Dr. Gerberding’s Remarks at the National Press Club Conference
The State of the CDC: Fiscal Year 2004
Protecting Health for Life
“The health of a people is really the foundation upon which all their happiness and all their powers as a state depend.”
Imagine a world where infants are born healthy and are nurtured in loving homes where they have the best possible start in life… a world where children arrive at school safe, well-nourished, and ready to learn…where teenagers have the information, motivation, and the hope they need to make healthy choices about their lifestyles and behaviors…where adults enjoy active and productive lives in safe and prepared communities ...and can remain independent and engaged with their families and friends throughout their senior years. This is the vision of the world that inspires the Centers for Disease Control and Prevention (CDC) – a vision of healthy people living in a safe and healthy world! Health is a precious resource that allows us fulfill our dreams…to carry out meaningful and satisfying work, to have warm relationships with and fulfill responsibilities to family and friends, to enjoy recreation and leisure time; to share adventures with our children and grandchildren, to be active, engaged, and a vital contributor to our communities.
Americans are passionate about health, but all too often, we fail to take steps to protect it. Indeed, our personal and financial investments in health protection are overshadowed by our investments in attempting to restore health once it is lost, or in coping with the consequences of poor health. According to the Institute of Medicine’s report The Future of the Public’s Health in the 21st Century (PDF, 308K), as much as 95% of our health spending is directed toward medical care and biomedical research, leaving only 5% for investments that preserve our health.
CDC’s core purpose is to help people protect their health and the health of those they care about. I thank the National Press Club for allowing me this opportunity to update you on our progress in Fiscal Year 2004, as we release our annual performance report – CDC: Protecting Health for Life (PDF, 11MB). In conjunction with our sister agencies in the Department of Health and Human Services, other federal agencies, and our wonderful partners in public health agencies, health care organizations, businesses, schools, and faith-based and community organizations across the country, I am pleased to report that in FY 2004 we have demonstrated important results and significant progress toward achieving our nation’s health protection goals.
From Afghanistan to Zambia, CDC’s extraordinary team of dedicated men and women have been working around the clock – and in more than 40 countries around the globe – to protect people’s health. Emerging and re-emerging domestic threats – like multi-drug resistant staphylococcal infection, outbreaks for salmonella food contamination, and West Nile virus – as well as global infections - like tuberculosis, malaria, AIDS, and avian influenza – have challenged CDC to take fast and effective action to save lives. Likewise, CDC has taken action to protect people from the consequences of occupational hazards, injuries, environmental exposures, and hurricanes and other natural disasters here in the United States and abroad. In FY 2004, our disease detectives were deployed 93 times to respond to outbreaks and other urgent challenges.
But protecting health requires more than the detection and management of urgent threats, exposures, or new diseases. Risks to health come in many other forms – personal lifestyles and decisions, educational disadvantages, socioeconomic challenges. Individually these risks adversely affect the health of millions of people, and collectively they create unacceptable disparities in health across our nation and the globe. The gain in life expectancy in the United States since the beginning of the 20th century, roughly 30 years, has been a major achievement. The challenge of the future will be to make additional years of life as healthy, productive, and satisfying as possible for all people. The good news is that many of the risks to health across our life stages are avoidable. Nevertheless, the challenge is great, the situation is urgent, and the time for even more action is now!
People, Passion, Priorities, and Performance…A Formula for Health Protection
To meet these and future challenges, we are transforming CDC. Fiscal year 2004 was a time of exciting – and often difficult - change as we defined our first agency-wide strategic opportunities in more than 20 years, and took the initial steps to implement them. Our Futures Initiative is guided by one charge: We exist to protect people’s health and our entire agency must be accountable for doing so. The result we seek is tangible improvement in people’s health status. It is in this context that CDC commits to ensure that, in the future, the health of the American people – our most important customers - is measurably improved and that those improvements are perceived by the American people as desirable and valuable in enabling them to pursue the enjoyment and fulfill the responsibilities that life holds.
CDC Merits Americans’ Trust
At the beginning of this fiscal year, The Harris Poll conducted a national survey about the work of 11 different federal government agencies. CDC topped the list – for both understanding and appreciation.
Nearly all the people surveyed said they know what CDC does: 96% -- up from 85% in 2001.
And 90% gave CDC high marks for its work – jumping up from 79% in 2001.
We believe that CDC deserves its worldwide reputation as a leader in health protection. But after seeking advice and insight from a wide variety of consumers, partners, and stakeholders, we learned that people want and expect us to do even more, and they want to participate more in the process. We learned that we need to expand the intramural and extramural scientific enterprises that provide the foundation for our credibility and our decisions if we are to stay ahead of the future health challenges we must address. We need to provide even better service to our customers so that people have what they need and want to make health decisions when they need it and where they need it. And we must leverage our investments more effectively and efficiently to accomplish our health protection goals – across CDC, across the Department of Health and Human Services, and across the many sectors of the entire health system. We also learned that we are sometimes perceived as being less than - instead of greater than - than the sum of our parts, and that we have missed opportunities to network the powerful brain trust that exists across our agency in achieving the largest possible impact on health.
