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Prevent and control disease, injury, illness, and disability across the liespan, and protect the public rom inectious,occupational, environmental, and terrorist threats.

Chapter 3

Strategic Goal 2:

Public Health Promotion and Protection,

Disease Prevention,and Emergency Preparedness



cHaPter 3: PUblic HealtH PrOmOtiOn anD PrOtectiOn, DiSeaSe PreVentiOn,anD emergencY PrePareDneSS

59HHS Strategic Plan FY 2007-2012

Troughout the 20th century, adances n publc healthand medcne resulted n reduced morbdty and mortalty

rom nectous dseases, ncludng nfuenza, polo, and

oodborne and waterborne llnesses. Chronc dseases,

such as heart dsease, stroke, cancer, and dabetes,

replaced nectous dseases as the major cause o llness

and death n the Unted States n the latter part o the 20th

century. In the new mllennum, the Naton contnues to

ace the challenge o chronc dsease because o unhealthy

and rsky behaors, enronmental eposures, and an

agng populaton.

STRATEGIC GOAL 2:

PUBLIC HEALTH PROMOTION AND PROTECTION,

DISEASE PREVENTION, AND EMERGENCY

PREPAREDNESS

Strategic Objective 2.1:

Preent the spread o nectous dseases.


Protect the publc aganst njures and

enronmental threats.

Strategic Objective 2.3:Promote and encourage preente health

care, ncludng mental health, lelong healthy

behaors, and recoery.


Prepare or and respond to natural and manmade

dsasters.




60 HHS Strategic Plan FY 2007-2012

oday, chronc dseases contnue to be sgncant health

problems that ace Amercans. As HHS works to address

these health ssues, nectous dseases hae reemerged

as a prorty or publc health n the Unted States. Foreample, rsky behaors such as unprotected se and

njectng drug use contnue to result n new HIV/AIDS

nectons. At the end o 2003, an estmated 1,039,000

to 1,185,000 persons n the Unted States were lng

wth HIV/AIDS. xvii Accordng to the Centers or Dsease

Control and Preenton (CDC), appromately 40,000

persons are nected wth HIV each year. Injectng drug

use s also a common current rsk actor or hepatts

C rus (HCV) necton. About 30,000 Amercans

are nected wth HCV each year, and about 3 mllon

are chroncally nected wth ths rus, whch s a

leadng ndcaton or ler transplants and hastens the

progresson o HIV n those who are conected.

Foodborne dseases cause an estmated 76 mllon

llnesses, 325,000 hosptalzatons, and 5,000 deaths n

the Unted States each year. Other known pathogens

account or an estmated 14 mllon llnesses, 60,000

hosptalzatons, and 1,800 deaths annually. xviii Morbdty

and mortalty rom njures and enronmental hazard

eposures also contnue to aect the health and well-

beng o Amercans.

Oer the past century, publc health adances n drnkng

water, wastewater, and recreatonal water qualty hae

dramatcally mproed the health o the Amercan people.

Howeer, drnkng water rom publc water systems causes

an estmated 4 to 16 mllon cases o gastrontestnal

llness per year. Durng 2003–2004, 62 waterborne dsease

outbreaks assocated wth recreatonal water were reported

by 26 States and Guam. Illness occurred n 2,698 persons,

resultng n 58 hosptalzatons and 1 death. xix

Although malara s techncally preentable and curable

recognzed and treated promptly, t remans oneo the world’s greatest threats to human health and

economc welare. Each year, malara klls more than 1

mllon people—the majorty, young chldren n Arca.

In a retrospecte analyss, t has been estmated that

economc growth per year o countres wth ntense

malara was 1.3 percent lower than that o countres

wthout malara. xx

Te 21st century s also marked by the threat o publc

health emergences. Tese threats hae become a

sgncant ocus or publc health at the Federal, State,

and local leels. Publc health threats and emergencescan ensue rom myrad causes—boterrorsm; natural

epdemcs o nectous dsease; terrorst acts that nole

conentonal eploses, toc chemcals, or radologcal

or nuclear deces; ndustral or transportaton

accdents; and clmatologcal catastrophes.

Strategc Goal 2, Public Health Promotion and Protection,

Disease Prevention, and Emergency Preparedness, seeks to

address these problems. Tere are our broad objectes

under Public Health:

Preent the spread o nectous dseases;•

Protect the publc aganst njures and•

enronmental threats;Promote and encourage preente health care,•

ncludng mental health, lelong health behaors,and recoery; and Prepare or and respond to natural and manmade•

dsasters.

HHS s postoned to address the publc health problems

o nectous dseases, njures and enronmental

hazards, chronc dseases and behaoral health

problems, and publc health emergences through

a comprehense set o strateges. HHS prodes

leadershp on these health ssues wthn the Federal

Goernment and collaborates wth numerous partners

across the Federal Goernment to achee these

objectes. Tese partners nclude the U.S. Departments

o Homeland Securty and Deense or publc health

emergency preparedness; the U.S. Enronmental

Protecton Agency (EPA) and U.S. Department o Labor

or enronmental and occupatonal health ssues; and

the U.S. Departments o Agrculture and Commerce, and

EPA, or ood saety.

Wthn HHS, multple operatng and sta dsons work together to deelop and mplement strateges to

achee the goal o preentng and controllng dsease,

njury, llness, and dsablty across the lespan and o

protectng the publc rom nectous, occupatonal,

enronmental, and terrorst threats. Key operatng

and sta dsons that contrbute to ths goal nclude

the Centers or Dsease Control and Preenton





(CDC), Food and Drug Admnstraton (FDA), Health

Resources and Serces Admnstraton (HRSA), Oce

o the Natonal Coordnator or Health Inormaton

echnology (ONC), Oce o the Assstant Secretary or Preparedness and Response (ASPR), and Substance

Abuse and Mental Health Serces Admnstraton

(SAMHSA). In addton, HHS’s Admnstraton on

Agng (AoA), Centers or Medcare & Medcad Serces

(CMS), Oce or Cl Rghts (OCR), Oce on Dsablty

(OD), Oce o Global Health Aars (OGHA), and Oce

o Publc Health and Scence (OPHS) play mportant

roles n addressng ths goal.

Below s a descrpton o each strategc objecte, ollowed

by a descrpton o the key programs, serces, and

ntates the Department s undertakng to accomplsh

those objectes. Key partners and collaborate

eorts are ncluded under each releant objecte. Te

perormance ndcators selected or ths strategc goal are

also presented wth baselnes and targets. Tese measures

are organzed by objecte. Fnally, ths chapter dscusses

the major eternal actors that wll nfuence HHS’s ablty

to achee these objectes, and how the Department s

workng to mtgate those actors.





Strategic Objective 2.1

Prevent the spread o inectious diseases.

Although modern adances hae conquered some

dseases, nectous dseases contnue to threaten

the Naton’s health. Outbreaks o Seere Acute

Respratory Syndrome (SARS), aan nfuenza, West

Nle Vrus, and monkeypo are recent remnders o

the etraordnary ablty o mcrobes to adapt and

eole to nect humans. Earler predctons o the

elmnaton o nectous dseases oten dd not take

nto account changes n demographcs, mgraton

patterns, and human behaors, as well as the ablty

o mcrobes to adapt, eole, and deelop resstance to

drugs. Inectous dsease can hae sgncant medcal

and economc consequences. Addressng oodborne

llnesses, ectorborne pathogens, ral hepatts,

HIV/AIDS and other seually transmtted nectons,

tuberculoss, antmcrobal resstance, and a possble

nfuenza pandemc s a sgncant prorty or HHS.

Although these dseases aect all Amercans, many

oten ht hardest the most ulnerable populatons—the

low-ncome populaton, mnortes, chldren and youth,

mmgrants, persons who are ncarcerated, and other

dsenranchsed populatons. Te selected perormance

ndcators at the end o ths chapter were chosen to

refect the mpact HHS has on these populatons.

Immunization

HHS has dented seeral key strateges or addressng

the threat o nectous dseases. One o the prmary

strateges s the use o accnes. HHS’s accne enterprse

ncludes outreach acttes and undng support or

chldhood and adult mmunzaton. HHS, through

CDC, wll protect Amercans rom accne-preentable

dseases by prodng health communcaton messages

about accnaton and supportng eorts to ncrease

mmunzaton coerage rates or both chldren and at-

rsk adults. OPHS coordnates and ensures collaboraton

among the many Federal agences noled n accne

and mmunzaton acttes. Te Assstant Secretary

or Health (ASH) prodes leadershp and coordnaton

among Federal agences, as they work together to carry

out the goals o the National Vaccine Plan. Te National





Vaccine Plan prodes a ramework, ncludng goals,

objectes, and strateges, or pursung the preenton

o nectous dseases through mmunzatons. In 2007–

2008, HHS wll reew and rese the estng National Vaccine Plan to ensure that t addresses new scentc

and saety ssues that hae emerged snce the rst plan

was deeloped. HHS also wll contnue estng eorts

to ncrease mmunzaton rates or accne-preentable

llness. Speccally, HHS, through CDC, wll deelop and

dssemnate health communcaton messages about

accnaton and support eorts to ncrease mmunzaton

coerage rates or both chldren and adults.

