What’s its role?
The Center for Disease Control and Prevention (CDC) seems to be constantly in the news. It can be related to food safety concerns, epidemics or environmental threats. With all this information being shared, it can make many people wonder what is the CDC’s role in public health? Why should we listen to what they say?
The Centers for Disease Control and Prevention (CDC) was founded July 1, 1946, as the replacement of the World War II Malaria Control in War Areas program that was operated under the Office of National Defense Malaria Control Activities. It started as a branch of the US Public Health Service and was located in Atlanta since malaria was so widespread in the southern states. In 1947, a payment of $10 was made by the agency to Emory University for 15 acres of land on Clifton Road in DeKalb County just outside the downtown of Atlanta and it’s still headquartered there today. At the time it was started, it had a budget of about $1 million and almost 60% of its personnel were involved with mosquito abatement and habitat control. However, in 1947, the plague laboratory of the Public Health Service (PHS) was became part of the CDC as the Epidemiology Division. In addition, a new Veterinary Diseases Division was formed that year. Due to biological warfare concerns during the Korean War, an Epidemic Intelligence Service (EIS) was established in 1951 and has since evolved into two-year postgraduate training program in epidemiology. The EIS investigates public health problems domestically and globally and became a prototype for the Field Epidemiology Training Programs (FETP), which are now found in many countries. The Venereal Disease Division of the PHS was shifted to the CDC’s control in 1957 and expanded their focus to include sexually transmitted diseases. The same thing happened with tuberculosis in 1960. In 1963 the Immunization program was created. The agency changed names several times, such as the Communicable Disease Center (1946), the National Communicable Disease Center (1967), the Center for Disease Control (1970) and Centers for Disease Control (1980). The US Congress added the words “and Prevention” to the name in 1992 but, decided that the initials should remain CDC because of the fact many people had come to associate it with the work that was being done at the agency. It’s become the leading national public health institute and the regulation of it now falls under the Department of Health and Human Services.
The CDC is led by a director. It’s a Senior Executive Service position, which means that it may be filled by a career employee or a political appointment from the President that does not require Senate confirmation. Most commonly the latter method is used. The CDC director also serves as the Administrator of the Agency for Toxic Substances and Disease Registry. Since its beginning, sixteen directors have served the CDC or its predecessors. It’s arranged into Centers, Institutes, and Offices, or CIOs. Each area carries out the agency’s activities in a particular field, but still provides intra-agency support and resource-sharing for issues that overlap into more than one field and specific health threats. Offices are subdivided into Centers, which are made up of Divisions and Branches. It’s important to note that the Center for Global Health and the National Institute for Occupational Safety and Health are freestanding organizations. There is about 15,000 people employed at CDC in 170 occupations in many locations besides Atlanta. It has facilities in Anchorage, Cleveland, Cincinnati, Detroit, Fort Collins, Hyattsville, Morgantown, Pittsburgh, Research Triangle Park, Spokane, Washington, D.C. and San Juan, Puerto Rico. It has field staff who work in all 50 states, Washington DC, Guam, Puerto Rico, US Virgin Islands and more than 120 countries. In order to operate all these various areas, the CDC’s budget for fiscal year 2018 was $11.9 billion. It bestows over 85% of its annual budget through grants that help many organizations each year advance health, safety and awareness at the community level throughout the US. It operates a number of notable training and fellowship programs, like the EIS and Public Health Associate Program (PHAP), which was founded in 2007 and is a two-year paid fellowship for recent college graduates to work in public health agencies all over the United States.
Now, the main goal of the CDC is to protect public health and safety through the control and prevention of disease, injury, and disability in the US and internationally. It does this by focusing national attention on developing and applying disease control and prevention, especially in areas like, infectious disease (West Nile virus, avian flu, swine flu, pandemic flu, Zika), foodborne pathogens (E. coli, Salmonella), environmental health (air, water and soil quality), occupational safety and health, terrorism preparedness (bioterrorism), health promotion, injury prevention and decreasing the creation of superbugs. A good example of this is the National Action Plan for Combating Antibiotic Resistant Bacteria. This initiative started with a budget of $161 million and included the development of the Antibiotic Resistance Lab Network. Also, the CDC researches and supplies information on non-infectious diseases, such as birth defects, obesity and diabetes. Their Biosafety Level 4 laboratories are some of the only ones that are in existence and serve as one of only two official repositories of smallpox in the world. Their programs deal with more than 400 diseases, health threats, and conditions that are major causes of death, disease, and disability. In order to get the word out about their findings, they provide educational information and activities to American citizens. The CDC’s website has material on various infectious and noninfectious diseases. They have launched various campaigns and websites to educate people about how certain infectious agents are transmitted and how to prevent them through proper hygiene. They have two programs under the Division of Select Agents and Toxins that help with the management of infectious diseases. The Federal Select Agent Program (FSAP) is a program that is run jointly with an office with the U.S. Department of Agriculture and helps to control substances, especially those that are rare and dangerous, that can cause disease in humans, animals and plants. Also, FSAP is responsible for inspections of labs in the US that work with hazardous pathogens. The Import Permit Program manages the importation of infectious biological materials.