We take this input very seriously, and are learning and innovating in response. We are making changes now, while we are a strong and healthy organization, because we must, we can, and we have the will to do so.
CDC’s core values – accountability, respect, and integrity – are not changing. These values epitomize the passion that motivates the men and women of CDC to do far more than what is required, to go anywhere in the world at any time a health threat emerges, and to be exemplars of excellence – in science and in service. The changes we are making through the Futures Initiative must respect this passion and these values, but at the same strengthen our capabilities in the “new normal” of globalization, connectivity, speed…and threats to health across our globe and across our life spans. We remain focused on achieving excellence in science, excellence in service, excellence in strategy, and excellence in the systems that support these activities in all our endeavors.
In FY 04, CDC articulated two overarching health protection goals:
All people – and especially those at greatest risk for health disparities – will achieve their optimal lifespan with the best possible quality of health in every stage of life.
People in all communities will be protected from infectious, occupational, environmental, and terrorist threats.
We are engaging people, partners, and scientific experts in the process of defining specific measurable goals and performance indicators that cascade from these overarching goals. In the State of CDC Report FY2004, we have presented draft goals for achieving health impact across five life stages (infants, children, adolescents, young adults, and older adults) and we are now vetting and these goals inside and outside of CDC. Likewise, we are defining specific goals that will drive our intramural and public health system preparedness efforts. Initial steps are in progress to develop goals relevant to healthy environments as well. The CDC agency health protection goals – for people, preparedness, and places - will set the direction for CDC in years to come. They will define our priorities and drive not only our resource allocation but also our research agenda and how we continue to recruit, train, and keep the best and brightest workforce to create evidence-based innovative and effective health protection programs. That’s why I’m particularly excited about the $21 million extramural Health Protection Research Initiative CDC announced in 2004. This targeted research effort will help solve some of America’s thorniest health problems by:
Funding creative investigators to develop effective workplace and community health protection programs to address the leading killers of Americans.
Supporting critical training in public health research to build our nation’s corps of diverse, well-trained health scientists.
And establishing two Centers of Excellence in Health Promotion Economics devoted to defining the most cost-effective ways to achieve health impact.
At CDC, three core values are central to our work and are NOT changing:
ACCOUNTABILITY - As diligent stewards of public trust and public funds, we act decisively and compassionately in service to the people’s health. We ensure that our research and our services are based on sound science and meet real public needs to achieve our public health goals.
RESPECT – We respect and understand our interdependence with all people both inside the agency and throughout the world treating them and their contributions with dignity and valuing individual and cultural diversity. We are committed to achieving a diverse workforce at all levels of the organization.
INTEGRITY – We are honest and ethical in all we do. We will do what we say. We prize scientific integrity and professional excellence.
This process of finding out what we can do and where we can have the biggest impact on health is supported by the Administration and both Houses of Congress. It means that the budget is linked to the goals…and that ultimately everyone will be able to see our progress. This is truly a transformation change. Change for any organization does not come easily, and there will be many bumps in the road as we evolve. Nevertheless, we are committed, we are making progress, and we will learn as we go, and we will succeed.
Input from CDC’s employees and customers motivated us to focus on improving our business services and management processes so that our other strategic changes could succeed. We are now working smarter and faster with the resources taxpayers have invested in us.
Here are just a few highlights from the State of CDC: FY 2004:
We have reallocated more than 600 open positions from administrative tasks to direct research and program activity positions – such as epidemiologists, medical officers, and laboratorians
We have reduced administrative costs by more than $83 million and made these resources available for frontline projects that directly benefit health
We will save $35 million over 7 years and improve our customer service by consolidating our 40 separate information hotlines into a single hotline – 1 800 CDC-INFO
We have improved the speed of our grants processing time by 25% and further improvement is expected
We have implemented NIH’s IMPACII research grants information system to provide better service to our extramural grantees
We initiated a pilot project to improve our service and accountability for state programs by assigning a senior CDC manager to directly work on site with state health officials
We have achieved “green lights” on all HHS Secretary’s and President’s management objectives
We have hired seven new Chief Management Officials to improve our service and accountability to internal and external CDC customers, and our accountability to taxpayers for stewardship of our funds
CDC is changing on the outside as well. In FY 2004, our $1.5 billion 10-year facilities modernization plan moved into high gear on five major buildings. This wise investment in tax dollars allows us to replace dilapidated buildings with modern, safe, and secure facilities to support our expanded role in fighting the health threats of the 21st century.
