TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Dixie Snider, Jr., MD, MPH Deputy Director of Public Health Science Centers for Disease Control and Prevention AcademyHealth CDC Research Agenda Session San Diego, CA June 7, 2004

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century CDC’s Futures Initiative Heath Protection for the 21 st Century InputIdeasImplementationImpact Outside-inOutside-in InteractiveInteractive Driven by dataDriven by data Focused on customersFocused on customers Strategic direction first, then structure & processesStrategic direction first, then structure & processes Outside-inOutside-in InteractiveInteractive Driven by dataDriven by data Focused on customersFocused on customers Strategic direction first, then structure & processesStrategic direction first, then structure & processes

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Ideas…New Strategies! Achieve health impact and reduce health disparities for customers (people whose health we protect)Achieve health impact and reduce health disparities for customers (people whose health we protect) –alignment (strategy, goals, & action) –performance measurement and improvement –integration across organizational units –marketing Lead the Nation’s public health systemLead the Nation’s public health system Expand public health research as the foundation for all our workExpand public health research as the foundation for all our work Expand global health impactExpand global health impact Support the world’s best workforce and maximize our effectiveness & accountabilitySupport the world’s best workforce and maximize our effectiveness & accountability

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century CDC’s Futures Initiative Why Change? Emerging Public Health Threats Aging Society Globalization Public Health Infrastructure Changing Demographics Rising Health Care Costs Aging Workforce Information Technology Human Genome

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Increase in Health Expenditures Health expenditures as percent of GDP projected to increase from 14.9% (2002) to 18.4% (2013)Health expenditures as percent of GDP projected to increase from 14.9% (2002) to 18.4% (2013) Per capita health spending in the US is highest in the world, yet we still rank behind 47 countries in life expectancyPer capita health spending in the US is highest in the world, yet we still rank behind 47 countries in life expectancy Source: The New York Times Magazine

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Health Status U.S. life expectancy is 2.5 years shorter than in Western Europe and Canada, and more than 3 years shorter than in JapanU.S. life expectancy is 2.5 years shorter than in Western Europe and Canada, and more than 3 years shorter than in Japan Obesity and obesity-related health risks cost the U.S. an estimated $125B per yearObesity and obesity-related health risks cost the U.S. an estimated $125B per year The U.S. ranks 28th in the world in infant mortalityThe U.S. ranks 28th in the world in infant mortality

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century CDC as a source of health information CDC Has a Perception of High Trust/ Reliability... “CDC is one of the first places I would turn to for reliable health information” % of respondents saying “Yes” “One of the health information sources I trust the most is the CDC”... But Few People Turn to CDC for Health Information “I do not remember hearing about health or disease info that came from the CDC in the past year” “I tried to get info about health or disease from the CDC in the past year” Source: Porter Novelli

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Where are people looking? Health Portals Govt. Agencies % of Internet Users Who Have Searched for Information from: Doctors’ Offices/ Hospital Sites/ Health Centers Pharma- ceutical Websites Non- Profit Orgs. Scientific Retrieval Systems Online Newsletters UniversitiesChat Rooms Source: Harris Poll (2003)

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century NIH vs CDC Budget $Billion Source: CDC, NIH NIH CDC

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Strategic Imperatives Health ImpactHealth Impact CustomersCustomers Public health systemPublic health system Public health researchPublic health research Global healthGlobal health Efficiency, effectiveness & accountabilityEfficiency, effectiveness & accountability

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Health Protection Goals Health Promotion & Prevention of Disease, Injury, and Disability:Health Promotion & Prevention of Disease, Injury, and Disability: All people will achieve their optimal lifespan with the best possible quality of health in every stage of life. Preparedness:Preparedness: People in all communities will be protected from infectious, environmental, and terrorist threats.