The CDC works closely with many international organizations such as the World Health Organization (WHO) as well as ministries of health and other groups on the front lines of outbreaks. It has several global divisions that include the Division of Global HIV and TB (DGHT), the Division of Parasitic Diseases and Malaria (DPDM), the Division of Global Health Protection (DGHP) and the Global Immunization Division (GID). Since 2005, their 10 Global Disease Detection Centers have discovered 12 pathogens and organisms that were previously unknown. Working with partnership with the WHO, they created the International Health Regulations (IHR), which is a legally binding agreement between 196 countries aimed at preventing, controlling and reporting on the international spread of disease by using various programs. The CDC plays a key role in US global health projects, like the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative. Since 2006, CDC has responded to more than 1,900 international disease outbreaks and health emergencies, including Ebola, Zika, MERS-CoV and avian influenza. During 2015 and 2016, CDC conducted more than 750 field investigations in 49 states, 5 US territories, and in 35 different countries to help determine what made people sick and if others have been exposed. On average, each day they are monitoring somewhere between 30-40 global threats. Due to their interventions, great strides have been made in many areas. One area is tuberculosis with an estimated 49 million lives being saved thanks to steps taken by the CDC to help prevent the spread of the disease. Also, smallpox has been eradicated and we are steadily getting closer to eradicating polio (the number of cases has dropped by more than 99% since 1988). Measles are still one of the leading causes of death in children outside of the US, but the number of cases globally has decrease by 79% from 2000 to 2015 due to vaccinations and other interventions put in place by the CDC. During the same timeframe, interventions against malaria have save about 6.8 million lives. As of 2016, it’s estimated that 6.4 million patients were put on life-saving HIV treatment, 30 million new infections have been averted and 7 million deaths prevented due to interventions that were started in 2000.
All of these interventions are key because in our interconnected world, a disease threat in one area is a disease threat to every other area. This is thanks to the ease and speed of global travel and the rapid expansion of commerce and trade. Diseases aren’t confined to borders, so it’s essential to block infectious disease from entering into the US because global health security mean national and economic security for the us. The CDC protects our nation against dangerous and expensive health threats by responding when and where they arise before they spread to our shores. This saves lives at the sources of the outbreak and here at home, which ultimately creates a safer world for everyone. Also, this reduces the amount of economic impact we feel from disease outbreaks. A good example of this is the 2014 Ebola outbreak. Congress passed a Continuing Appropriations Resolution which allocated $30 million towards CDC’s efforts to fight the virus. Most of the work was done in areas that the virus originates in. For people who travel to other parts of the world from the US, the CDC collects and publishes health information in a comprehensive book called the CDC Health Information for International Travel, or “yellow book”. It’s available in print as a new edition every other year and online where it’s updated more frequently. It includes current travel health guidelines, vaccine recommendations and data on specific travel destinations. The CDC also issues travel health notices on its website.
Besides working abroad to keep Americans safe, the CDC works on issues that are threating us here at home, such as non-communicable, chronic diseases caused by obesity, physical inactivity and tobacco use. They track several things, such as threats to health, leading causes of death, how easy or hard it is to get health care in America, differences in health in various regions and among various groups of people. They use several important data and tracking systems to achieve this work. One is the Behavioral Risk Factor Surveillance System (BRFSS), which provides data to states on personal health behaviors within their state. States can use this data to address urgent and emerging health issues. The data is collected monthly in all 50 states, Washington DC, American Samoa, Palau, Puerto Rico, US Virgin Islands and Guam. Another tracking system is the National Environmental Public Health Tracking Network and it monitors the quality of our air, soil and water. This helps us to know if anything in the environment poses a threat to human health. With nearly 26 million Americans having asthma, the Tracking Network has contributed to better management of it due to monitoring air quality. All local and state labs must be able to detect and respond to health threats in order to prevent premature death, injury and disease. The CDC trains and guides state and local public health lab partners how to do this. By having this connection, the CDC can discover patterns of disease and respond when needed.
One area that CDC is constantly monitoring because it’s a serious threat to our nation’s health are foodborne illnesses because they make about 48 million Americans sick every year with about 3,000 of these people dying. When a threat from a foodborne illness appears, the CDC identifies the germ because they know each germ’s unique DNA. They also find out where the outbreak is happening and what foods or situations might be the cause. Once they have this information, they help to devise new steps to take to keep the food safer and share this information and technology with consumers, business and local/state/federal partners in order to help prevent people from becoming sick. When you consider how much food we, as a nation, consume on a daily basis, this can be a daunting task, so they work closely with numerous partners, such as the Food and Drug Administration (FDA), US Department of Agriculture’s Food Safety and Inspection Service (FSIS), health departments, industry/businesses and consumers. Due to this cooperation, we are seeing fewer problems with contamination of our food supply. However, there is still work that needs to be done, especially when it comes to vibrio and salmonella. Vibrio is a rare, but serious disease that is the result of eating undercooked seafood. Salmonella is the result of eating raw poultry, eggs, beef and unwashed fruit and vegetables and causes of most hospitalizations and deaths related to foodborne illnesses.
The Center for Disease Control and Prevention is the nation’s leading public health agency and keeps Americans secure by controlling disease outbreaks, making sure the food and water we are consuming is safe, helping people to avoid leading causes of death (heart disease, cancer, stroke and diabetes) and working globally to reduce threats to the nation’s health. It’s led by the world’s experts in disease detection, outbreak investigation, laboratory systems and emergency response. Since it is usually relatively free of political manipulation, the advice and critical services it provides to keep us safe, healthy and secure should be trusted.