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FY 1999 Performance Plan
Executive Summary
CDC's mission statement succinctly states how the agency approaches its responsibilities as the nation's prevention agency. Accomplishing this mission is predicated on CDC's ability to build on the following agency strengths:
A unique and critical aspect of CDC's leadership role is embodied by its National Center for Health Statistics (NCHS). NCHS provides strong leadership 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 based solidly in 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 increased substantially 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 one 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 flu strains around the globe, and as a World Health Organization Collaborating Center in using sophisticated techniques to provide scientific data essential for vaccine development and developing an influenza vaccine. 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 to 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.
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 over 70 percent of the deaths in the United States, 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 with technological advances, and CDC's role includes addressing the public health aspects of toxic exposures. CDC's vision of "Healthy People In a Healthy World Through Prevention" means working with partners to prevent the leading health threats confronting Americans.
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 effectively--and cost effectively--promote health and quality of life by preventing disease, disability, and injury.
During a one-year period that began in mid-1995, the CIOs of CDC engaged in a planning process that involved their stakeholders and employees in identifying strategic issues for CDC. The agency-wide goals were intended to be broad and all-encompassing. Because CDC's opportunities and responsibilities are often determined by societal changes and environmental events, as opposed to planned internal actions, the goals had to project a broad, overarching approach that relates the agency's programs to the public health community and to the public in general. Under each goal statement, strategies were articulated to elaborate the goal statement as well as describe ways to achieve goals.
The CDC strategic framework was developed in the following way: Actions needed to achieve the agency goals were drafted by the CIOs in the form of strategic (five-year) and annual goals. Annual goals represented the first year of achievement of the five-year goal. Performance measures were also developed by the CIOs for both strategic and annual goals. Specific, measurable objectives were developed to support CIO strategic and annual goals.
Healthy People 2000 goals and objectives serve as a foundation for a number of CDC's performance measures. However, it should be noted that although CDC has lead responsibility for several of the objectives contained in Healthy People 2000, achievement of the goals represents a national effort in which CDC partners with other Federal, State, local, and community public health entities. Therefore, performance measures within CDC's plan have been crafted to reflect the collaborative nature of CDC's program activities. For example, a number of CDC's programs are designed to improve State and local government systems. Outcome measures for such programs would not convey meaningful information about CDC's role in these capacity building activities, and for this reason, process and output measures are proposed in these areas.
Below are the four strategic goals that capture the direction for CDC over the next five years. Each goal statement is followed by a brief presentation that associates the CDC goals and strategies with CDC's budget program activities. Resources required to achieve these activities have been submitted as part of CDC's budget submission.
Program Activities and Strategies for accomplishing Goal 1
CDC's strategy for assuring a strong science base for public health action requires an agency
commitment to support and conduct high quality epidemiologic, laboratory, behavior, and social
science research. Through its programs in Environmental Health, Infectious Diseases, Occupational
Safety and Health, Epidemic Services, and the Prevention Centers, CDC advances the science base in
public health by conducting and supporting both extramural and intramural research on a wide range
of public health issues. For FY 1999, research on several major public health issues will be
conducted in order to improve decision making, to examine health outcomes, or to prevent disease. To
ensure the scientific foundation of public health practices, CDC is coordinating the development of
the Guide to Community Preventive Services. This Guide will provide public health
practitioners, their community partners, and policy makers with evidence-based recommendations for
planning and implementing population-based services and policies at the community and state level.
Program Activities and Strategies for accomplishing Goal 2
To accomplish this goal, emphasis will be on assuring that CDC's surveillance and health information
systems address current health issues and problems and that existing and new CDC data systems are
carefully coordinated and integrated. CDC's Health Information and Surveillance Systems Board
stimulates and sponsors innovation in health information and surveillance systems supportive of the
essential public health services. In addition, epidemiologic and laboratory capacity for
surveillance and response will be strengthened. Making health information available to a wide
audience is a major CDC priority that requires adjustments to existing data and surveillance systems
and modifications of the procedures for accessing information. For FY 1999, this goal is
accomplished through many of CDC's program activities, with emphasis on Health Statistics, the
Preventive Health and Health Services Block Grant, Epidemic Services, and Cancer Registries.
Program Activities and Strategies for accomplishing Goal 3
The strategy to address this goal requires CDC to commit to systematic planning and evaluation of
its programs and products and when feasible to document the costs and benefits of prevention
programs. The establishment of a mechanism for continuous review and feedback on the science
produced in and through CDC-funded projects is an important means for improving the overall
effectiveness of the agency. The processes of planning, evaluating, peer reviewing, and providing
feedback assure that the research standards and policy guidelines developed by CDC provide current
and reliable information for use in health promotion and disease prevention programs. To augment
this process, CDC is developing a framework for evaluation in public health practice, an activity
that will encourage combining the science of evaluation with the demands of program management. This
framework, to be completed in FY 1999, will enhance the capacity of health officials to use
evaluation as an ongoing means to improve the quality and test the effectiveness and efficiency of
health promotion and disease prevention work.
Program Activities and Strategies for accomplishing Goal 4
To accomplish this goal, a major emphasis must be placed on expanding CDC's partners to reflect the
diversity of the nation. The role and influence of the community is vital when designing,
implementing, and evaluating public health intervention strategies. There are many areas where CDC
is building the capacity of its partners to carry out important public health programs. Through
state and local health departments, prevention and control programs focus on the reduction of
sexually transmitted diseases, HIV/AIDS, tuberculosis, vaccine preventable diseases, breast and
cervical cancer, diabetes, injuries, and childhood lead poisoning. An example of efforts to target
programs to those in greatest need, in FY 1999 CDC will test the feasibility and effectiveness of
community-based interventions for primary and tertiary prevention of diabetes and its complications
in a large African-American population. The training of public health leaders in the science of
public health practice is also critical in addressing future public health issues. For example, the
CDC-sponsored Public Health Leadership Institute is an ongoing program that develops the leadership
skills of public health officials at the Federal, state, and local levels.
CDC's performance plan discusses performance objectives and measures by functional areas. The plan is organized in this way to provide the reader with an understanding of how programs within the agency complement and relate to one another. In developing performance measures, we attempted to provide outcome measures whenever possible. However, we also looked at programs realistically, taking factors into consideration that may have an effect on performance measures. These factors included:
Arrayed under each of the functional areas within the plan are programs and performance indicators for complementary programs. For example, the infectious diseases functional area encompasses several disease prevention programs: CDC's Emerging Infections, Tuberculosis, HIV/AIDS, and Sexually Transmitted Diseases Programs. Functional areas within the plan are:
Frequency of data collection varies between programs. For example, some proposed measures rely upon on-going quarterly report data, while others may represent annual collection efforts.
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This page last reviewed Friday,
January 18, 2002
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Office of the
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