Prevent and control disease, injury, illness, and disability across the lifespan, and protect the public from infectious, occupational, environmental, and terrorist threats.
Throughout the 20th century, advances in public health and medicine resulted in reduced morbidity and mortality from infectious diseases, including influenza, polio, and foodborne and waterborne illnesses. Chronic diseases, such as heart disease, stroke, cancer, and diabetes, replaced infectious diseases as the major cause of illness and death in the United States in the latter part of the 20th century. In the new millennium, the Nation continues to face the challenge of chronic disease because of unhealthy and risky behaviors, environmental exposures, and an aging population.
Today, chronic diseases continue to be significant health problems that face Americans. As HHS works to address these health issues, infectious diseases have reemerged as a priority for public health in the United States. For example, risky behaviors such as unprotected sex and injecting drug use continue to result in new HIV/AIDS infections. At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS.xvii According to the Centers for Disease Control and Prevention (CDC), approximately 40,000 persons are infected with HIV each year. Injecting drug use is also a common current risk factor for hepatitis C virus (HCV) infection. About 30,000 Americans are infected with HCV each year, and about 3 million are chronically infected with this virus, which is a leading indication for liver transplants and hastens the progression of HIV in those who are coinfected.
Foodborne diseases cause an estimated 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Other known pathogens account for an estimated 14 million illnesses, 60,000 hospitalizations, and 1,800 deaths annually.xviii Morbidity and mortality from injuries and environmental hazard exposures also continue to affect the health and well-being of Americans.
Over the past century, public health advances in drinking water, wastewater, and recreational water quality have dramatically improved the health of the American people. However, drinking water from public water systems causes an estimated 4 to 16 million cases of gastrointestinal illness per year. During 2003–2004, 62 waterborne disease outbreaks associated with recreational water were reported by 26 States and Guam. Illness occurred in 2,698 persons, resulting in 58 hospitalizations and 1 death.xix
Although malaria is technically preventable and curable if recognized and treated promptly, it remains one of the world’s greatest threats to human health and economic welfare. Each year, malaria kills more than 1 million people—the majority, young children in Africa. In a retrospective analysis, it has been estimated that economic growth per year of countries with intensive malaria was 1.3 percent lower than that of countries without malaria.xx
The 21st century is also marked by the threat of public health emergencies. These threats have become a significant focus for public health at the Federal, State, and local levels. Public health threats and emergencies can ensue from myriad causes—bioterrorism; natural epidemics of infectious disease; terrorist acts that involve conventional explosives, toxic chemicals, or radiological or nuclear devices; industrial or transportation accidents; and climatological catastrophes.
Strategic Goal 2, Public Health Promotion and Protection, Disease Prevention, and Emergency Preparedness, seeks to address these problems. There are four broad objectives under Public Health:
- Prevent the spread of infectious diseases;
- Protect the public against injuries and environmental threats;
- Promote and encourage preventive health care, including mental health, lifelong health behaviors, and recovery; and
- Prepare for and respond to natural and manmade disasters.
HHS is positioned to address the public health problems of infectious diseases, injuries and environmental hazards, chronic diseases and behavioral health problems, and public health emergencies through a comprehensive set of strategies. HHS provides leadership on these health issues within the Federal Government and collaborates with numerous partners across the Federal Government to achieve these objectives. These partners include the U.S. Departments of Homeland Security and Defense for public health emergency preparedness; the U.S. Environmental Protection Agency (EPA) and U.S. Department of Labor for environmental and occupational health issues; and the U.S. Departments of Agriculture and Commerce, and EPA, for food safety.
Within HHS, multiple operating and staff divisions work together to develop and implement strategies to achieve the goal of preventing and controlling disease, injury, illness, and disability across the lifespan and of protecting the public from infectious, occupational, environmental, and terrorist threats. Key operating and staff divisions that contribute to this goal include the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), Health Resources and Services Administration (HRSA), Office of the National Coordinator for Health Information Technology (ONC), Office of the Assistant Secretary for Preparedness and Response (ASPR), and Substance Abuse and Mental Health Services Administration (SAMHSA). In addition, HHS’s Administration on Aging (AoA), Centers for Medicare & Medicaid Services (CMS), Office for Civil Rights (OCR), Office on Disability (OD), Office of Global Health Affairs (OGHA), and Office of Public Health and Science (OPHS) play important roles in addressing this goal.