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century People will benefit from state-of-the art detection, investigation, and containment of infectious, terrorism, and environmental threats. The government public health, health care delivery, business, educational sectors and other sectors of the health system will be integrated to protect people from infectious, environmental, and terrorist threats. Preparedness Goals

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Health promotion and prevention of disease, injury, and disability by life-stage InfantChildTeenAdultSenior

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Infant: By 2015, the United States is one of five countries with the highest rates of infant survival (Baseline 28th, 1999) Adolescents: By 2015, at least 95% of adolescents practice behaviors which protect them from illness and injury now and in the future. (NHIS baseline) Seniors: By 2015, average lifespan of older Americans is increased by 2 years Life-stage Goals [Draft] Children: By 2015, mortality is reduced 20%, saving an additional 800 lives per year (NCHS Baseline). Adults: By 2015, at least 90% of adults have a healthy weight (NHANES baseline)

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Organizational Design Principles Strategy and goals derive from population health assessments (“customers’ health”) to achieve health impactStrategy and goals derive from population health assessments (“customers’ health”) to achieve health impact Strategy and goals drive agency’s priorities and allocationsStrategy and goals drive agency’s priorities and allocations Emphasis on research and innovationEmphasis on research and innovation Health protection “marketing”Health protection “marketing” Consolidation of business & other cross- cutting servicesConsolidation of business & other cross- cutting services

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century CDC’s History

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Epidemiology Program Office National Immunizations Program Public Health Practice Program Office National Center on Birth Defects & Developmental Disabilities National Center for Chronic Disease Prevention & Health Promotion National Center for Environmental Health National Center for Health Statistics National Center for Infectious Diseases National Center for Injury Prevention and Control National Center for HIV, STD, and TB Prevention National Institute for Occupational Safety and Health Office of the Director Office of Global HealthCDC Washington Office Office of Program Planning and Evaluation Office of Women’s Health Office of Health and Safety Office of Equal Employment Opportunity Office of Executive Secretariat Office of Minority Health Office of Science Policy and Technology Transfer Office of Communication Office of the Chief Operating Officer Office of Genomics and Disease Prevention Department of Health and Human Services Centers for Disease Control and Prevention (CDC)

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Coordinating Center for Health Information and Services Business Public Health Systems Health Care DeliveryFederalAgenciesEducation National Center for Health Marketing National Center for Public Health Informatics National Center for Health Statistics Coordinating Center for Infectious Diseases NCID, NCHSTP, NIP Coordinating Center for Health Promotion NCCDPHP, NCBDDD, Genomics Coordinating Center for EIO NCEH/ATSDR NCIPC, NIOSH Office of Global Health Office for Terrorism Preparedness & Emergency Response Strategy and Innovation Innovation Chief of Science Chief of Public Health Improvement Human Capital Management Customers People whose health we want to improve Executive Leadership Team Management CouncilExecutive Board Partners Alliances Stakeholders Office of the Chief Operating Officer Office of the Chief of Staff CDC Washington Director Channels

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Changing CDC Strategic imperatives Health Impact Goals Organization Design Employee Education Internal and External Communications Leader Accountability Recognition & Rewards Business Process Redesign

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century FROMTO No overall measure of success No overall measure of success Lack of customer segmentation Lack of customer segmentation Limited partner capacity (state and local health depts) Limited partner capacity (state and local health depts) CDC’s Futures Initiative Clearly articulated and measured Clearly articulated and measured Segmented customer approach Segmented customer approach Strong partner network Strong partner network Revitalized state & local health departments Revitalized state & local health departments Media, business, health care delivery, schools, communities Media, business, health care delivery, schools, communities

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century FROMTO Primary focus on Infectious Disease and Preparedness Primary focus on Infectious Disease and Preparedness Disease specific, fragmented approach to global Disease specific, fragmented approach to global Inefficient work processes Inefficient work processes Silos/organization Silos/organization Focus on process Focus on process Primary focus on Infectious Disease, Preparedness and Prevention Primary focus on Infectious Disease, Preparedness and Prevention Comprehensive integrated global approach Comprehensive integrated global approach Efficient work processes Efficient work processes Integrated organization (maintaining specialization) Integrated organization (maintaining specialization) Focus on impact Focus on impact CDC’s Futures Initiative

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century FROMTO Minimal applied research Minimal applied research Fragmented approach to customers/partners Fragmented approach to customers/partners Difficult to do business with Difficult to do business with Strong applied research Strong applied research Integrated approach to customers/partners Integrated approach to customers/partners Easy to do business with (standard of good gov’t) Easy to do business with (standard of good gov’t) CDC’s Futures Initiative

TM CDC’s Futures Initiative Creating the Future of CDC for the 21 st Century Futures Initiative: Improving Health Impact