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CDC Overhauls Organization, Shifts Toward Preparedness
 Photo by Graham Ramsay |
CDC Overhauls Organization, Centers on Preparedness and Prevention
This spring, the Centers for Disease Control and Prevention (CDC) announced the most extensive reorganization since its creation in 1946 as the lead federal agency for protecting the health and safety of Americans. Called the Futures Initiative, the refocusing of the CDC's mission and restructuring of the agency has been touted as the agency's response to the changing public health needs of the nation. Led by CDC director Julie Gerberding, the initiative characterizes the CDC's mission as twofold: preparedness, in which "people in all communities will be protected from infectious, environmental, and terrorist threats" and health promotion and prevention of disease, injury, and disability, in which "all people will achieve their optimal life span with the best possible quality of health in every stage of life."Reactions to the reorganization from stakeholders have been mixed, since it creates apparent winners and losers. Some in the occupational health community, for example, are unhappy with the initiative's placement of the National
| Preparing and responding to terrorism will likely require coordination not only within the CDC, but across federal agencies as disparate as public works and law enforcement. |
According to Frank Bove (MS '84, ScD '87, HSPH), a senior epidemiologist in the Division of Health Studies at ATSDR, much of the disagreement over the initiative reflects the conflict between two different cultures: the business management/social marketing culture and the public health advocacy culture. "The former focuses on individual customers or stakeholders," he said, "whereas the latter focuses more on institutional barriers." He cites the example of obesity, which he argues is seen by the proponents of the Futures Initiative as an issue primarily of lifestyle. In contrast, a public health advocacy approach might focus on the role of advertising, fast food chains, the built environment (urban sprawl), and the like. He concludes that the "battle over the Futures Initiative can be seen primarily as a philosophical-political clash."
Bove concedes that structural reorganization of the CDC could reduce agency fragmentation. "CDC has a silo mentality internally so that different centers of CDC rarely work together or find it difficult to work together," he said. "The internal silo problem could be partially solved by structural change, but the problem at CDC really is more an attitudinal problem than a structural problem."
Top-down Coordination
Charles Schable, director of the CDC's Office of Terrorism Preparedness and Emergency Response (OTPER) sees advantages in the reorganization. OTPER was housed in the Office of the Director prior to the Futures Initiative, but the initiative has brought it new focus, giving it more responsibility for coordinating the CDC's terrorism preparedness and response activities. He describes the three main objectives of his office as providing strategic direction for the agency, assuring adequate funding distribution, and providing accountability for those funds and the programs for which they were allocated."In the past," he said, "there was little coordination at the Office of the Director's level, and the main program, the Bioterrorism Preparedness and Response Program, resided within one of the centers [the National Center for Infectious Diseases]. With OTPER being an office of the director, and the leader of OTPER directly reporting to Dr. Gerberding, there are high-level policymakers involved with the terrorism preparedness and emergency response agenda for the agency and our partners... . All of these controls will assure the agency moves forward as a whole, rather than in fits and starts."
Preparing and responding to terrorism will likely require coordination not only within the CDC, but across federal agencies as disparate as public works and law enforcement. OTPER has relationships with those agencies involved in preparing and responding to terrorism, including the Department of Homeland Security and the Environmental Protection Agency. OTPER has an active duty Air Force lieutenant colonel who works as a liaison with the Department of Defense and has staff members who assist the White House Security Council and are in daily communication with the Office of the Secretary of the Department of Health and Human Services. Furthermore, according to Schable, members of the OTPER staff serve as members of the Secretary's Emergency Response Teams (SERTs).
Public Health Standards
Ed Thompson, chief of Public Health Improvement for the CDC, is responsible for supporting and providing standards for the U.S. public health system. Though the CDC does not have the authority to set standards, it can set requirements for state and local authorities to qualify for CDC funds. "Once standards are set by the practice community, CDC will use an all-carrot, no-stick approach," he said. "We will develop ways to incentivize meeting the standards, rewarding those who do." Thompson says that public health experts at the state and local levels are working together with nongovernmental organizations such as the Robert Wood Johnson Foundation to develop these standards.Global health is also a priority in the newly reorganized CDC, which has declared that it will, as one of its six strategic objectives, "establish clear priorities for its global programs and increase global connectivity to ensure rapid detection and response to emerging health threats." Steven Blount, associate director for global health at the CDC, says that there are many reasons Americans should and do care about global health. "The reasons run the gamut from self-protection to altruism," he said. "In a world that has vastly shrunk due to mobility of people and goods, the U.S. has no choice but to be involved in global health if we are to protect the health of Americans." Further, he argues, health issues have become increasingly linked to national security. Beyond issues of security and commerce, said Blount, the U.S.'s involvement in assisting other countries in improving health is "simply the right thing to do."
--Erica Seiguer, a sixth-year MD-PhD student studying economics in Harvard's Doctoral Program in Health Policy
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.
Website of Interest
CDC's Futures Initiative