XII. Environmental and Occupational Health

FY 2000 Performance Plan - Revised Final FY 1999 Performance Plan

Birth Defects Prevention

Birth defects occur in three out of every hundred births in the United States. CDC is actively engaged in efforts to monitor trends in birth defects over time, determine what causes birth defects, develop prevention strategies and evaluate their effectiveness. Unfortunately, because most of the causes of birth defects remain unknown, prevention is not yet possible. This is the main reason that reductions in the incidence of specific birth defects cannot be used to measure performance. Other factors that hamper to measure progress toward reducing the number of birth defects include the fact that some birth defects and would require a large number of births to be monitored in order to draw conclusions about changes in the rates. In addition, environmental and behavioral factors may vary geographically, therefore, state-based information is very important. CDC has chosen to emphasize the on-going efforts to increase the number of states (and thereby the number of births) that are monitored through high quality birth defect surveillance systems. The Network being developed is designed to share data resulting in more information available about rare defects and geographic variations.

This type of collaborative data sharing has resulted in breakthroughs regarding possible prevention strategies, and has led to major prevention efforts such as those directed at increasing women's consumption of folic acid to prevent the serious and common birth defects spina bifida and anencephaly. This exciting prevention opportunity is highlighted in CDC's second birth defects prevention objective, and as more birth defects prevention breakthroughs are made, new objectives will be added.

Performance Goals and Measures

Performance Goal: By 2002, the National Birth Defects Prevention Network will include 38 states.

Performance Measure:

FY Baseline	FY 1999 Appropriated	FY 2000 Estimate
21 (1997).	By 1999, 30 states will participate in the National Birth Defects Prevention Network.	By 2000, 35 states will participate in the National Birth Defects Prevention Network.

Developing a network of state-based birth defect surveillance programs that are sharing data regarding cases of birth defects that occur in states will improve CDC's ability to monitor trends and geographic variations in birth defect rates across the country. This will result in an enhanced ability to measure performance of birth defect prevention programs, including the national folic acid awareness and education program. The Network is developing standards regarding minimum data sets and criteria for membership, and this will enable us to track our progress at minimal cost. However, to reach our objective of 38 states, CDC funds will be used to support efforts to develop birth defect surveillance systems in states. Between 10 and 16 cooperative agreements awards ($50,000-150,000) will be implemented in FY 1998 to support this objective.

Performance Goal: Increase the number of women who consume 0.4 micrograms of folic acid from a baseline of 25% in 1996 to 50% by 2002.

Performance Measure:

FY Baseline	FY 1999 Appropriated	FY 2000 Estimate
25% (1996).	By 1999, 35% of women of reproductive age will be consuming 0.4 micrograms of folic acid.	By 2000, 40% of women of reproductive age will be consuming 0.4 micrograms of folic acid.

The final outcome of interest for this objective is the reduction of folic acid-preventable spina bifida and anencephaly as a result of women's increased consumption of folic acid. However, we do not have the ability to measure decreases in the rate of spina bifida and anencephaly on a national basis. However, we can measure changes in the number of women consuming sufficient folic acid through nationally representative biennial surveys. These surveys were implemented to assess the performance of our efforts, prior to the development of our GPRA measures. Originally, the surveys were being conducted every other year. CDC recently made the decision to make the surveys annual to better assess our progress, as well as establish baselines prior to full implementation of a national program. The FY 1998 survey is currently underway. The current cost of the annual surveys is about $150,000 per year. The development of the National Birth Defects Prevention Network (another CDC GPRA objective) will enable us, in the future, to monitor trends in the incidence of spina bifida and anencephaly.

Verification/Validation of Performance Measure: The accomplishment of these performance measures are verified by counting the number of states who agree to the conditions of membership of the National Birth Defect Prevention Network and begin to share data and a national survey of reproductive age women, which is currently conducted every other year. Both of these objectives require the collaboration and participation of a number of partners, including state health departments, advocacy organizations and others. A National Task Force on Folic Acid, representing these and other groups, has been formed to guide these efforts and promote the use of folic acid.

Links to DHHS Strategic Plan

These performance objectives are related to DHHS Goal 1: Reduce major threats to the health and productivity of all Americans and DHHS Goal 5: Improve public health systems.

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