Te Vaccines or Children Program (VFC), whch

prodes mmunzatons or elgble chldren6 at ther

doctors’ oces, wll contnue to be a cornerstone

o the HHS nectous dsease preenton strategy.

VFC also helps chldren whose nsurance does

not coer accnatons when they recee them at

partcpatng Federally Qualed Health Centers

and Rural Health Clncs. HHS also wll work to

ncrease rates o accnaton aganst nfuenza and

pneumococcal ruses through ts Natonal Infuenza

and Pneumococcal Vaccnaton Campagn. Ts jont

ntate noles CDC, CMS, FDA, HRSA, IHS, and

NIH along wth State and local health departments,

Medcad agences, trbal representates, health

care proders, and the Natonal Coalton or Adult

Immunzaton. It ams to prode accnatons or

nfuenza and pneumona to benecary populatons.

HIV/AIDS

OPHS coordnates all HIV/AIDS-related scentc and

polcy matters, such as new deelopments and program

acttes wthn the areas o research, HIV preenton,

HIV care and treatment, and budget deelopment.

OPHS also ensures the eecte and accountable

management o the Department’s HIV/AIDS programs.

6 Chldren 18 years o age and younger who meet at least one

o the ollowng crtera are elgble: (1) a chld who s elgble or

the Medcad program; (2) a chld who has no health nsurance

coerage; (3) Amercan Indan or Alaska Nate; (4) a chld, sered

by a Federally Qualed Health Center or Rural Health Clnc, whose

health nsurance benet plan does not nclude accnatons.

Buldng on ts estng surellance, research, and

screenng acttes, CDC apples well-ntegrated,

multdscplnary programs o research, surellance, rsk

actor, and dsease nterenton to preent and control thespread o HIV necton. For eample, CDC s the source

o natonal data on the epdemc and supports preenton

programs n eery State, guded by communty plannng.

Tese programs reach those at hghest rsk or acqurng

or transmttng necton wth eecte nterentons to

reduce ther rsk and protect ther health. CDC and HRSA

wll support eorts to ncrease knowledge o communty

capacty to respond to HIV and ncrease HIV testng

status, ocusng especally on groups and communtes

at the hghest rsk o necton. FDA s responsble

or ensurng the saety o the Naton’s blood supply by

mnmzng the rsks o nectous dsease transmsson

and other hazards whle acltatng an adequate supply o

blood and blood products.

Routne and targeted HIV testng wll be key strateges

or preentng new HIV nectons and mprong

outcomes or those who test poste. Indduals

nected wth HIV who are aware o ther necton are

less lkely to engage n rsky behaors and are more lkely

to take steps to protect ther partners. Addtonally,

ndduals nected wth HIV who are aware o ther

necton can take adantage o the therapes that can

keep them healthy and etend ther les.

Addtonally, FDA wll contnue ts work wth

nternatonal drug regulatory authortes to promote

epedted reew o generc antretroral drugs under

the President’s Emergency Plan or AIDS Relie (PEPFAR).

HHS, through ts operatng dsons, especally CDC

and HRSA, s one o the major mplementng partners

or PEPFAR, and manages preenton, treatment,

and care acttes n the 15 ocus countres o the

Emergency Plan and more than 20 others. HHS also prodes part o the Federal Goernment’s nancal

contrbuton to the Global Fund to ght AIDS,

tuberculoss, and malara, and s part o the nteragency

team that gudes U.S. polcy toward the und.





outbreak gudelnes, a repostory or resources and

tools, and perormance ndcators or the response to

enterc dsease.

o address waterborne dseases, CDC wll contnue to

partner wth EPA to ll crtcal data gaps by prodng

mproed dsease surellance data, creatng edence-

based gudelnes and tranng or nestgatons,

epandng access to water-related normaton,

collectng data to dene the magntude and burden

o waterborne llness, ealuatng water-related

nterentons to mproe publc health, and deelopng

laboratory samplng and detecton methodologes. As

part o ts preparedness eort, CDC wll also deelop,

mproe, and deploy rapd samplng and detecton

methods or potental waterborne threats. Prodng

comprehense publc health protecton to all

communty users o water wll create a more eecte

Federal response amed at reducng the burden o

waterborne dsease n the Unted States.

Global Health

One key strategy or preentng the spread o nectous

dsease s preentng t rom reachng the Unted

States. HHS wll collaborate wth the World Health

Organzaton (WHO) and other nternatonal partners

to prode epdemologc and laboratory support to

assst countres n addressng dsease threats through

mproed dsease detecton. HHS also wll prode

programmatc epertse, tranng, and undng support

to assst wth surellance, control, elmnaton, and

eradcaton acttes or dseases such as measles,

polo, aan nfuenza, and HIV/AIDS, as well as the

proson o techncal assstance wth sae and healthy

water and mproed santaton.

Immunzaton has reolutonzed chld health n

countres throughout the world. WHO estmates thatalmost 40 percent o chld deaths or chldren younger

than 5 years o age are potentally preentable by

accnes. xxi HHS has been a major supporter o global

ntates to eradcate polo; control measles; and

ntroduce new accnes or pneumoccocal dseases,

rotarus, and possbly n the near uture, malara

and een HIV. HHS remans commtted to acheng

Zoonotic7/Vectorborne Diseases

o address zoonotc and ectorborne dseases, HHS

wll deelop plans to respond to a dsease outbreak that encompasses anmal, ector, and human eperts

workng n synergy. CDC wll deelop dsease

surellance systems that ncorporate anmal, ector,

and human data to prode an eecte publc health

response that wll mtgate the mpact o a multspeces

outbreak. CDC wll deelop, test, and deploy mproed

methods or the detecton and control o nsectborne

ruses and bactera and wll mproe the capacty to

detect the ntentonal release o plague, Rabbt Feer

(tularema), and other agents wth boterror potental.

FDA wll oster the deelopment o preente accnesor malara, dengue eer, and other ector-borne

and zoonotc dseases by workng wth ndustry and

academa. In addton, surellance, detecton, and

response systems wll be deeloped and tested to

address domestc and nternatonal epdemcs o

ectorborne pathogens wth the potental to harm the

U.S. populaton.

Foodborne/Waterborne Illnesses

o combat oodborne llness, FDA and CDC wll

work together to protect publc health through preente strateges that mproe surellance,

nspecton, trackng, detecton, nestgaton,

control, and preenton o oodborne outbreaks and

dsease; strengthen the enorcement o regulatons;

and broaden educaton about these problems. HHS

wll mproe the mportant natonal collaborate

surellance and response networks o the FoodNet,

PulseNet, and OutbreakNet to make them aster,

more response, and capable o more detaled

nestgatons. FDA and CDC, along wth the U.S.

Department o Agrculture, and other organzatons, wll contnue to partcpate n the Councl to Improe

Foodborne Outbreak Response, a group created to

deelop tools that acltate the nestgaton and

control o oodborne dsease outbreaks. Oer the

net seeral years, the Councl wll deelop multstate

7 Zoonotc dseases are caused by nectous agents (such as

mosqutoes) that can be transmtted between (or are shared by)

anmals and humans.





HHS wll contnue to work wth other Federal

partners to control malara through partcpaton

n the President’s Malaria Initiative(PMI), an

ntergoernmental ntate led by the Unted States

Agency or Internatonal Deelopment (USAID), CDC,

NIH, the U.S. Departments o State and Deense, and

the Natonal Securty Councl. Te goal o PMI s to

reduce malara deaths by hal n each target country

ater 3 years o ull mplementaton. Te ntatehelps natonal goernments deler proen, eecte

nterentons—nsectcde-treated bed nets, ndoor

resdual sprayng, prompt and eecte treatment

wth artemsnn-based combnaton therapes, and

ntermttent preente treatment to people at greatest

rsk, pregnant women and chldren younger than 5

years old. As o June 2007, work s ongong n the rst

three PMI countres (Angola, anzana, and Uganda) as

well as the our added n 2006 (Malaw, Mozambque,

Rwanda, and Senegal). Later n 2007, acttes wll

begn n the nal eght countres (Benn, Ethopa,Ghana, Kenya, Lbera, Madagascar, Mal, and Zamba),

whch wll brng the program to ts ull complement o

15 countres wth a hgh burden o malara n Arca.

