ADDRESSING CDCS POLICY PRIORITIES John Auerbach MBA Associate

ADDRESSING CDC’S POLICY PRIORITIES John Auerbach, MBA Associate Director for Policy Acting Director, Office for State, Tribal, Local and Territorial Support, CDC Craig Thomas, Ph. D Director, Division of Public Health Performance Improvement Office for State, Tribal, Local and Territorial Support, CDC

CDC Strategic Directions Improve health security at home and around the world Better prevent the leading causes of illness, injury, disability, and death Strengthen public health/ health care collaboration

OADP Mission and Priorities OADP’s mission is to identify and advance opportunities to use policy, leverage health system transformation, and engage other sectors to improve the public’s health. OADP’s priorities are to § Identify high-value prevention and public health policies and interventions § Increase the understanding and use of credible evidence of prevention’s impact by policy makers, health care, and public health § Catalyze collaboration among public health, health care, and other sectors, with special focus on those opportunities expanded by the Affordable Care Act

Three Buckets of Prevention Traditional Clinical Prevention Innovative Clinical Prevention Total Population or Community-Wide Prevention 1 2 3 Increase the use of evidence-based services Provide services outside the clinical setting Implement interventions that reach whole populations Health Care Public Health Auerbach J. , The 3 Buckets of Prevention. Journal of Public Health Management and Practice 2016. http: //journals. lww. com/jphmp/Citation/publishahead/The_3_Buckets_of_Prevention_. 99695. aspx

Buckets 1 & 2: “ 6|18” Initiative Promote adoption of evidence-based interventions in collaboration with health care purchasers, payers, and providers High-burden health conditions 6|18 Evidence-based interventions that can improve health and save money

Bucket 3: Community-Wide Health Improvement COMING SOON! Development of a total population 6|18 -like Initiative

OSTLTS Mission Advance US public health agency and system performance, capacity, agility, and resilience

OSTLTS Overview § Help for capacity and performance improvement for state, tribal, local, and territorial public health agencies § Specialized training for new public health officials and professionals § Guidance on using public health law to improve public health § Targeted communication, teleconferences, website, and assessment tools

What We Do Workforce development § • • Public Health Associate Program National Leadership Academy for the Public’s Health Technical assistance § • • • Funding Public Health Law Program Partnership support Tribal support Communication tools § Performance improvement • Accreditation • Preventive Health and Health • • Services (PHHS) Block Grant Prevention Status Reports Public health improvement training Health system transformation Customized support to health officials

Prevention Status Reports (PSRs) A suite of CDC reports that highlight—for all 50 states and the District of Columbia— the status of public health policies and practices designed to address priority public health problems. Alcohol-Related Harms Motor Vehicle Injuries Food Safety Nutrition, Physical Activity, and Obesity Healthcare-Associated Infections Prescription Drug Overdose Heart Disease and Stroke Teen Pregnancy HIV Tobacco Use

Current Issues

FY 2017 Proposed Increases Comparison to FY 2016 § Protecting Americans from infectious diseases • Antibiotic resistance (+$40 M) • Quarantine and migration (+$15 M) • Viral hepatitis (+$5 M) § Protecting against global and domestic threats • Global health protection (+$10 M) • Polio eradication (+$5 M) • Select Agent Program (+$5 M)

FY 2017 Proposed Increases Comparison to FY 2016 (continued) § Preventing the leading causes of disease, disability, and death • Good health and wellness in Indian Country (+$15 M) • Drug overdose prevention (+$10 M) • Gun violence prevention research (+$10 M) • Non-occupational noise-induced hearing loss (+$10 M) • National Violent Death Reporting System (+$8 M) § Monitoring health • Building and facility improvements (+$21 M) • Laboratory safety (+$5 M)

Detect and Protect—FY 2017 Proposal Tackling our biggest drug-resistant threats The FY 2017 President’s budget requests $200 M (an increase of $40 M) to § § § Slow development of resistant bacteria and prevent spread of resistant infections Strengthen surveillance to track antibiotic resistance (AR) threats and measure impact Advance development and use of rapid and innovative diagnostic tests Accelerate research and development for new antibiotics, otherapies, and vaccines Support partnerships for prevention, detection, control, and research

