How Americans can get a better return on their health care investments

Each year, the U.S. spends nearly $9,000 for the health of every American -- far more than what the governments of other countries spend on the health of their citizens – yet life expectancy and health outcomes are generally worse for Americans than for citizens of other developed nations in North America and Europe.

Disparities in health outcomes also occur among populations and geographic areas within the U.S., note CDC Director Tom Frieden, M.D., M.P.H. and CDC Associate Director for Science Harold Jaffe, M.D.  Drs. Frieden and Jaffe are co-authors of a commentary article capping a special July 4 issue of The Lancet -- The Health of Americans -- featuring articles by CDC scientists.

“Americans deserve better health, particularly given the amount of money we spend on health care,” both authors wrote.  “We have made some progress, but much more progress is possible.”

How can health in the U.S. improve?  Drs. Frieden and Jaffe propose:

• Adoption of broad public health policies by federal, state, and local governments.  For example, a number of state governments have reduced smoking rates by increasing excise taxes on tobacco products and by creating tobacco-free workplaces and other public spaces. Additionally, laws requiring seat-belt use and child safety-seat use would reduce deaths from car crashes.
• Better access to and improved quality of health care.  The Affordable Care Act of 2010 will make health insurance available to tens of millions of previously uninsured Americans.  Other provisions of the ACA are designed to improve both the quality and efficiency of clinical care.
• Increased delivery of preventive services within health care settings.  Combining public health and clinical care approaches is the best way to address some chronic illnesses.  A good example is the Million Hearts program, aiming to prevent one million heart attacks and strokes within five years.  Clinical approaches include the use of aspirin in high-risk individuals, improving blood pressure control and cholesterol management, and providing support to smokers who wish to quit.  Public health measures are being taken to decrease smoking, i.e., CDC’s Tips From Former Smokers campaign and intake of artificial trans fats and sodium.
• Better individual choices.  Providing healthy environments and health education increases the opportunities for Americans to make better lifestyle choices.

The commentary is embargoed until 6:30 p.m. (ET) on Wednesday, July 2. 

U.S. health is linked to global health
What has global health got to do with the health of Americans?  Plenty, according to Anne Schuchat, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases and her colleagues at the CDC’s Center for Global Health.

In the Lancet Viewpoint article, Global Health and the U.S. Centers for Disease Control and Prevention, Dr. Schuchat and her colleagues noted that the health of Americans is part of global health.  Half the produce consumed by Americans is grown in other countries and 60 million Americans travel or work outside the U.S. Emerging diseases and pathogens highly resistant to antimicrobial drugs know no boundaries and are a mere plane trip away.  Nations everywhere are vulnerable to the release of infectious microbes anywhere.

“The world is more interconnected than ever before,” said Dr. Schuchat.  “That’s why CDC is working 24/7 to help other nations prevent, detect, and respond to serious health threats of any kind.”

Dr. Schuchat and her colleagues highlight several examples of CDC’s key participation in U.S. implemented “whole-government” approaches to global health:

• The U.S. President’s Emergency Plan for AIDS (PEPFAR), started by former President George W. Bush, targets the resource constrained countries hit hardest by the HIV pandemic.  In 2011, President Barack Obama and then-Secretary of State Hilary Clinton put forward the vision of an AIDS-free generation: the virtual elimination of mother-to-child HIV transmission greatly reduced sexual transmission of HIV, and universal access to HIV treatment.  The PEPFAR program now is well on the way to achieving these goals.
• The CDC is one of five World Health Organization International Collaborating Centers for Surveillance, Epidemiology, and Control of Influenza.  CDC has collaborated with its international partners to prepare for possible pandemics from the deadly flu viruses that have emerged in recent decades – and to rapidly respond to the flu pandemic of 2009.
• Since the frightening emergence of Severe Acute Respiratory Syndrome (SARS), CDC has strengthened the nation’s surveillance for SARS-like illnesses.  This preparedness paid off when the surveillance system detected H7N9 avian influenza soon after it emerged.
• CDC’s capacity-building program in Haiti permitted a rapid recovery of public health services after the nation’s devastating 2010 earthquake.  This permitted the rapid detection of and response to Haiti’s cholera outbreak within days of its introduction.

“CDC focuses on the protection of Americans and improvements in the health and capacity of people worldwide through partnerships with ministries of health, other U.S. Government agencies, non-governmental organizations, and multilateral organizations,” wrote Dr. Schuchat and her colleagues, “The goal of these efforts is to improve health and strengthen capacity while striving for a world more secure from emerging threats.”

CDC continues to strengthen its commitment to global health.  CDC’s workforce currently includes more than 300 public health professionals and some 1,330 locally employed staff working in some 60 countries.

The Lancet Viewpoint article, Global health and the U.S. Centers for Disease Control and Prevention will be released on Tuesday, July 1 and are embargoed until 6:30 p.m. (ET) Wednesday, July 2.

Other CDC articles appearing in the Lancet series: The Health of Americans 
Affordable Care Act increasing collaboration between clinical care and public health

One effect of the Patient Protection and Affordable Care Act of 2010 will be to increase the impetus for collaboration between the U.S. public health and health care systems, which for nearly a century have operated with little interaction, notes Frederic E. Shaw, M.D., J.D., senior advisor to the CDC’s Office of Health System Collaboration, one of the authors of the Lancet series article The Patient Protection and Affordable Care Act: opportunities for prevention and public health.

