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Public Health in the First Decade of the 21st CenturyPublic Health in the First Decade of the 21st CenturyPhiladelphia, PA March 24, 2004
Ed Thompson, MD, MPHEd Thompson, MD, MPHDeputy Director for Public Health Services
Centers for Disease Control and Prevention
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ANTHRAXANTHRAX
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West Nile Virus 1999
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West Nile Virus 2000
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West Nile Virus 2001
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West Nile Virus 2002
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9100 cases 222 deathsAs of January 21, 2004
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1971U.S. civilian vaccination stopped
200338,257 civilians vaccinated
1971U.S. civilian vaccination stopped
200338,257 civilians vaccinated
(as of 8/8/03)
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8437 cases worldwide
813 deaths
8437 cases worldwide
813 deaths
33 U.S. cases No Deaths33 U.S. cases No Deaths( plus 159 “suspect” cases)
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PUBLIC HEALTHPUBLIC HEALTH
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PUBLIC HEALTHPUBLIC HEALTH
72 total U.S. cases
37 lab-confirmed
35 suspect/probable
72 total U.S. cases
37 lab-confirmed
35 suspect/probable
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Fak Has Kilu Shot Demand Rises Sharply
Vicious flu strain hits nation early
In Colorado, Flu Outbrelled at Least 5 Children
Shortage of Flu Shots Prompts RationingVaccine Being Reserved For Highest-Risk Patients
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PUBLIC HEALTHPUBLIC HEALTH
Whatgoesaround
Whatgoesaround
ComesaroundComesaround
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Old Public Health ThreatsOld Public Health Threats
The MicrobeThe MicrobeMalariaMalaria
Plasmodium Plasmodium vivaxvivax
The VectorThe Vector
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New Public Health ThreatsNew Public Health Threats
The VectorThe Vector“Travel from a SARS affected area & having “Travel from a SARS affected area & having
an exposure to a person infected with an exposure to a person infected with SARS”SARS”
The MicrobeThe MicrobeCoronavirusCoronavirus, SARS, SARS--CoVCoV
A new, severe respiratory A new, severe respiratory illness that has been reported illness that has been reported
worldwide. worldwide.
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“They fancied themselves free, and no one will ever be free so long as there are pestilences.”
- Albert Camus, The Plague
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Obesity Trends* Among U.S. AdultsBRFSS, 1985
(*BMI ≥30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15%-19% 20%-24% ≥25%
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Obesity Trends* Among U.S. AdultsBRFSS, 1990
No Data <10% 10%-14% 15%-19% 20%-24% ≥25%
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Obesity Trends* Among U.S. AdultsBRFSS, 1991
No Data <10% 10%-14% 15%-19% 20%-24% ≥25%
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Obesity Trends* Among U.S. AdultsBRFSS, 1993
No Data <10% 10%-14% 15%-19% 20%-24% ≥25%
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Obesity Trends* Among U.S. AdultsBRFSS, 1995
No Data <10% 10%-14% 15%-19% 20%-24% ≥25%
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Obesity Trends* Among U.S. AdultsBRFSS, 1997
No Data <10% 10%-14% 15%-19% 20%-24% ≥25%
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Obesity Trends* Among U.S. AdultsBRFSS, 1999
No Data <10% 10%-14% 15%-19% 20%-24% ≥25%
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Obesity Trends* Among U.S. AdultsBRFSS, 2000
No Data <10% 10%-14% 15%-19% 20%-24% ≥25%
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Obesity Trends* Among U.S. AdultsBRFSS, 2001
(*BMI ≥30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15%-19% 20%-24% ≥25%
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Blood Lead Levels in the U.S. Population 1976–1999NHANES II, III, 99+
1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Year
18
2
4
6
8
10
12
14
16
Blo
od L
ead
Lev
els (
mg/
dL)
0
2.7 2.0
unleadedgasoline
Introduced1979
leadpaintBan1976
can solderphase-out
Begins1978
lead &copperRule1991
cansolderends1992
leadedgas
ends1996
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The New Normal
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The New Normal
Preparedness and Response to EmergenciesPreparedness and Response to Emergencies
ANDAND
Protection of Health from Predictable ThreatsProtection of Health from Predictable Threats
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The New Normal
Preparedness and Response to EmergenciesPreparedness and Response to Emergencies
AND