Addtonal normaton about HHS’s eorts n global

health can be ound later n ths chapter n In the

Spotlight: Global Health Initiatives.

global polo eradcaton and meetng the global target

to achee a 90 percent reducton n measles mortalty

by 2010 as compared to 2000. Eorts to combat

accne- preentable dseases oerseas not only assst

global eorts at lowerng chld mortalty, but also help

to protect U.S. chldren rom susceptblty to these

debltatng dseases.

One specc set o acttes that HHS wll contnue

n support o ts global health strategy s n the areao malara preenton. CDC supports preenton and

control o malara throughout the world n partnershp

wth local, State, and Federal agences n the Unted

States; medcal and publc health proessonals;

natonal and nternatonal organzatons; and oregn

goernments. Specc strateges nclude conductng

malara surellance, preenton, and control acttes

n the Unted States; prodng consultaton, techncal

assstance, and tranng to malara-endemc countres

to change and mplement proen polces to decrease

malara burden; conductng multdscplnary researchn the laboratory and n the eld, to deelop new tools

and mproe estng nterentons aganst malara

worldwde; and translatng research ndngs nto

approprate global polces and eecte practces

through the Roll Back Malaria Partnership and other

nternatonal partners.






Protect the public against injuries and

environmental threats.

Injures are the leadng cause o death among chldren

and adults younger than 44 years o age n the Unted

States. About 160,000 people de each year n the

Unted States rom njures; mllons more are njured

and sure xxii; and nearly 30 mllon people sustaned

njures serous enough to requre treatment n an

emergency room. Many njured people are let wth

long-term dsabltes.

HHS has a partcular responsblty to prode the

scence base needed to reduce occupatonal njures;the perormance ndcators at the end o ths chapter

measure ths progress. CDC conducts the majorty o

njury preenton acttes that support ths objecte.

CDC ocuses on strateges to address nterpersonal

olence, resdental res, alls, and workplace

njures and mortalty. Tese nclude dentyng rsk

actors, conductng surellance, and supportng

mplementaton acttes.

Workplace Injuries

CDC promotes sae and healthy workplaces throughnterentons, recommendatons, and capacty buldng.

o achee the objecte o protecton aganst njures

n the workorce populaton, CDC actely engages

employers to promote commercal motor ehcle saety

by prodng techncal assstance and dssemnatng

Hazard Alerts and Fact Sheets that present practcal

preenton strateges n both Englsh and Spansh.

CDC also works wth the Mne Saety and Health

Admnstraton on the jont commttee eamnng how

the newly deeloped personal dust montor (PDM) can

be utlzed on a daly bass n underground coal mnes.Te PDM, recently deeloped by CDC n collaboraton

wth manuacturers, labor, and ndustry, assesses coal

mners’ eposure to coal dust n underground mnes and

represents the rst adancement n more than 30 years

or montorng eposures.





Fire-Related Injury Prevention

CDC wll contnue to support State programs to

montor, denty, and track re-related njures andto epand smoke alarm nstallaton and re saety

educaton programs n communtes at hgh rsk.

Environmental Hazards

Interactons between people and ther enronment

also pose a rsk to ther health. Enronmental

health hazards nclude water pollutants, chemcal

pollutants, ar pollutants, mold, and radaton rom

natural, technologc, or terrorst eents. HHS works n

collaboraton wth other Departmental-leel agences,

ncludng EPA and the U.S. Department o Labor’s

Occupatonal Saety and Health Admnstraton, to

address enronmental hazards. o support ths larger

Federal eort, HHS wll conduct targeted preenton

and surellance acttes amed at rasng awareness

o, montorng, and mtgatng threats. CDC and FDA

wll support ths eort by usng estng technologes

and methods to measure the eposure to enronmental

chemcals n humans and the ood supply. CDC also wll

nestgate new technologes and methods to epand the

number o chemcals measured n humans.

Childhood Lead Poisoning Prevention

CDC s addressng the problem o chldhood lead

posonng through proson o undng and techncal

assstance to State and local chldhood lead posonng

preenton programs. Tese programs are workng to

ensure that screenng, lead-hazard reducton, model

legslaton, and other preenton mechansms occur

throughout the country. CDC wll buld on these eorts

by deelopng and dssemnatng gudance or the

proper treatment o chldren ater they are dented as

hang eleated blood leels. Violence Against Women

HHS has deeloped a Volence Aganst Women Steerng

Commttee, whch coordnates the HHS response to

ssues related to olence aganst women and ther

chldren. Ts commttee, led by ASH, comprses

representates rom ACF, AoA, CDC, FDA, HRSA, NIH,

OPHS, the Oce o the Secretary, and SAMHSA. Te

commttee s also responsble or coordnatng HHS

olence-related acttes wth those o other Federal

agences. Ts steerng commttee wll work to reneand ocus HHS’s acttes on addressng olence

aganst women. More normaton about HHS’s eorts

to address amly olence can be ound n Strategic

Goal 3, Objective 3.1.

Youth Violence Prevention

CDC unds Academc Centers o Ecellence to deelop

and mplement communty response plans to preent

youth olence. Tese Centers also tran health

proessonals and conduct youth olence preenton

research projects. CDC wll contnue undng theseCenters. Te agency also wll denty modable

rsk actors that protect adolescents rom becomng

ctms or perpetrators o olence and wll ncrease

publc awareness regardng datng olence among

adolescents through nteracte programs such as

Choose Respect .






Promote and encourage preventive health

care, including mental health, lielong healthy behaviors, and recovery.

Chronc dseases—such as heart dsease, cancer, and

dabetes—are among the leadng causes o death and

dsablty n the Unted States. Tese dseases account

or 7 o eery 10 deaths and aect the qualty o le o

90 mllon Amercans. xxiii Although chronc dseases are

among the most common and costly health problems,

they are also among the most preentable.

AHRQ, AoA, CDC, CMS, FDA, HRSA, IHS, OD, OPHS,

and SAMHSA currently support a arety o programsand ntates amed at reducng the prealence o

chronc dseases and helpng people wth chronc

condtons manage ther dseases more eectely.

State and local health departments, natonal and

nternatonal health organzatons, phlanthropc

oundatons, and proessonal, oluntary, and

communty organzatons are key partners n these

health promoton and dsease preenton acttes.

In the perod o 2007–2012, these agences wll

contnue to support these acttes and wll work to

epand, enhance, and mproe ther eecteness.Te Department selected key perormance ndcators

that represent a broad array o acttes, ncludng

cardoascular health, cancer screenng, and programs

to reduce substance abuse and sucde.

Preventive Services

A paradgm sht has occurred n health care, resultng n

a renewed emphass on preenton. o reap the benets

o preenton, both health care proders and health care

consumers must rst understand what those benets

are. Te Medcare Prescrpton Drug, Improement, andModernzaton Act (MMA) o 2003 (Publc Law 108-173)

epanded Medcare’s menu o preente benets by

coerng an ntal preente physcal eamnaton. Ts

benet, also reerred to as the “ Welcome to Medcare”

st, allows new Medcare benecares to get up-to-date

normaton on mportant screenngs and accnatons,

as well as to talk wth ther health care proder about





ther medcal hstory and how to stay healthy. All

benecares enrolled n Medcare Part B wth eecte

dates that begn on or ater January 1, 2005, wll be

coered or ths benet.

Te Welcome to Medicare st enables the health care

proder to prode a comprehense reew o hs or

her patent’s health, to denty rsk actors that may

be assocated wth arous dseases, and to detect

dseases early when outcomes are best. Te health

care proder s also able to educate hs or her patent

about the Medcare-coered serces they need n order

to preent, detect, and manage dsease; to counsel

them on dented rsk actors and possble lestyle

changes that could hae a poste mpact on ther

health; and to make reerrals or ollowup appontments

or necessary care. CMS wll contnue to support and

conduct outreach related to the Welcome to Medicare

benet to ncrease benecares’ utlzaton.

Although Medcare pays or many crtcal preente

screenngs, ewer than 1 n 10 adults aged 65 or

older recee all recommended screenngs and

mmunzatons. CDC’s Healthy Aging Program wll

contnue to support a model program, Sickness

Prevention Achieved through Regional Collaboration

(SPARC), whch has shown sgncant success nbroadenng the use o preente serces. SPARC

promotes publc access to serces, helps medcal

practces prode preente serces, and strengthens

local accountablty or serce delery.