Below is a description of each strategic objective, followed by a description of the key programs, services, and initiatives the Department is undertaking to accomplish those objectives. Key partners and collaborative efforts are included under each relevant objective. The performance indicators selected for this strategic goal are also presented with baselines and targets. These measures are organized by objective. Finally, this chapter discusses the major external factors that will influence HHS’s ability to achieve these objectives, and how the Department is working to mitigate those factors.
Strategic Objective 2.1: Prevent the spread of infectious diseases.
Although modern advances have conquered some diseases, infectious diseases continue to threaten the Nation’s health. Outbreaks of Severe Acute Respiratory Syndrome (SARS), avian influenza, West Nile Virus, and monkeypox are recent reminders of the extraordinary ability of microbes to adapt and evolve to infect humans. Earlier predictions of the elimination of infectious diseases often did not take into account changes in demographics, migration patterns, and human behaviors, as well as the ability of microbes to adapt, evolve, and develop resistance to drugs. Infectious disease can have significant medical and economic consequences. Addressing foodborne illnesses, vectorborne pathogens, viral hepatitis, HIV/AIDS and other sexually transmitted infections, tuberculosis, antimicrobial resistance, and a possible influenza pandemic is a significant priority for HHS. Although these diseases affect all Americans, many often hit hardest the most vulnerable populations—the low-income population, minorities, children and youth, immigrants, persons who are incarcerated, and other disenfranchised populations. The selected performance indicators at the end of this chapter were chosen to reflect the impact HHS has on these populations.
Strategic Objective 2.2: Protect the public against injuries and environmental threats.
Injuries are the leading cause of death among children and adults younger than 44 years of age in the United States. About 160,000 people die each year in the United States from injuries; millions more are injured and survivexxii; and nearly 30 million people sustained injuries serious enough to require treatment in an emergency room. Many injured people are left with long-term disabilities.
HHS has a particular responsibility to provide the science base needed to reduce occupational injuries; the performance indicators at the end of this chapter measure this progress. CDC conducts the majority of injury prevention activities that support this objective. CDC focuses on strategies to address interpersonal violence, residential fires, falls, and workplace injuries and mortality. These include identifying risk factors, conducting surveillance, and supporting implementation activities.
Strategic Objective 2.3: Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery.
Chronic diseases—such as heart disease, cancer, and diabetes—are among the leading causes of death and disability in the United States. These diseases account for 7 of every 10 deaths and affect the quality of life of 90 million Americans.xxiii Although chronic diseases are among the most common and costly health problems, they are also among the most preventable.
AHRQ, AoA, CDC, CMS, FDA, HRSA, IHS, OD, OPHS, and SAMHSA currently support a variety of programs and initiatives aimed at reducing the prevalence of chronic diseases and helping people with chronic conditions manage their diseases more effectively. State and local health departments, national and international health organizations, philanthropic foundations, and professional, voluntary, and community organizations are key partners in these health promotion and disease prevention activities. In the period of 2007–2012, these agencies will continue to support these activities and will work to expand, enhance, and improve their effectiveness. The Department selected key performance indicators that represent a broad array of activities, including cardiovascular health, cancer screening, and programs to reduce substance abuse and suicide.
Strategic Objective 2.4: Prepare for and respond to natural and manmade disasters.
The Pandemic and All-Hazards Preparedness Act of 2006 (PAHPA; Public Law 109-417) codified the HHS Secretary’s role as lead for the Federal public health and medical response to emergencies and incidents covered by the National Response Plan (NRP), and authorizes HHS’s operational control of Federal public health and medical response assets during these events.8 In addition, the development of the Homeland Security Council’s National Strategy for Pandemic Influenza has stressed the importance of preparedness for natural and manmade disasters that have public health impact. Many of the strategies undertaken by HHS to achieve preparedness and response capability are done in concert with or in support of other Federal departments and agencies, State and local governments, and private sector entities. This collaborative approach is vital given that public health emergencies have the potential to affect nearly every sector of society. One of HHS’s largest investments is to develop and stockpile the countermeasures needed to respond to the most serious disasters. Consequently, a performance indicator listed at the end of this chapter assesses the readiness of States to utilize these supplies. A second indicator focuses on the extent to which State emergency management plans cover the broad array of individuals with special needs, specifically measuring plans for those with disabilities.