Protection of Health from Predictable ThreatsProtection of Health from Predictable Threats
AND
Chronic diseases
Environmental threats
Injury
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The New Normal
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The New NormalThe New Normal
The Old Normal That Ain’t Gonna ChangeThe Old Normal That Ain’t Gonna Change
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The American Public Health System
STATE
STATE
LOCAL
LOCAL
FEDERAL
FEDERAL
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The American Public Health System
STATE
STATE
LOCAL
LOCAL
FEDERAL
FEDERAL
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The American Public Health System
STATE
STATE
LOCAL
LOCAL
FEDERAL
FEDERAL
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The New NormalThe New Normal
The Old Normal That Ain’t Gonna ChangeThe Old Normal That Ain’t Gonna Change
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The New NormalThe New Normal
The Old Normal That Ain’t Gonna ChangeThe Old Normal That Ain’t Gonna Change
The Imperative for CDC to ChangeThe Imperative for CDC to Change
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CDC’s Futures InitiativeCDC’s Futures InitiativeIdeas…Input…Implementation…ImpactIdeas…Input…Implementation…Impact
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Why Change?Why Change?Why Change?
By modernizing its strategy, CDC can enhance its overall impact on the health status of the public.
CDC must work to sustain our reputation as the premier public health agency within HHS.
By modernizing its By modernizing its strategy, CDC can enhance strategy, CDC can enhance its overall impact on the its overall impact on the health status of the public. health status of the public.
CDC must work to sustain CDC must work to sustain our reputation as the our reputation as the premier public health premier public health agency within HHS.agency within HHS.
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Aging population
Increasing diversity
Escalating health costs
Changes in access to health care services
Health disparities
Global threats
Terrorism
Epidemic effects of chronic diseases
Aging population
Increasing diversity
Escalating health costs
Changes in access to health care services
Health disparities
Global threats
Terrorism
Epidemic effects of chronic diseases
Ready for Challenges of the 21st Century
Ready for Challenges of Ready for Challenges of the 21the 21stst CenturyCentury
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New Strategic GoalsNew Strategic GoalsNew Strategic Goals
Preparedness: All communities will be protected from infectious, environmental, and terrorist threats.
Health promotion and 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: All communities will be : All communities will be protected from infectious, environmental, protected from infectious, environmental, and terrorist threats.and terrorist threats.
Health promotion and prevention of disease, injury, and disability:: All All people will achieve their optimal lifespan people will achieve their optimal lifespan with the best possible quality of health in with the best possible quality of health in every stage of life.every stage of life.
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Strategic ImperativesStrategic ImperativesStrategic Imperatives
Customer-focus
Public Health Research
Leadership for the nation’s health system
Increased focus on Global Health
Effectiveness and Accountability
CustomerCustomer--focus focus
Public Health ResearchPublic Health Research
Leadership for the nation’s health system Leadership for the nation’s health system
Increased focus on Global HealthIncreased focus on Global Health
Effectiveness and AccountabilityEffectiveness and Accountability
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ImplementationImplementationImplementationCommunication
TeamCommunicationCommunication
TeamTeam
Strategic Imperatives
Teams
Strategic Strategic Imperatives Imperatives
TeamsTeams
Health ProtectionGoals Team
Health ProtectionHealth ProtectionGoals TeamGoals Team
Business Practices Team
Business Business Practices TeamPractices Team
OrganizationalDesign Team
OrganizationalOrganizationalDesign TeamDesign Team
Health Protection Impact!
Health Protection Health Protection Impact!Impact!
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CommunicateCommunicateCommunicate
Check Futures Updates at the Futures Initiative Internet Web site: www.cdc.gov/futures
Contribute your questions and comments at [email protected].
Check Futures Updates at Check Futures Updates at the Futures Initiative the Futures Initiative Internet Web site: Internet Web site: www.cdc.gov/futures
Contribute your questions Contribute your questions and comments at and comments at [email protected].
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www.CDC.govwww.CDC.gov