AHRQ accomplshes adopton and delery o edence-

based clncal preenton serces to mproe the

health o Amercans through two man aenues: work

n support o the Unted States Preente Serces

ask Force (USPSF) and Preenton Portolo eorts

amed at dssemnaton and mplementaton o the

ask Force’s recommendatons. As the USPSF makesedence-based recommendatons, t s the job o

AHRQ to get the word out to clncans and the general

publc as rapdly as possble. Accomplshng ths goal

more quckly puts actonable normaton nto the

hands o clncans, gudng them to perorm ndcated

serces and not to perorm serces or whch the

edence ndcates more harm than benet. Gettng the

word out ncreases the delery o approprate clncal

preente serces. Clncans and polcymakers across

the Naton hold the work o the USPSF n hgh regard.

Heart Disease and Stroke

Heart dsease and stroke are the most common

cardoascular dseases. For both men and women

n the Unted States, heart dsease and stroke are the

rst and thrd leadng causes o death, respectely,

accountng or nearly 40 percent o annual deaths. xxiv

Although these largely preentable condtons are more

common among people 65 years or older, the number

o sudden deaths rom heart dsease among people

aged 15 years to 24 years has ncreased. Te economc

mpact o cardoascular dsease on the Naton’s healthcare system contnues to grow as the populaton ages.

A key strategy or HHS n addressng heart dsease

and stroke and ts rsk actors s educatng health

practtoners and the publc about the mportance

o preenton, about the sgns and symptoms o

heart attack and stroke, and about the mportance o

callng 911 quckly. o make women more aware o

the danger o heart dsease, the Natonal Heart, Lung,

and Blood Insttute at NIH has collaborated wth

other organzatons to sponsor a natonal campagn

called Te Heart ruth. Te campagn’s goal s to rase

women’s awareness about ther rsk o heart dsease,

and has resulted n strkng mproements n women’s

awareness o heart dsease and ther acknowledgment

o personal rsk. CDC’s Heart Disease and Stroke

Prevention Program wll contnue to help States control

hgh blood pressure and hgh blood cholesterol, both

o whch are rsk actors or cardoascular dseases,

among resdents; ncrease awareness o the sgns

and symptoms o heart attack and stroke; mproe

emergency response; mproe qualty o care; and

elmnate health dspartes. Medcare’s preente

serces coer cardoascular dsease screenngs.

HHS wll contnue to prode natonal leadershp to

preent death and dsablty rom heart dsease and

stroke and to epand support to State cardoascular

dsease preenton eorts. FDA also contrbutes to

preenton o heart dsease through ts ood labelng





regulatons. For eample, the recent requrement

or trans-at normaton on ood labels prodes

consumers wth addtonal normaton on the at

content o packaged oods. Reductons n consumptono trans-atty acds are epected to reduce the rsk o

heart dsease sgncantly.

Cancer

Cancer s the second leadng cause o death n the

Unted States and costs appromately $210 bllon

annually. xxv Cancer does not aect all racal or ethnc

groups equally. Arcan-Amercans are more lkely to

de o cancer than any other racal or ethnc group,

reealng a large health dsparty related to ths dsease.

CDC’s National Comprehensive Cancer Control Program unds States, terrtores, and trbes to buld coaltons,

assess the burden o cancer, determne prortes, and

deelop and mplement comprehense cancer control

programs. Tese programs help communtes across

the country to reduce cancer rsks, detect cancers

earler, mproe cancer treatment, and enhance qualty

o le or cancer patents. CDC s supportng these

programs to ensure that cancer preenton and control

reaches those at hghest rsk o deelopng cancer and

n the greatest need o assstance.

CDC’s National Program o Cancer Registries collects

data on the occurrence o cancers through State

and terrtoral regstres. CDC s supportng cancer

regstres throughout the Unted States to enable publc

health proessonals to better understand and address

cancer and ts causes.

Makng cancer screenng, normaton, and reerral

serces aalable and accessble to all Amercans s

essental or reducng the hgh rates o cancer and

cancer deaths. CDC’s National Breast and Cervical

Cancer Early Detection Program wll contnue tosupport screenng and dagnostc eams or low-

ncome women wth lttle or no health nsurance. Te

program wll also support educaton and outreach,

and case management serces. CDC’s prostate cancer

control ntates support normaton dssemnaton

to the publc, physcans, and polcymakers about the

rsks and benets o prostate cancer screenng.





FDA adances cancer preenton through the

deelopment and lcensure o cancer preenton

accnes.

Included n Medcare’s menu o preente serces are

screenngs or colorectal and prostate cancer, as well as

annual mammograms or women 40 years and older.

Overweight and Obesity

Oer the last 20 years, rates or oerweght and obesty

hae ncreased dramatcally n the Unted States.

Obesty has now reached epdemc proportons. CDC

reports that two-thrds o nonnsttutonalzed U.S.

adults age 20 and older are oerweght or obese; a thrd

are obese. xxvi Te epdemc s not lmted to adults,

howeer. Te percentage o young people who are

oerweght has more than doubled n the last 20 years.

People who are obese are at ncreased rsk or heart

dsease, hgh blood pressure, dabetes, and some cancers.

CDC, FDA, and OPHS are the prmary HHS operatng

dsons workng to reduce obesty and oerweght n

the Unted States, wth a ocus on mprong nutrton

and ncreasng physcal actty. CDC wll contnue to

support eorts to address obesty through proson

o techncal assstance, tranng, and consultaton

to unded State programs. CDC and ts partners

create, ealuate, and montor programs, polces, and

practces to preent and control obesty. CDC wll

epand communcaton eorts to promote physcal

actty and good nutrton n workstes, schools, and

health care settngs.

FDA also contrbutes to obesty control through ts

ood labelng regulatons and educaton programs.

For eample, Make Your Calories Count, FDA’s Web-

based learnng program, helps consumers make

normed choces that contrbute to lelong healthy

eatng habts.Te OD physcal tness program, I Can Do It, You Can

Do It, targets the obesty and oerweght challenges o

chldren and youth through physcal eercse based

on the awards system o the Presdent’s Commttee

on Physcal Ftness and Sports Program. Te program

ncludes a mentee-mentor relatonshp and an

ealuaton component.





In addton, Dietary Guidelines or Americans prodes

scence-based adce to promote health and to reduce

rsk or major chronc dseases and condtons, through

det and physcal actty. Major causes o morbdty andmortalty n the Unted States are related to poor det and

a sedentary lestyle. Combned wth physcal actty,

ollowng a det that does not prode ecess calores,

accordng to the recommendatons n ths document,

should enhance the health o most ndduals.

As a companon to the Dietary Guidelines or Americans,

HHS wll work oer the net 2 years to deelop

comprehense gudelnes, drawn rom scence, to

help Amercans t physcal actty nto ther les.

Te Physical Activity Guidelines or Americans wll be

ssued n late 2008. Te Physical Activity Guidelines

wll summarze the latest knowledge about actty

and health, wth depth and feblty targetng specc

populaton subgroups, such as older adults and chldren.

Ts work s nspred by the Presdent’s personal

dedcaton to physcal tness and hs desre that eery

Amercan hae access to scence-based gudelnes.

Diabetes

In the last 15 years, the number o people n the

Unted States wth dagnosed dabetes has more than

doubled, reachng 14.6 mllon n 2005. xxvii Dabetes,

whch s also assocated wth oerweght and obesty,

can cause heart dsease, stroke, blndness, kdney

alure, pregnancy complcatons, lower etremty

amputatons, and deaths related to nfuenza and

pneumona. In addton to the mllons o Amercans

wth dabetes, an estmated 41 mllon adults aged 40

to 74 are predabetc and are at hgh rsk o deelopng

dabetes. xxviii Te ncreasng burden o dabetes and

ts complcatons s alarmng. Howeer, much o

ths burden could be preented wth early detecton,

mproed delery o care, and better educaton on

dabetes sel-management.

CDC montors the burden o dabetes natonally and

wll contnue to eplore better ways to collect dabetes

data on groups most at rsk. CDC also prodes undng

or capacty buldng and program mplementaton

to States and terrtores or dabetes preenton and

control programs. Oer the net 5 years, CDC wll

epand the number o mplementaton grants ater

rst deelopng grantee capacty through phase one

capacty grants.

CDC also works wth NIH to support dabetes

educaton. Tese operatng dsons wll contnue

to collaborate to enhance the network o more than

200 publc and prate partners who work to ncrease

knowledge about dabetes and ts control among

health care proders and people wth or at rsk or

dabetes. IHS also wll support dabetes preenton

and control through moblzng and nolng

Amercan Indan/Alaska Nate communtes to

promote dabetes management strateges. For

Medcare benecares dagnosed wth predabetes

and those preously tested who hae not been

dagnosed wth predabetes, or those who hae neer

been tested or the dsease, dagnostc screenng

tests are aalable. For Medcare benecares wth

dabetes, Medcare oers Diabetes Sel-Management

raining and Medical Nutrition raining.