AR Initiative: Year 2, Key Activities CDC plans to award most FY 2017 AR Initiative funding extramurally. In addition to sustaining AR capacities started in FY 2016, CDC will § Expand state public health laboratory/epidemiologic capacity in all 50 states, six large cities & Puerto Rico to expand use of whole genome sequencing technology to rapidly screen food-borne bacteria for resistance § Expand/establish state healthcare-associated infections /AR Prevention Programs in up to 50 states (from 25 programs established in 2016), the six largest local health departments & Puerto Rico § Extend use of the NHSN antibiotic use reporting option from 130 facilities in 30 states (as of December 2015) to more than 750 facilities in all 50 states

Prescription Drug Overdose Initiative The FY 2017 President’s budget requests an increase of $10 M to § Fully expand efforts to promote opioid prescribing guideline dissemination and uptake § Create clinical decision support tools derived from guidelines to provide real-time assistance with prescribing decisions in a multitude of health care settings § Support and identify best practices in communities and states to prevent overdose § Scale up successful approaches that improve prescribing for chronic pain and reduce opioid overdose and death

Good Health and Wellness in Indian Country Initiative The FY 2017 President’s budget requests an increase of $15 M to § Address leading causes of death § Address chronic diseases, depression and mental health, suicide, substance use, and motor vehicle injuries § Incorporate culturally driven wellness practices that build resilience and strengthen social and emotional well-being in existing program

Mental Health Public health approach to suicide prevention Suicide rates have increased steadily for the past 15 years 14. 0 24% 10. 0 8. 0 6. 0 4. 0 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 0. 0 2001 2. 0 1999 Suicide Rate (per 100, 000 pop. ) 12. 0 2000 $30 million requested (as part of HHS-wide $500 million initiative) to implement/evaluate comprehensive suicide prevention programs, based on promising models • In partnership with injury control research centers and state health departments § Address key risk factors for suicidal behavior, including substance abuse and mental illness § Reduce likelihood that suicidal ideation will progress to a suicide attempt, and that a suicide attempt will lead to death §

Flint, Michigan Water Crisis—What Is CDC Doing? § Assessing the size and scope of the problem § Communications § Long-term monitoring § Personnel support § Educational outreach

Zika Virus: A New Threat Reported for first time in Brazil in May 2015 § Evidence of transmission in Puerto Rico, USVI & more than two dozen countries in the Americas § • Potential for further spread with warmer weather • Low likelihood of widespread transmission in contiguous US states Countries/territories with active Zika transmission (as of Feb. 3, 2016) Difficult to control Aedes mosquitoes § Research underway to understand: § • Risk of birth defects; Guillain-Barre • Better diagnostics • Better vector control • Vaccine Range of Aedes aegypti mosquitoes in United States

Zika virus—What Is CDC Doing? § Working with partners to • Educate healthcare providers and the public about Zika • Post travel notices and other travel-related guidance • Provide state and territorial health laboratories with diagnostic tests • Detect and report cases • Support mosquito control programs both in the United States and around the world

CDC Zika Emergency Supplemental Request—$828 M § § § Support Zika preparedness in states/territories with mosquito populations known to transmit Zika Enhance mosquito control through lab, epidemiology, and surveillance capacity in at-risk areas Establish rapid response teams to limit potential US clusters Improve lab capacity and infrastructure for Zika and other infectious diseases Track Zika virus in communities and in mosquitoes Deploy targeted prevention and education strategies § § § Expand Pregnancy Risk Assessment Monitoring, improve Guillain-Barré syndrome tracking & birth defect registries detect risks related to Zika Increase research into link between Zika and microcephaly Enhance international capacity for virus surveillance, expand epi training, laboratory testing, healthcare provider training & vector surveillance/control in high-risk countries Improve diagnostics, including advanced methods to refine tests Support advanced developments for vector control

For more information, contact CDC 1 -800 -CDC-INFO (232 -4636) TTY: 1 -888 -232 -6348 www. cdc. gov