HEALTH IMPACT IN FY 2004
Protecting Health… for Life documents the health protection impact CDC achieved in FY 2004 and here are a few key highlights:
Infant and toddler health:
Highest every childhood vaccination coverage rates
Improved folate intake among Latinas to prevent spina bifida
35% reduction in Group B streptococcal infection among African American infants
90% reduction in invasive pneumococcal disease due to strains covered by caused by the vaccine among Alaskan children under 2 years
GetSmart about antibiotic use campaign reached 86 million people
Just yesterday, through a collaboration of national partners, CDC launched a campaign to promote greater awareness of early childhood development milestones. “Learn the Signs. Act Early” is all about providing parents the information and resources they need to help them identify early signs of autism and other developmental disorders. It is bringing together parents, children health care providers, childcare providers, and teachers in a decidedly upstream activity that can really make a difference in a child’s future.
Verb campaign associated with 34% more physical activity among pre-targeted pre-teens
95% vaccination coverage among children entering school
Innovative mobile van program supported at Johns Hopkins for community outreach to support safety in urban homes
Successful project at Jefferson Elementary in Green Bay Wisconsin to reduce bullying
Innovative program supported at Columbia University to improve conflict resolution skills deployed to 6000 teachers and 175,000 teens
Preventing the tragedy of youth violence is a high priority at CDC. Under the Direction of Dr. Arias’s work, our National Center for Injury Prevention and Control is targeting prevention of unintentional injuries in all age groups. As you heard in the President’s State of Union Address earlier this month, First Lady Laura Bush will be leading a nationwide effort to keep young people out of gangs and to reduce youth violence. In 2004, CDC supported an evaluation of the Resolving Conflict Creatively Program conducted by Columbia University’s Academic Center of Excellence for Youth Violence Prevention. The program has been shown to significantly decrease conduct problems and increase academic achievement in the young people enrolled, and is being adopted in 15 school districts around the country. Economic evaluation has found that these positive impacts can be achieved for just $98 per young person per year.
Teen smoking reduced to 22%, on track to achieve Healthy People 2010 goal
School-based programs to decrease sexually transmitted diseases reached more than 30,000 students and may have prevented 114 cases of pelvic inflammatory disease in Philadelphia schools
Adult and Older Adult Health
21,000 women have participated in WISEWOMAN to screen for chronic health conditions as they get mammograms
Steps to a Healthier US programs increased to include 40 communities to address diabetes, obesity, and asthma
2,200 leaders have been trained to reduce the disability associated with arthritis
Through CDC’s Advancing HIV Prevention Initiative, more than 500,000 rapid HIV test kits have been shipped to health departments and community-based organizations in 35 states. Nearly 39,000 people were tested in the first quarter of 2004; 513 tested positive—and found out right away. With a traditional test, as many as one-third of those infected wouldn’t have returned for their results, missing out on lifesaving treatment and information to help protect others.
Health protection is working in South Carolina to get at-risk elders up and moving. Praisercise combines diabetes education and exercise to gospel music. It appeals to older adults whose church community is often an extended family. Praisercise is conducted at multiple sites weekly, and includes diabetes education along with song and movement. One group started through CDC’s REACH 2010 program now travels throughout neighboring communities performing their soul-stirring routines and attracting physical activity converts.
The influenza vaccine shortfall emerged just as the last fiscal year ended. It proved to be one of the biggest challenges we faced in 2004, carrying over to 2005 – and the lessons we learned this season will help us prepare for the next season or for the possibility of a pandemic in the future. Our response provides a compelling validation of the new CDC.
Experts from at least 9 of CDC’s 12 centers and institutes contributed to the emergency operation.
Our emergency communication system was activated to reach partners and customers in healthcare, business, education, and of course, the public health sectors through traditional and new innovative channels.
For the first time ever, we were able to measure vaccine coverage as the season progressed.
For the first time ever we were able to share proprietary information from the vaccine manufacturer with health officials through a secure website.
For the first time ever, we had a stockpile of influenza vaccine and antiviral medications.
And for the first time ever, we were able to use our Biosense electronic public health network to capture local emergence of influenza in real-time across our nation.
As a result, we achieved vaccine protection that surpassed that of last year for some high priority populations. One of the people responsible for this tremendous effort is with me here today: Dr. Jeanne Santoli. I’d like to take this opportunity to thank you, Jeanne, for all you did to ensure the best possible protection for all Americans. You are a true health protection hero!
In summary, the State of CDC is Great! and getting even better. I am privileged and honored to be a part of the agency’s leadership team. The wonderful men and women at CDC are passionate about their work because they know they make a difference. The health protection achievements described in The State of CDC FY2004 are some of the many ways we are contributing to a safer healthier world. I invite you to share our vision and welcome your ideas about how we can do even more to Protect Health… For Life!