Oral Health

Mouth and throat dseases, whch range rom cates

to cancer, cause pan and dsablty or mllons o

Amercans each year. Ts act s dsturbng because

almost all oral dseases can be preented. For chldren,

cates are a common problem that begns at an early

age. ooth decay s also a problem or U.S. adults,

especally or the ncreasng number o older adults

who hae retaned most o ther teeth. Despte ths

ncrease n tooth retenton, tooth loss remans a

problem among older adults.

CDC s the lead Federal agency responsble or

promotng oral health through publc health

nterentons. CDC has and wll contnue to assstStates n strengthenng ther oral health programs,

reachng people hardest ht by oral dseases, and

epandng the use o measures that are proen eecte

n preentng oral dseases. CDC currently prodes 12

States wth unds, techncal assstance, and tranng

to buld strong oral health programs. Eght o the

12 States recee undng to deelop and coordnate





communty water fuordaton programs or school-

based dental sealant programs. Wth CDC support,

States can better promote oral health, montor oral

health behaors and problems, and conduct andealuate preenton programs.

Substance Use/Abuse

Te use o alcohol, tobacco, and llct drugs eacts a

sgncant health and economc toll on ndduals

and communtes n the Unted States. In 2005, 19.7

mllon (8.1 percent) Amercans aged 12 years and older

used an llct drug, 71.5 mllon (29.4 percent) used a

tobacco product, and 126 mllon (51.8 percent) used

alcohol. xxix obacco use s the leadng preentable

cause o death n the Unted States, resultng n

appromately 440,000 deaths each year. xxx

CDC supports basc mplementaton programs

to preent and control tobacco use n the States,

terrtores, and trbal areas. CDC also works wth

a arety o natonal and nternatonal partners to

promote acton through partnershp n tobacco control

eorts wth WHO and WHO Member States. Buldng

on these estng acttes and partnershps, CDC

wll work to engage busness sectors n supportng

comprehense tobacco preenton and control programs, ncludng the benets o tobacco-ree

workplaces and the mportance o access to cessaton

serces to employees who are tryng to qut smokng.

For Medcare benecares who use tobacco, cessaton

counselng s a coered preente serce.

As part o ts eorts to reengneer ts approach to

substance abuse preenton, SAMHSA has created

a strategc ramework that s bult on scence-based

theory, edence-based practces, and the knowledge

that eecte preenton programs must engage

ndduals, amles, and entre communtes. SAMHSA’s

new Strategic Prevention Framework (SPF) sets nto

place a step-by-step process that empowers States and

communtes to denty ther unque substance use

problems, buld or enhance nrastructure to support

solutons, and mplement the most eecte preenton

eorts or ther specc needs. It also ncludes

montorng and ealuaton to ensure accountablty





and eecteness o the program eort. SAMHSA wll

contnue to utlze the SPF and epand ts use through tsState and local grant programs.

Suicide Prevention

For eery two ctms o homcde n the Unted States,

there are three Amercans who take ther own les.

Sucde s a potentally preentable publc health

problem. Studes o youth who hae commtted sucde

hae ound that 90 percent had a dagnosable mental

and/or substance abuse dsorder at the tme o ther

death. xxxi SAMHSA supports acttes authorzed by the

Garrett Lee Smth Memoral Act o 2004 (Publc Law 108-355), whch support statewde youth sucde nterenton

and preenton strateges n schools, nsttutons o

hgher educaton, juenle justce systems, substance

abuse and mental health programs, oster care systems,

and other youth support organzatons. Addtonally,

OD s workng on an ntate to understand and help

preent sucde among persons wth dsabltes and

those who ncur dsabltes.

Risk Reduction

Chronc condtons currently lmt acttes or 12mllon older people lng n communty settngs n

the Unted States; 25 percent o these ndduals are

unable to perorm basc acttes o daly lng, such

as bathng, shoppng, dressng, or eatng. Furthermore,

alls are the leadng cause o njury-related deaths and

hosptal admsson among older people and account or

between 20 bllon and 30 bllon health care dollars n

the Unted States each year. Tese numbers wll ncrease

dramatcally n the comng years wth the agng o theBaby Boom Generaton. AHRQ, AoA, CDC, CMS, and

NIH contrbute to research, demonstratons, the settng

o natonal standards and gudelnes, and the proson

o grants and techncal assstance to help older adults

manage ther chronc dseases and preent alls and to

encourage them to le healthy and acte lestyles.

For eample, AoA unds an Evidence-Based Disability

and Disease Prevention grant program and publc/

prate partnershp whch deploys proen dsablty

and dsease preenton programs at the communty

leel that empower older ndduals to make

behaoral changes that wll reduce ther rsk o dsease,

dsablty, and njury. AHRQ and AoA, n collaboraton

wth CDC, CMS, and NIH, are deelopng and testng

a specal Knowledge ranser program targeted at

State and local agency sta to promote and acltate

the utlzaton o edence-based dsease preenton

programs or older people at the communty leel. CDC

unds all preenton research, research dssemnaton,

and research translaton and mplementaton that help

decrease alls and ncrease stablty n moble older

adults. CMS s demonstratng a health promoton and

dsease preenton program through the Medicare

Senior Risk Reduction Demonstration to determne

whether health rsk reducton programs that hae been

deeloped, tested, and shown to be eecte n the

prate sector can be talored to the Medcare program

to help benecares mproe ther health and thus

reduce the need or health care serces.






Prepare or and respond to natural and

manmade disasters.

Te Pandemc and All-Hazards Preparedness Act o

2006 (PAHPA; Publc Law 109-417) coded the HHS

Secretary’s role as lead or the Federal publc health and

medcal response to emergences and ncdents coered

by the Natonal Response Plan (NRP), and authorzes

HHS’s operatonal control o Federal publc health

and medcal response assets durng these eents.8 In

addton, the deelopment o the Homeland Securty

Councl’s National Strategy or Pandemic Infuenza has

stressed the mportance o preparedness or naturaland manmade dsasters that hae publc health mpact.

Many o the strateges undertaken by HHS to achee

preparedness and response capablty are done n

concert wth or n support o other Federal departments

and agences, State and local goernments, and prate

sector enttes. Ts collaborate approach s tal

gen that publc health emergences hae the potental

to aect nearly eery sector o socety. One o HHS’s

largest nestments s to deelop and stockple the

countermeasures needed to respond to the most serous

dsasters. Consequently, a perormance ndcator lstedat the end o ths chapter assesses the readness o States

to utlze these supples. A second ndcator ocuses on

the etent to whch State emergency management plans

coer the broad array o ndduals wth specal needs,

speccally measurng plans or those wth dsabltes.

Te Oce o the Assstant Secretary or Preparedness

and Response (ASPR) s the sngle oce responsble or

preparedness and response acttes wthn HHS. As the

prncpal adsor to the Secretary on all matters related

to publc health and medcal preparedness and response

emergences, ASPR leads and promotes a collaborateapproach wth many partners, ncludng ACF, AoA, CDC,

CMS, FDA, HRSA, OPHS, and SAMHSA. For addtonal

normaton on ths topc, see In the Spotlight: Emergency

Preparedness, Prevention, and Response.

8 An ecepton to ths authorzaton s those assets under the

control o the U.S. Department o Deense.





Key strateges that wll be used to enhance publc

health and medcal emergency preparedness and

response nclude:

Deelopng the Natonal Health Securty Strategy,•

startng n 2009; Awardng cooperate agreements to States or•

other elgble enttes to conduct the acttes o the Natonal Health Securty Strategy; andRentegratng the Natonal Dsaster Medcal•

System wthn HHS.

A major ocus o preparedness acttes wll be

the mplementaton o the Biomedical Advanced

Research and Development Authority (BARDA), and

countermeasures deelopment. Te nternatonal preparedness acttes nclude the International

Health Regulations, whch wll come nto orce n

June 2007. Tese regulatons requre members to

deelop, strengthen, and mantan core surellance

and response capactes to detect, assess, noty, and

report publc health eents to WHO and respond to

publc health rsks and publc health emergences.

WHO, n turn, wll ealuate members’ publc health

capactes, promote techncal cooperaton, oer

logstcal support, and acltate the moblzaton

o nancal resources or buldng capacty n

surellance and response.

Workorce Readiness

HHS wll denty, put on a roster, and tran deployable

teams o medcal and publc health proders, ncludng

HHS personnel (both commssoned ocers and cl

serce employees), other Federal employees, and

oluntary sta. HHS meets regularly wth ts ESF-89

Federal partners to denty mssons, orm teams

wth the sklls needed to meet the mssons, denty tranng and equpment requrements, and ntate

9 Emergency Support Function (ESF)-8—Health and Medical

Services. ESF-8 prodes coordnated Federal assstance to

supplement State and local resources n response to publc health

and medcal care needs ater a major dsaster or emergency, or durng

a deelopng potental medcal stuaton. Assstance proded under

ESF-8 s drected by HHS through ts eecute agent, ASPR.





tranng. HHS has dented the logstcal support

needs or these teams and has deeloped specc tasks

or meetng these logstcal needs. Eamples o these

needs nclude medcal supples, equpment, housng,and ood requrements.