Shaw and colleagues suggest that new clinical care/public health collaborations may take different forms.  For example, collaborations may address a single disease or common set of risk factors, as seen with the Million Hearts Initiative to prevent a million heart attacks and strokes within five years.  Collaboration may come in the form of coordination of care, as when clinical providers refer patients to community programs.  Collaboration may also take the form of integration to help make health care systems more affordable, accountable, and better organized.

The researchers sum up in the article the several ways in which the Patient Protection and Affordable Care Act can advance the health of the U.S. population.

The Affordable Care Act was created to expand access to the security of health coverage, control health care costs, and improve health care quality and coordination. Through the Affordable Care Act, millions of Americans will qualify to get health care coverage that fits their needs and budget, including important preventive services such as tobacco use screenings and tobacco cessation, blood pressure screening and aspirin therapy, cancer screenings, and other services that must be covered with no additional costs. Visit Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325) to learn more.

The Lancet series article, The Patient Protection and Affordable Care Act: opportunities for prevention and public health, is embargoed until 6:30 p.m. (ET) June 30.  

Injury and violence in America is preventable

Every three minutes, an American suffers an injury-related death.  In the Lancet series article, Prevention of Injury and Violence in the USA, lead author Tamara M. Haegerich, PhD, of CDC’s Division of Unintentional Injury Prevention and her colleagues at CDC’s National Center for Injury Prevention and Control, review the burden of injuries and violence in the United States.

The researchers also looked at effective interventions and discussed methods to bring interventions into practice. Alliances between the public health community and medical care organizations, health care providers, states, and communities can reduce injuries and violence.  The CDC encourages partnerships between medical and pubic health communities to consistently frame injuries and violence as predictable and preventable, identify and promote adoption of evidence-based interventions, provide scientific information to decision makers, and strengthen the capacity of an integrated health system to prevent injuries and violence.

Infectious diseases in the U.S.: a continuing challenge

Most of the global burden of infectious diseases – nearly a quarter of deaths – is borne by people in low-income countries.  Yet, these diseases present substantial challenges to health and health care resources in the U.S., notes Rima Khabbaz, MD, CDC deputy director for infectious diseases and colleagues.

In their Lancet series article Challenges of infectious diseases in the USA, researchers noted that recent national strategies undertaken to reduce the burden of infectious diseases have brought some successes, but many problems persist.  The largest gains will be achieved through focused efforts to reduce high-burden and high-consequence diseases and to strengthen efforts to promote early detection and response of emerging infections.

Eliminating the leading preventable causes of death and disability in the U.S.

Chronic diseases account for most health-related suffering, disability, and death in the U.S. – and for the vast majority of health care spending, notes Ursula Bauer, Ph.D., M.P.H., director of the CDC’s National Center for Chronic Disease Prevention and Health promotion and her colleagues.

To help in addressing this burden, CDC recommends four cross-cutting strategies that address multiple conditions and risk factors simultaneously: enhanced epidemiology and surveillance; environmental approaches that promote health and healthy behaviors; health system interventions to improve use of clinical and other preventive services; and improved linkages between community resources and clinical services.

In their Lancet series article, Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA, Bauer and her colleagues cited the need to increase efforts in assessing data, to be even more vigilant with surveillance systems, and to use comprehensive approaches that can be scaled up to reach the entire population, with a focus on people with the poorest health status.

Please Note: The prevention articles on injury and violence, infectious diseases and chronic diseases in the USA will be released by Lancet on Monday, June 30 and is embargoed until to 6:30 p.m. (ET) Tuesday, July1.

Building U.S. preparedness capabilities

Since 2001, public-health advances make the U.S. better able to prepare for the complex and interconnected threats to national health security, note Ali Khan, MD, former director of the CDC’s Office of Public Health Preparedness and Response; and Nicole Lurie, MD, HHS assistant secretary for preparedness and response.

In their Lancet Series article, “Health security in 2014: building on preparedness knowledge for emerging health threats,” Drs. Khan and Lurie note that these advances made in preparedness have paid off not only in responding to actual incidents, such as the Boston bombing and the fungal meningitis outbreak, but in better public health, such as advances in making vaccines and implementing strategies for addressing antimicrobial resistance.

Other examples include:

• Coordination of the state-of-the-art emergency operations centers at HHS and CDC.
• Upgrade of CDC’s Laboratory Response Network to include more than 150 labs across the U.S.
• Improvement of the National Disaster Medical System
• Establishment of the Biomedical Advance Research and Development Authority (BARDA) to support the advanced medical countermeasures

“Complex and interconnected problems have spurred innovation across government to create interconnected solutions,” said Dr. Lurie.

The Lancet series article, Health security in 2014: building on preparedness knowledge for emerging health threats, is scheduled to be released by Lancet on Tuesday, July 1 and is embargoed until 6:30 p.m. (ET) Wednesday, July 2.  

To get copies of articles in “The Health of Americans” series, please email Lancet’s media relations office at pressoffice@lancet.com.  Starting July 1 through July 4, the papers will be available on line at http://www.thelancet.com/series/health-of-americans-2014

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES