II. Strategic Planning: A Foundation for Performance Measurement
In June 1995, CDC launched an agency-wide strategic planning process to refocus the organization's priorities, directions for the future, and assess constituents' requirements. Even though this process was initiated to satisfy the requirements of the Government Performance and Results Act (GPRA), the director of CDC decided to conduct full-scale strategic and performance planning to ensure that CDC continues to be a leader in public health policy and practice. This annual performance plan builds upon those efforts.
The agency used its document published in 1994, "Strategic Thinking at the Centers for Disease Control and Prevention," as a foundation for continuing strategic planning at CDC and to move the agency forward into the 21st century. To continue the process, CDC reconfirmed that the vision and mission statements contained in the 1994 document were still valid.
The CDC vision conveys an idea of what the world would be if CDC's health promotion and disease prevention goals were fully achieved. The agency is committed to helping create a safe physical and social environment where health is both protected and promoted nationally and internationally. CDC believes that prevention is the foundation for achieving this vision.
Mission: To promote health and quality of life by preventing and controlling disease, injury, and disability.
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:
- Prevention strategies based on sound scientific knowledge.
- Leadership and technologic capabilities of state and local health organizations and the integration of those capabilities with private health organizations.
- Trained public health workers and leaders.
- Ability to serve a diverse population with a diverse work force.
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 many 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.
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.
Goal 1 Science: Assure a strong science base for public health action.
The applied techniques of epidemiology, laboratory, behavioral, and social sciences are the primary tools that CDC uses to understand the causes of poor health, identify populations at risk, and develop interventions for disease control and prevention. As research provides more information about the relationships between the physical, mental, and social dimensions of well-being, a broader approach to public health has become important in the quest for answers to prevent and solve health problems. CDC is committed to expanding its research agenda to help bridge the gap between research and public health practice. Through the integration and communication of scientific information, the most effective public health solutions will be translated into practice in the Nation's communities. Sound public health policy decisions are based on excellence in science and provide the means to achieve the best results.
Program Activities and Strategies for accomplishing Goal 1
CDC's strategy for assuring a STRONGscience 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 2000, 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 continuing to coordinate 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.
Goal 2 Assessment: Detect and assess threats to public health.
The wisdom and legitimacy of public health decisions are crucially affected by the quality of the information on which they are based. A unique role of CDC is to provide comprehensive information on health including health status, health risks, the health care system, and health-related outcomes. By maintaining a broad-based monitoring capability, CDC can quickly detect and assess public health threats. CDC's assessment capability, epidemiologic and laboratory surveillance, and response capacity ensure a system that identifies health problems and deploys teams of experts to help resolve the problems promptly. Additionally, the assessment and surveillance capacity ensures data for analysis that can help identify causes of disease early and assist in decisions about appropriate research, policy, and programmatic actions.
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 2000, 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.
Goal 3 Policy: Provide leadership for the nation in prevention policy and practice.
As the emphasis in responsibility for public health services moves from the federal level of government to local governments, CDC will continue in a crucial public health role. CDC's leadership in prevention policy can and should help focus scientific and professional expertise in setting national public health policy. CDC also encourages actions on the part of other federal, state, and local agencies, tribal nations and private organizations to aid in the reduction of threats to health and the promotion of good health. Public health leadership includes the provision of funds and technical assistance, the development of national health data, the conduct of research, and the development of policies and practices that are shaped by science. Through these mechanisms, CDC assures that the public's interest is best served by the measures and programs that are adopted. CDC's role in policy development includes communicating with all affected parties, considering the long-term effects of policy decisions, and speaking for persons or groups who have difficulty being heard.
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.
Goal 4 Assurance: Assure the public's health through the translation of research into effective community-based action.
This goal is oriented toward developing the capacity of public health departments to carry out essential public health programs and services, and involve community institutions and community groups in health promotion and disease prevention. As CDC strengthens its ongoing relationships with state and local health agencies, it is also committed to building partnerships with non-governmental organizations at the community and national levels. These partnerships are essential for the design, implementation, and evaluation of sound prevention programs. What people understand about their health and potential risks to their health is of major concern in public health. CDC is committed to promoting effective health communication, conveying information to appropriate populations, and facilitating access to health information. The agency seeks to enhance the public's health knowledge through communication that is congruent with the values of diverse communities.
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 are 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. In FY 2000, CDC will continue its efforts in the training of public health leaders in the science of public health practice. Training efforts in this area are 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.