Ts actty bulds upon the transormaton

acttes o the Commssoned Corps o the USPHS

(Commssoned Corps). Te Commssoned Corps

prodes a unque source o well-traned, hghly

qualed, dedcated publc health proessonals who

are aalable to respond rapdly to urgent publc

health challenges and health care emergences.

Te Commssoned Corps’ response to Hurrcane

Katrna s a powerul eample o what ts ocers

can do. In response to Hurrcane Katrna, the

Commssoned Corps deployed more than 2,000

ocers—the largest deployment n ts hstory—and

stll has personnel n the eld prodng care n

Lousana today. Te transormaton wll acltate

orce management mproements that are necessary

or the Commssoned Corps to uncton een more

ecently and eectely. Te current actty usng

rosters s amed at structurng ocers nto teams,

and then tranng them as a team. Ts approach

denes clarty o roles and epectatons, and assuresthat leadershp and management o the ocers n the

deployed stuaton are well understood and ther roles

are eecutable.

hese teams wll nterace wth the Dsaster

Medcal Assstance eams (DMAs) elded under

the National Disaster Medical System (NDMS).

he greatest utlty o the DMAs s n mmedate

emergency response, and they are consdered the

ntal responders or emergency medcal needs

durng the rst 72 hours ater an eent. HHS

and other Federal agences wll be responsble

or the other requrements n the contnuum o

health needs, ncludng some aspects o health

serces delery durng eacuaton, hosptal care,

low-ntensty aclty-based care or populatons

wth specal needs (such as chronc dseases and

dsablty), and other health outreach acttes.

Threat Agent Identication

CDC and FDA wll contnue to deelop and support

laboratory capacty epanson to mproe analyss

o bologcal or toc substances that uses aldated,

proen methods or derent sample matrces.

CDC and FDA wll also support the deelopment

and aldaton o laboratory methods or prorty

bologcal and toc substances through the

Laboratory Response Network.

Emergency Preparedness

HHS admnsters two major grant programs that

support State and local capactes, as well as

capabltes to prepare or and respond to publc health

emergences. Oer the net 5 years, these programs wll

sht dramatcally, rom a ocus on capacty buldng to

mprong targeted capabltes.

ASPR admnsters the National Bioterrorism Hospital

Preparedness Program, whch, through States, enhances

the ablty o the health care system, ncludng

hosptals, to prepare or and respond to boterrorsm

and other publc health emergences. Program prorty

areas oer the net 5 years nclude mprong bed and

personnel surge capacty, decontamnaton capabltes,

solaton capacty, and pharmaceutcal supples, as wellas supportng tranng, educaton, drlls, and eercses.

CDC admnsters the Public Health Emergency Preparedness

Cooperative Agreement Program, whch prodes unds

to States and localtes or State and communty-leel

preparedness. Oer the net 5 years, HHS wll place

ncreased emphass on acheng benchmarks and

standards or preparedness by recpents o both undng

streams as requred by PAHPA.

Countermeasures

HHS, through all o ts operatng dsons, seeksto shape and eecute a comprehense medcal

countermeasures program to protect our ctzens

aganst the threats o today and nto the uture. Ts

msson encompasses the breadth o acttes requred

to accomplsh that goal, ncludng threat agent

montorng and dsease surellance and detecton,

as well as research, deelopment, acquston,





storage, deployment, and utlzaton o medcal

countermeasures. NIH leads the eort or medcal

countermeasure basc research, early stage product

deelopment, and clncal research. FDA s commttedto acltatng the deelopment and aalablty o sae

and eecte medcal countermeasures. CDC has

responsbltes ncludng dsease montorng through

ts nectous dsease surellance program and medcal

countermeasure storage and deployment through

ts Strategic National Stockpile (SNS) program. Te

SNS procures and stores large quanttes o medcne

and medcal supples to protect the Amercan

publc there s an emergency (e.g., terrorst attack,

nfuenza pandemc, or earthquake) seere enough

to cause local supples to run out. HHS wll contnue

to nest n research and deelopment o medcal

countermeasures, procure sae and eecte materals

or the SNS, and work wth States to ensure that

they are prepared to request, recee, and utlze SNS

materals n the case o a publc health emergency.

Pandemic Infuenza

HHS pandemc nfuenza mplementaton acttes

support the larger National Strategy or Pandemic

Infuenza, and many are conducted n concert wth or

n support o other Federal departments and agences.Te key strateges or pandemc nfuenza preparedness

ocus on nternatonal acttes; domestc surellance;

publc health nterentons; medcal response; accnes,

antrals, dagnostcs, and personal protecte equpment;

passe and acte surellance or accne saety;

communcaton; and support or State, local, and trbal

preparedness. HHS, prmarly through ASPR, CDC, FDA,

NIH, and OPHS, wll contnue to support the National

Strategy by completng actons n these strategy areas.

One major area o ocus wll be buldng the prepandemc

and pandemc nfuenza accne producton capacty and

accne supply. In Aprl 2007, FDA approed the rst U.S.

accne or humans aganst the H5N1 nfuenza rus. FDA

wll contnue to acltate adanced product deelopment

o both seasonal and pandemc nfuenza medcal

countermeasures, ncludng noel accnes, antrals,

and rapd dagnostcs. Ts wll be accomplshed by

prodng assstance to ndustry partners on domestc

manuacturng capabltes, acceleratng the reews o

seasonal and pandemc nfuenza related products, and

ssung gudance to eternal stakeholders on arous

regulatory subjects, ncludng clncal requrements orlcensure o seasonal and pandemc nfuenza accnes.

HHS agences also wll work closely wth other Federal

agences and nternatonal partners, such as WHO and the

mnstres o health n target countres. HHS has orward-

deployed a quantty o amfu n Asa or the purposes

o mountng a contanment operaton to attempt to

halt a potental nfuenza pandemc. In addton, HHS

s engaged n a number o nternatonal pandemc

preparedness acttes, through the International

Partnerships on Avian and Pandemic Infuenza, the Security

and Prosperity Partnership o North America, and the

Global Health Security Initiative.

People With Disabilities

Under Eecute Order 13347, all Federal emergency

preparedness eorts must address the needs o

ndduals wth dsabltes and other ulnerable

populatons. HHS has taken a leadershp role n

engagng the dsablty communty and prodng

gudance to partners to address the unque health

needs o ndduals wth dsabltes and other

ulnerable populatons, ncludng chldren and youth wth specal health care needs. In 2006, HHS and the

U.S. Department o Homeland Securty cosponsored a

workng conerence or State emergency preparedness,

publc health, agng, and dsablty agences to acltate

dalog and collaboraton among these organzatons

toward the common goal emboded n the Eecute

Order. Te result has been a lng laboratory or State

and Federal cooperaton and shared learnng around

the ssue o emergency preparedness or ulnerable

populatons. OD and ASPR wll mplement and

montor the use o the dsablty-based preparedness

toolkt and publc health sta tranng modules—

deeloped by a broad-based HHS workgroup—to

ensure that the needs o chldren, youth, and adults

wth dsabltes and chronc condtons are ully

understood by rst responders and other emergency

response proders at the Federal, trbal, State, and

local leels durng all emergency stuatons.





ASPR, OD, and OCR are workng wth the AmercanRed Cross to deelop an ntake and assessment tool

that wll be used at shelters to ealuate the unctonal

needs o all ndduals, ncludng ndduals wth

dsabltes. Ts tool wll help ensure that ndduals

wth dsabltes hae equal access to shelter serces

and are sered n the most ntegrated settng

approprate. On the local leel, OCR’s 10 regonal

oces are workng wth other oces n HHS and States

to prode techncal assstance and resources to plan

or and respond to needs o ndduals wth dsabltes

n the eent o an emergency.

Protected Health Information. In ts reew o State

and local emergency plans ssued n the summer o 2006,

the U.S. Department o Homeland Securty dented

msunderstandng and conuson surroundng the

applcaton o the HIPAA Pracy Rule protectons to

normaton sought or emergency response plannng

purposes. OCR has mplemented a new Web-based

nteracte decson tool desgned to assst emergency

preparedness and recoery planners n determnng

how to access and use health normaton consstent

wth the HIPAA Pracy Rule. Te tool gudes emergency

preparedness and recoery planners through a seres

o questons regardng how to apply the HIPAA Pracy

Rule. Te tool s aalable on OCR’s Web ste along

wth bulletns contanng normaton or emergency

proders on the dsclosure o protected health

normaton to assst wth dsaster rele eorts.