The Office of the Assistant Secretary for Preparedness and Response (ASPR) is the single office responsible for preparedness and response activities within HHS. As the principal advisor to the Secretary on all matters related to public health and medical preparedness and response emergencies, ASPR leads and promotes a collaborative approach with many partners, including ACF, AoA, CDC, CMS, FDA, HRSA, OPHS, and SAMHSA. For additional information on this topic, see In the Spotlight: Emergency Preparedness, Prevention, and Response.
Key strategies that will be used to enhance public health and medical emergency preparedness and response include:
- Developing the National Health Security Strategy, starting in 2009;
- Awarding cooperative agreements to States or other eligible entities to conduct the activities of the National Health Security Strategy; and
- Reintegrating the National Disaster Medical System within HHS.
A major focus of preparedness activities will be the implementation of the Biomedical Advanced Research and Development Authority (BARDA), and countermeasures development. The international preparedness activities include the International Health Regulations, which will come into force in June 2007. These regulations require members to develop, strengthen, and maintain core surveillance and response capacities to detect, assess, notify, and report public health events to WHO and respond to public health risks and public health emergencies. WHO, in turn, will evaluate members’ public health capacities, promote technical cooperation, offer logistical support, and facilitate the mobilization of financial resources for building capacity in surveillance and response.
Meeting External Challenges
Within the Public Health Promotion and Protection, Disease Prevention, and Emergency Preparedness goal, changes on population demographics, shifts in burden of disease, uncertainty related to the scope and timing of public health emergencies, and the potential threat of zoonotic diseases will significantly influence the ability of HHS to achieve the objectives related to this goal.
As the Nation’s population ages, a greater proportion of Americans will be older and expected to live longer. These shifts will result in an increased chronic disease burden and a greater need for public health interventions to prevent or control these diseases. HHS will work to mitigate these effects by promoting the translation of the evidence base for health promotion and disease prevention for older adults at the community level. HHS also will continue to develop and implement cost-effective models to support increasingly frail older adults in their homes.
A shifting distribution in disease burden also affects the ability of HHS to achieve its public health objectives. For example, HIV-related disease and affected populations will result in an expansion of the number of HIV-infected individuals who need treatment and related care. Infections in new subpopulations could be difficult to identify, reach, and serve. HHS is developing improved disease surveillance and outreach strategies to identify and reach newly affected populations in the United States. HHS also is providing assistance to service providers in planning and capacity-building efforts to meet these changes.
In the public health emergency preparedness arena, external factors represent both threats and opportunities. First, the unexpected scope of emergencies in terms of probability of occurrence, place, time, and type makes resource allocation and targeting a significant challenge. A hurricane can result in significant public health consequences as Hurricane Katrina did in 2005, or may result in little or no health impact. A bioterrorist attack could be widespread, occur simultaneously in multiple locations, or be limited to one room in one building. HHS is addressing this uncertainty by planning for multiple scenarios in its all-hazards preparedness program. HHS also is providing guidance to help States and localities enhance their capacity to respond to natural or manmade disasters of varying severity and scope. Second, external factors also provide opportunities for shared planning, response, and evaluation. By working with our Federal, State, local, and tribal partners, we can leverage resources and personnel to improve overall level and quality of both preparedness and response.
Emerging pathogens, many of which are zoonotic in origin, also affect emergency preparedness. Because the habitats of animals and people are inextricably linked, there is an increased possibility for exposure to zoonotic diseases. HHS understands this link, and is coordinating strategies to mitigate zoonotic diseases that originate in animals in order to protect both animal and human health. HHS collaborates with other Federal departments and agencies and international organizations that focus on animal health, as well as with State governments and academic institutions, to address zoonotic diseases.