, we would reach a balance between protecting health and providing the best possible disease care.Building on the knowledge generated by biomedical research and our world class treatment system, we can bring the scientific expertise of CDC and others to bear on protecting health before serious complications develop. With CDC at the helm, the public health network in our states and communities is positioned to play a lead role in health system transformation.

Opportunities and Investments in Health Protection
CDC continues to identify and implement effective strategies to protect health and prevent disease, injury and disability for anyone, anytime, any place.These strategies are diverse and wide-ranging and involve every part of the agency working collaboratively to achieve better health.From a life stage perspective, we are working to improve health through research into the causes of birth defects, child maltreatment and youth violence prevention, and immunization efforts for both children and adults.We are promoting healthy places through support for walkable communities, occupational safety measures, health promotion in schools and worksites, and prevention of infections in health care settings.We continue to advance preparedness for emerging health threats by enhancing risk communications methodologies, developing informatics systems to integrate and analyze disparate information in real time, and building capacity for community-based surveillance and control of infectious disease. We are expanding the public′s access to credible health information through health marketing, new media, and innovative e-health interventions. And we are working to improve global health through such efforts as promoting safe water and distributing insecticide-treated bed nets to prevent malaria.These are just a few examples of the innovative work CDC is doing in collaboration with many partners to protect health.

The FY 2009 budget request for CDC contains a number of investments that will further advance the capacity of the public health system to combat health threats at home and abroad. An increase of nearly $20.0 million is requested for the Strategic National Stockpile, enabling CDC to continue to purchase, warehouse and manage medical countermeasures to respond to a catastrophic health event, whether naturally occurring or manmade.An additional $10.3 million is requested to upgrade capacity within the Laboratory Response Network for detecting and responding to radiological events.An increase of $33.4 million to expand the U.S. Quarantine and Migration Health System will leverage CDC′s ability to protect the public from disease threats before they arrive at our borders, and targeted efforts to prepare for an influenza pandemic will continue in FY 2009 with an additional request of $3.1 million.The threat of an influenza pandemic has not diminished and CDC remains committed to preparing for the full spectrum of public health threats.

In addition, the FY 2009 budget request includes an overall investment of $93.0 million for the President′s Domestic HIV/AIDS Testing Initiative to support additional testing activities and early diagnosis in medical and community-based settings. And, as we look for opportunities to improve our nation′s health, we recognize the importance of obtaining reliable, high quality data to guide and evaluate decisions about changes that may be pursued in our health care system. Increased investment of $11.1 million for health statistics will sustain and enhance a variety of surveys and statistical programs which provide comprehensive data essential to public health decision-making at CDC, within HHS, and across all levels of government.To advance our monitoring and surveillance capacity, an increase of $15.5 million is requested for the BioSense surveillance system to enable real-time situational awareness during public health emergencies and to make that information useful at the local, state, federal and international levels. These investments will help CDC continue to provide accurate, timely health estimates and high priority interventions needed by public health, health care, homeland security and many other sectors.

Impact and Accomplishments
CDC is focused on achieving ever-greater impact on the health of the people and places we serve, domestically and internationally. We are committed to effectiveness and efficiency in our programs to ensure the greatest impact, and we are working strategically to solve complex emerging threats to health. Let me close by highlighting just a few examples of what CDC has achieved over the past year in each of our key health protection goal areas.

Healthy People in Every Stage of Life

Addressing Disparities in Diabetes Risk Factors at a Community Level
CDC′s Racial and Ethnic Approaches to Community Health (REACH) program supports community adoption of evidence-based interventions that reflect distinct cultures and local realities. To address increasing burden of diabetes among the Hispanic population, the REACH program in Hidalgo County (NM) is working in partnership with local community groups to implement the La Vida (Lifestyles and Values Impact Diabetes Awareness) Program. La Vida offers diabetes education classes, support groups, community outreach, and grocery store tours that include instructions on how to read food labels. Median A1c levels, which measure blood glucose control to help determine risk for diabetes complications, dropped significantly among Hidalgo Medical Services patients within one year of involvement in the program. This is one example of a successful community-based intervention that is helping to improve health across life stages.

Healthy People in Healthy Places

Preventing Fire-related Injuries among Older Adults
To reduce fire-related injuries and loss of life and property among homebound older adults, CDC is partnering with the Meals on Wheels Association of America to implement the Residential Fire Homebound Elderly Lifeline Project (Fire H.E.L.P.). This initiative involves home screening for smoke alarms; education on fire risk factors and escape planning; and installation and periodic testing of free smoke alarms with long-life batteries. During this partnership′s pilot phase in five Texas communities, local fire departments have assisted in installing approximately 5,000 smoke alarms in the homes of older adults, reducing the risk of fire-related injury and saving lives.

People Prepared for Emerging Health Threats

Combating Foodborne Illness
CDC′s systems for monitoring and containing outbreaks of foodborne illness are increasingly important in light of recent high profile outbreaks and public concern over the safety of the food supply.For example, in early 2007, CDC′s coordination of surveillance, epidemiology, and laboratory systems helped to link 715 cases of Salmonella infection in 48 states to peanut butter produced at a single factory.This led to a large product recall, the closing and rebuilding of the factory, and increased attention by our regulatory partners to dry processed foods.Through collaborative research efforts, we can develop a better understanding of the sources and ecologies of foodborne disease in order to establish more effective control and prevention measures.

Healthy People in a Healthy World

Hunting Down the Source of the Deadly Marburg Virus
CDC′s international presence allows us to mobilize quickly and efficiently for global outbreak response. For example, when two miners fell ill with Marburg hemorrhagic fever at the Kitaka mine in Uganda in early August 2007, CDC staff worked with the Ugandan Ministry of Health to quickly identify the etiology, contain the outbreak, and act on a rare opportunity to trace the outbreak to its source. CDC also assisted in tracing every known contact of the infected miners through the 21-day incubation period to ensure that the outbreak had been contained. By the time the CDC team left Uganda in early September, they and partners from South Africa had collected more than 1,000 bats from the Kitaka mine.Ongoing testing may further elucidate the role of bats in the maintenance of Marburg virus in nature, uncover the mode of transmission to humans, and guide development of measures to prevent infection.The results of these studies will aid CDC′s goal of protecting people in the U.S. and abroad from emerging health threats.

Moving Forward
Thank you for the invitation to appear before the Subcommittee this afternoon to highlight CDC′s role in protecting public health.I look forward to a sustained dialogue as we work towards health system transformation over the long term, with public health and health care acting as equal partners in this important effort.If we are to begin to engage in a broad effort to improve the health of the population, we must continue to leverage our resources and broaden our emphasis as a nation to include health protection as well as disease care.Making health a priority in the U.S. will require renewed synergy between the population-based health protection efforts of CDC and its partners, and the clinical prevention and individualized disease care efforts of the health care delivery system. Thank you for your continued support of our important work, and I would be happy to answer any questions.