Equal Access

OCR has taken steps, consstent wth a Federal

Goernmentwde eort, to help ensure that ndduals

wth Lmted Englsh Procency (LEP) hae equal access

to normaton, shelters, and other eacuaton and rele

eorts. For eample, OCR s workng wth ASPR and the

Amercan Red Cross to deelop an ntake and assessment

tool that wll be used at shelters to denty and address

communcaton needs o ndduals wth LEP. On the

local leel, OCR’s regonal oces are workng wth HHS

partners and States to prode techncal assstanceand resources to plan or and respond to the needs o

ndduals wth LEP n the eent o an emergency.

Inormation Technology Support

HHS wll be deelopng a deployable, nteroperable rst

responder electronc health record system. Te electronc

health record system or dsasters wll mantan the

securty and condentalty o health normaton. Te

ntenton s to eld test possble platorms durng the 2007

hurrcane season to gan nsght nto ther benets and

lmtatons. Tere are ew estng systems and standards

n the broader health enronment to nteract wth at ths

tme, so the epected benets are to ensure qualty o care

and contnuty o normaton sharng durng a publc

health emergency and ts atermath. Wder health sector

standards deelopment and endorsement by the Health

Inormaton echnology Standards Panel and the Secretary

wll be completed to captalze on the desred benets o

ths approach toward contnuty and qualty o care.





Perormance Indicators

Most Recent Result FY 2012 Target


Prevent the spread o inectious diseases.

2.1.1

Achee or sustan mmunzaton coerage o

at least 90% n chldren 19 to 35 months o age

or:

a) 4 doses o Dphthera-etanus-Pertusss

(DtaP) accne;

b) 3 doses o polo accne;

c) 1 dose o Measles-Mumps-Rubella (MMR)

accne;

d) 3 doses o hepatts B accne;

e) 3 doses o Haemophlus nfuenzae type b

(Hb) accne;

) 1 dose o arcella accne; and

g) 4 doses o pneumococcal conjugate

accne (PCV7).

a) DaP: 86%;

b) Polo: 92%;

c) MMR: 92%;

d) Hepatts B: 93%;

e) Hb: 94%;

) Varcella: 88%; and

g) PCV7: 83%.

At least 90%

2.1.2

Increase the proporton o people wth HIV

dagnosed beore progresson to AIDS.

76.5% 81%

2.1.3

Reduce the ncdence o necton wth key

oodborne pathogens:

Cases/100,000: Cases/100,000:

a) Campylobacter;

b) Eschercha col O157:H7;

c) Lstera monocytogenes; and

d) Salmonella speces.

a) 12.72;

b) 1.06;

c) 0.30; and

d) 14.55.

a) 12.30;

b) 1.00;

c) 0.23; and

d) 6.80.

2.1.4

Increase the rate o nfuenza accnaton:

a) n persons 65 years o age and older; and

b) Among nonnsttutonalzed adults and

hgh rsk, aged 18 to 64.

a) 59.6%; and

b) 25.3%.

a) 90%; and

b) 60%.





Most Recent Result FY 2012 Target


Protect the public against injuries and environmental threats.

2.2.1

a) Reduce nonatal work-related njures

among youth ages 15 to 17; and

a) 4.4/100 FE10; and a) 4.2/100 FE; and

b) Reduce atal work-related njures among

youth ages 15 to 17.

b) 2.7/100,000 FE. b) 2.8/100,000 FE


Promote and encourage preventive health care, including mental health, lielong healthy behaviors, and recovery.

2.3.1

Reduce complcatons o dabetes among

Amercan Indans and Alaska Nates by

ncreasng the proporton o patents wth

dagnosed dabetes that hae acheed blood

pressure control (<130/80).

37% 50%

2.3.2

Increase the proporton o women aged 40

years and older who receed a mammogram

wthn the precedng 2 years.

74.6% 77%

2.3.3Reduce 30-day use o l lct substances (age 12

and older).7.9% 5.8%

2.3.4 Reduce the number o sucde deaths. 32,439 30,584


Prepare or and respond to natural and manmade disasters.

2.4.1

Increase the percentage o State publc health

agences prepared to use materel contaned n

the Strategc Natonal Stockple (SNS).

70% 90%

2.4.2

Increase the number o States and terrtores

that nclude persons wth dsabltes n

emergency management plans and responses.

6 55

Note: Addtonal normaton about perormance ndcators s ncluded n Append B.10

10 FE = ull-tme equalent employee, and one FE = 2,000 hours worked (aerage hours worked by a ull-tme employee n a year).





ths uncertanty by plannng or multple scenaros

n ts all-hazards preparedness program. HHS also

s prodng gudance to help States and localtes

enhance ther capacty to respond to natural ormanmade dsasters o aryng seerty and scope.

Second, eternal actors also prode opportuntes or

shared plannng, response, and ealuaton. By workng

wth our Federal, State, local, and trbal partners,

we can leerage resources and personnel to mproe

oerall leel and qualty o both preparedness and

response.

Emergng pathogens, many o whch are zoonotc n

orgn, also aect emergency preparedness. Because

the habtats o anmals and people are netrcably

lnked, there s an ncreased possblty or eposure

to zoonotc dseases. HHS understands ths lnk,

and s coordnatng strateges to mtgate zoonotc

dseases that orgnate n anmals n order to protect

both anmal and human health. HHS collaborates

wth other Federal departments and agences and

nternatonal organzatons that ocus on anmal

health, as well as wth State goernments and academc

nsttutons, to address zoonotc dseases.





Preparedness strateges ocus on ensurng that

ndduals, amles, ulnerable populatons, and

communtes are prepared or publc health emergences

and dsasters. Response strateges ocus on promotngreslency and responsblty n communtes and among

the ctzenry n response to a publc health emergency.

Tese strateges nclude:

Developing and using policies and plans. HHS s

deelopng natonal and Departmental polces and

plans or response to publc health and medcal threats

and emergences. Areas o plannng nclude deelopng

and mantanng the National Health Security Strategy, a

coordnated strategy, and the mplementaton plan or

publc health emergency preparedness and responsethat ncludes an ealuaton o progress o Federal, State,

local, and trbal enttes, based on edence-based

benchmarks and objecte standards that measure leels

o preparedness. Ts response also ncludes deelopng

a strategc plan to ntegrate bodeense and emergng

nectous dsease requrements wth adanced research

and deelopment, strategc ntates or nnoaton,

and the procurement o qualed countermeasures

(wthn the purew o the Bomedcal Adanced

Research and Deelopment Authorty, or BARDA11).

Aligning resources and building partnerships. HHSs algnng Departmental enttes to support the ASPR

preparedness, preenton, and response msson and

s buldng producte strategc partnershps—at the

domestc and nternatonal leels, wthn the prate

and publc sectors—to combat boterrorsm and other

publc health threats and emergences.

Coordinating emergency preparedness and response

activities. Acttes nclude coordnatng the

acceleraton o adanced research, deelopment, and

procurement o qualed countermeasures, ncludng

pandemc or epdemc products (wthn the purew

o BARDA). HHS also coordnates publc health and

medcal response systems wth releant Federal, State,

local, and trbal ocals and wth the Emergency

Medical Assistance Compact to ensure ntegraton

o preparedness and response acttes or publc

11 Ts agency would lead n the deelopment o new medcal

countermeasures aganst boterrorsm and natural dsease outbreaks.





health emergences. HHS also works to ensure that

the National Disaster Medical System (NDMS),12 the

Medical Reserve Corps (MRC),13 and the Emergency

System or Advanced Registration o Volunteer Health Proessionals (ESAR-VHP)14 are properly coordnated to

mamze and streamlne the response to publc health

emergences.

Enhancing response personnel capacity. Ts process

begns wth establshng and mantanng a Medical

Reserve Corps to prode or an adequate supply o

olunteers n the case o a Federal, State, local, or trbal

publc health emergency. HHS s also deelopng core

health and medcal response currculums and tranng

to mproe responses to publc health emergences.

Enhancing preparedness through leadership and

support. HHS eorts enhance State and local publc

health and medcal preparedness—prmarly health

departments and hosptals, prodng epert medcal,

scentc, and publc health leadershp and adce.

