1. 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, PhD
Director, Division of Public Health Performance Improvement
Office for State, Tribal, Local and Territorial Support, CDC

2. CDC Strategic Directions
Improve health security at home and around the world
Better prevent the leading causes of illness, injury, disability, and death
The 6|18 Initiative relates to one of CDC’s 3 strategic directions - strengthening public health and health care collaboration in the context of the rapidly transforming health care system.
It is important for those working in public health to strengthen this collaboration because of the unprecedented opportunities to expand prevention and population health as components of health care and to move in the direction of an integrated health system with more of an upstream focus – other than a health care system that has its resources concentrated in acute care.
Throughout the nation, there are meaningful discussions involving governors and other elected officials, insurers, and health care providers to redesign the health system. We have been saying for some time that public health needs to get to the table where those discussions are occurring if we are to be taken seriously and have a role.
Strengthen public health/ health care collaboration

3. 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

4. Three Buckets of Prevention
Total Population or Community-Wide Prevention
Traditional Clinical Prevention
Innovative Clinical Prevention
Increase the use of evidence-based services 1
Provide services outside the clinical setting 2
Implement interventions that reach whole populations 3
Health Care
Public Health
Auerbach J., The 3 Buckets of Prevention. Journal of Public Health Management and Practice

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

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

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

8. 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

10. What We Do Performance improvement 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

11. 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
Food Safety
Healthcare-Associated Infections
Heart Disease and Stroke
HIV
Motor Vehicle Injuries
Nutrition, Physical Activity, and Obesity
Prescription Drug Overdose
Teen Pregnancy
Tobacco Use
The Prevention Status Reports (PSRs) is a suite of 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 including:
Excessive alcohol use
Food safety
Healthcare-associated infections
Heart disease and stroke
HIV
Motor vehicle injuries
Nutrition, physical activity, and obesity
Prescription drug overdose
Teen pregnancy
Tobacco use
Although information about state public health policies and practices is publicly available in various locations, this information is widely dispersed and can be hard for decision makers to find and understand.

12. Current Issues FY 2017 CDC program level budget
Flint, Michigan water crisis
Zika

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

14. 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 (+$15M)
Drug overdose prevention (+$10M)
Gun violence prevention research (+$10M)
Non-occupational noise-induced hearing loss (+$10M)
National Violent Death Reporting System (+$8M)
Monitoring health
Building and facility improvements (+$21M)
Laboratory safety (+$5M)

15. Detect and Protect—FY 2017 Proposal Tackling our biggest drug-resistant threats
The FY 2017 President’s budget requests $200M (an increase of $40M) 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, other therapies, and vaccines
Support partnerships for prevention, detection, control, and research

16. 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

17. Prescription Drug Overdose Initiative
The FY 2017 President’s budget requests an increase of $10M 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

18. Good Health and Wellness in Indian Country Initiative
The FY 2017 President’s budget requests an increase of $15M 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

19. Mental Health Public health approach to suicide prevention
$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
Suicide rates have increased steadily for the past 15 years
24%

20. Flint, Michigan Water Crisis—What Is CDC Doing?
Assessing the size and scope of the problem
Communications
Long-term monitoring
Personnel support
Educational outreach
Assessing the size and scope of the problem
CDC/ATSDR believes all children in Flint should have the opportunity to have blood lead testing.
Communications
CDC continues to provide crisis and emergency risk communication training.
Long-term monitoring
Working with partners to develop recommendations in support of wraparound services for affected children to include long-term monitoring to identify and address health effects in the children of Flint.
Personnel support
Since February 1, 2016, about 55 staff members have provided scientific, technical, and programmatic leadership and support to the Michigan Department of Health and Human Services, Michigan Department of Environmental Quality, Genesee County Health Department, City of Flint, and the Governor’s Flint Water Interagency Coordinating Committee.
Educational outreach
Working with the American Academy of Pediatrics to create a repository of scientific article and web-based resources on water contamination and lead toxicity in children.

21. 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
Difficult to control Aedes mosquitoes
Research underway to understand:
Risk of birth defects; Guillain-Barre
Better diagnostics
Better vector control
Vaccine
Countries/territories with active Zika transmission
(as of Feb. 3, 2016)
Range of Aedes aegypti mosquitoes in United States

22. 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

23. CDC Zika Emergency Supplemental Request—$828M
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
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