HHS also leads nternatonal programs, ntates,

and polces that deal wth publc health and medcal

emergency preparedness and response related to

naturally occurrng threats such as nectous dseases

and delberate threats rom bologc, chemcal, nuclear,

and radaton sources. In addton, the Departmentawards contracts, grants, and cooperate agreements,

or enters nto other transactons, such as prze

payments, to promote nnoaton n technologes that

may assst countermeasures and produce adanced

12 Te NDMS s a ederally coordnated system that augments

the Naton’s medcal response capablty. Te oerall purpose

s to establsh a sngle ntegrated natonal medcal response

capablty or assstng State and local authortes n dealng wth

the medcal mpacts o major peacetme dsasters and to prode

support to the mltary and th e VA medcal systems n carng or

casualtes eacuated back to the Unted States rom oerseas armed

conentonal confcts.

13 Te MRC establshes teams o local olunteer medcal and publc health proessonals who can contrbute ther sklls and

epertse throughout the year and durng tmes o communty need.

14 ESAR-VHP works to establsh standardzed olunteer

regstraton systems wthn each State and n the terrtores that w ll

nclude readly aalable, erable, and up-to-date normaton o

the olunteer’s dentty, lcensng, credentalng, accredtaton, and

prlegng n hosptals or other medcal acltes that mght need

olunteers. Establshment o these natonally accepted gudelnes

to buld ther State systems would aord each State the ablty to

quckly denty, and better utlze, health proessonal olunteers n

emergences and dsasters.





research and deelopment; conducts research on

and deelops research tools and other deces and

technologes; and supports research to promote

strategc ntates (wthn the purew o BARDA).

HHS also awards compette grants or cooperate

agreements to support the mproement o surge

capacty and enhancement o communty and hosptal

preparedness or publc health emergences.

Protecting vulnerable populations. HHS ensures that

State and local emergency plans nclude attenton to

persons wth dsabltes n all emergency management

plans and responses.

Providing support in emergencies. HHS rapdly

prodes publc health and medcal support to Federal,

State, local, and trbal ncdents o natonal sgncance

or publc health and medcal emergences.

Establishing the Public Health Emergency Medical

Countermeasures Enterprise. HHS has deeloped

a strategy or the Public Health Emergency Medical

Countermeasures Enterprise. Te ultmate goal s to

establsh the oundatonal elements that wll support

medcal countermeasure aalablty and utlzaton or

the hghest prorty chemcal, bologcal, radologcal,

and nuclear threats acng the Naton.

Establishing a nationwide situational awareness.

HHS s workng to deelop and mplement a near-real-

tme electronc natonwde publc health stuatonal

awareness capablty through an nteroperable network o

systems to enhance early detecton o, rapd response to,

and management o potentally catastrophc nectous

dsease outbreaks and other publc health emergences.





Wthn HHS, CDC works to detect, ery, and quckly

respond to outbreaks o nectous dseases around

the globe and to control other health threats at

ther orgn to preent nternatonal spread. omantan the saety o the Amercan people, FDA

regulates mllons o products produced abroad. NIH

addresses global health challenges through nnoate,

collaborate research and tranng programs, and

through nternatonal partnershps. SAMHSA

works wth postconfct and postdsaster countres

to enable stakeholders to work together to address

the mental health needs o ther peoples. It also

helps to admnster programs to tran and support

mental health proessonals rom deelopng natons.

Buldng on ts leadershp o the domestc Ryan Whte

HIV/AIDS Program, HRSA prodes tranng and

qualty mproement nterentons n the President’s

Emergency Plan or AIDS Relie (PEPFAR).

HHS has a sgncant nternatonal presence. HHS

sta—both cl serants and USPHS ocers—sere

around the globe. Tese dedcated proessonals work

to mproe the health o the world—through ther

work on PEPFAR, the President’s Malaria Initiative

(PMI), the Global Polio Eradication Initiative (GPEI),

or through work to encourage nnoate, cooperate

bomedcal research wth researchers rom other

countres. HHS also regularly sends ts sta to work as

health attachés n U.S. Embasses and Mssons abroad.

Tese health attachés represent the U.S. Goernment to

host-country mnstres o health and to nternatonal

organzatons such as WHO.

Achievements

Trough ts work n nternatonal health, HHS boasts a

number o sgncant accomplshments. In the rst 3

years o PEPFAR, n 15 ocus countres n Arca, Asa,

and the Carbbean, HHS, through the eorts o CDC,

FDA, and HRSA, has played a sgncant role n the

U.S. Goernment’s support o antretroral treatment

or 820,000 people lng wth HIV/AIDS. In ts role

n PEPFAR, HHS has also joned the U.S. eort n

supportng care or almost 4½ mllon people, ncludng

2 mllon orphans and ulnerable chldren, as well as

counselng and testng or 18.6 mllon people.

Global Health Initiatives

HHS’s Mandate

Te mandate o the U.S. Department o Healthand Human Serces s to protect the health o the

Amercan people. Eents n recent years, howeer, hae

made t clear that our eorts to protect Amercans’

health cannot end at our borders.

Pathogens and other threats to human health are as

moble as we are, and hae become more and more

dangerous through growng drug resstance and

natural mutatons. As the world’s populaton becomes

ncreasngly moble, and as dseases change, our own

health becomes more and more ntertwned wth the

world’s health.

Te health o other natons s also closely ted to economc

productty, socal stablty, and good goernance. Such

economc, socal, and poltcal realtes clearly ntersect

wth our natonal nterest, and urther compel us to

address a arety o global health concerns.

Health-related programmng can also hold a specal

place as a oregn-polcy tool or the U.S. Goernment.

Our work to mproe global health demonstrates

the generosty o the Amercan people. Gen the

unersal alue populatons place on good health,edence-based, publc-health nterentons can help to

transcend poltcal boundares.

Meeting its Mandate

HHS works to mproe global health through drect

assstance, techncal and program support, tranng

and capacty buldng, and through research.




In the rst year o PMI, whch HHS and the Unted

States Agency or Internatonal Deelopment

(USAID) mplement jontly, PMI delered le-sang

nterentons to preent and control malara n the rstthree countres (Angola, anzana, and Uganda). Nearly

1 mllon long-lastng nsectcde-treated bed nets

(INs) were dstrbuted; appromately hal a mllon

INs that were not long lastng were re-treated; more

than 2 mllon people were protected rom malara

ater the nterors o ther homes were sprayed wth

nsectcdes; and appromately 1.2 mllon treatments

o artemsnn-based combnaton therapy were

procured and dstrbuted.

Trough CDC’s partcpaton n the GPEI, HHS has

played a sgncant role n spearheadng the global

ght to eradcate polo. At the launch o the GPEI n

1988, polo was endemc n more than 125 countres,

and paralyzed 350,000 chldren each year. In 2006,

only 1,985 people were paralyzed by polo, and now,

only 4 endemc countres reman. CDC contnues to

prode sgncant techncal epertse and support to

goernments and nternatonal organzatons n the

ght to eradcate polo.

HHS, through the work o CDC, s a core partner n

the global Measles Initiative, whch also ncludes the Amercan Red Cross, Unted Natons Foundaton,

Unted Natons Chldren’s Fund, and WHO. Te work

o ths ntate has had a sgncant eect on measles

deaths globally. Such deaths hae allen by 60 percent

worldwde, rom an estmated 873,000 deaths n 1999,

to 345,000 n 2005. In Arca, measles deaths ell by 75

percent, rom an estmated 506,000 to 126,000 n that

same perod. A concerted ntate n the Amercas

snce 2002 has elmnated endemc measles rom the

Western Hemsphere.

Interagency Eorts

We also know that we cannot achee our global health

goals alone. In our work, HHS partners wth many

other Departments, ncludng the U.S. Departments

o State, Deense, Agrculture, Homeland Securty, and

Commerce. HHS also collaborates closely wth USAID

and wth EPA. HHS also enjoys ecellent blateral

partnershps wth other goernments, as well as good

workng relatonshps wth multlateral organzatons,

nongoernmental and ath-based organzatons, and

wth the prate sector.

HHS s also commtted to workng to achee seeral o

the Mllennum Deelopment Goals (MDGs) deeloped

by the Unted Natons. Eght MDGs were deeloped

n September 2000 at the Unted Natons Mllennum

Summt to help prode a ramework or leaders to

mproe the health and well-beng o men, women,

and chldren around the world. Te ntent s to make

sgncant mproement n these areas by 2015. O the

MDGs deeloped, HHS s partcularly ocused on MDG

4 (reduce chld mortalty), MDG 5 (mproe maternal

health), and MDG 6 (combat HIV/AIDS, malara, and

other dseases).

Important as nternatonal health may be today,

addressng ts challenges wll be crucal n the uture.

I the U.S. Goernment s to contnue ts leadershp n

global aars, t must contnue to oster these hgh-

tech, publc health nstruments or engagng the world,

both to mtgate global health rsks and to strengthen

U.S. publc dplomacy abroad.

Health and Human Services: hhsplanc3

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