CDC/ATSDR
Centers for Disease Control and Prevention/
Agency for Toxic Substances and Disease Registry
z
President’s Budget
Request
Fiscal Year 2014
Overview
• Overview of CDC
• FY 2014 President’s Budget Request
• Questions and answers
CDC: Our nation’s
health protection agency
• Founded in 1946
• Part of the U.S.
Department of Health
and Human Services
• Headquartered in
Atlanta, Georgia
• 10,000+ full-time
employees
• 70% of funding helps
state and local public
health departments,
others
CDC activities
• Monitor health
• Detect and investigate health problems
• Conduct research to enhance prevention
• Develop evidence for policies that improve public's health
• Promote healthy behaviors and implement prevention
strategies
• Foster safe and healthful environments
• Provide leadership and training
Save lives, protect people,
save money through prevention
• Ready 24 hours a day, 7 days a week to respond to and
prepare for infectious diseases, environmental hazards,
injuries, and other health threats and emergencies
• Analyzes health information and investigates health threats to
protect people in the U.S. and around the world
• Promotes proven methods to prevent disease,
improve health, and lower health costs
Putting science into action
CDC turns science into real-world solutions and
applies science to protect people and improve health
Strengthen communities
Majority of CDC’s funding goes to state and local public
health departments, providing them with resources and
support to protect Americans from health threats
CDC protects Americans from threats
from this country and around the world
CDC operates ~150 labs with
~2,500 scientists and other lab staff
Infectious diseases
(reference, diagnosis,
research)
Environmental health
(genetics, nutrition,
chemicals, toxins)
Preparedness and
response
(bioterrorism,
outbreaks, disasters)
Occupational
safety and health
(workplace safety)
Lab standards
and science
(quality & regulatory
compliance)
Global health
(HIV, malaria, TB,
emerging diseases)
CDC lab facilities in the U.S.
Morgantown, WV
Ft Collins, CO
Cincinnati, OH
Anchorage,
AK
Atlanta, GA
San Juan, PR
Key winnable battles
Six areas where public health can have
a substantial impact
Tobacco
HealthcareAssociated
Infections
Teen
Pregnancy
Nutrition,
Physical Activity,
Obesity and
Food Safety
Motor
Vehicle
Injuries
HIV
CDC works to protect us from health,
safety, and security threats
• Provides real-time response during emergencies
• Works with state and local health departments to
investigate and control outbreaks
• Every day, CDC begins at least one investigation of
potentially deadly health threat
• On average, CDC
discovers one new
microbe or new
form of an old one
each year
"CDC is the 9-1-1
for the world.”
Ambassador
Carson,
Assistant Secretary of
State for African Affairs
CDC tracks food poisoning cases
and monitors for outbreaks across
the U.S. to help keep us healthy
In 2012 CDC
• Tracked >30 pathogens known to cause
foodborne illness
• Monitored an average of 20 clusters of
foodborne illness every week
• Investigated >200 cases that cross state
lines
“There are certain
things only a
government can do.
And one of those
things is ensuring
that the foods we eat
are safe and do not
cause us harm.”
President Obama
• Information led to recall of 300 products, such as peanut
butter, leafy greens, cantaloupes, sprouts, ground beef, raw
scraped ground tuna, mangoes, dry dog food, and ricotta
cheese
CDC’s disease detectives
Epidemic Intelligence Service (EIS)
• 2-year program of service and on-the-job
training for health professionals interested
in practice of epidemiology
• Every year, 70–80 people assigned to
CDC or state/local health departments
• EIS officers conduct epidemiologic
investigations, research, and public health
surveillance nationally and internationally
• 75% of EIS graduates stay
in public health at CDC or
in state/local health
departments
www.cdc.gov/eis
CDC provides health information
CDC publishes scientific journals and educates the public by
providing health information so they can make informed
decisions about their health, safety, and security
CDC staff throughout the world
300+ direct hires in 50+ countries
1,300+ host country national staff
40+ staff detailed to international organizations
CDC Global Disease Detection Centers
CDC staff
GDD regional
center
CDC global immunization activities
CDC staff
Global immunization
activities
CDC global influenza activities
CDC staff
CDC influenza
international
CDC malaria assignees
CDC staff
CDC malaria
assignees
CDC Field Epidemiology Training Programs
CDC staff
CDC Field
Epidemiology
Training Programs
CDC and Department of
Defense collaborations
CDC staff
DoD collaboration
CDC global AIDS program
CDC staff
CDC global AIDS
program
CDC provides assistance
throughout the world
CDC staff
GDD regional
center
Global
immunization
CDC influenza
international
CDC malaria assignees
CDC Field Epidemiology
Training Program
DoD collaboration
CDC global AIDS program
CDC helps save lives and reduce
illness around the world
• Protects our borders by stopping epidemics before they spread
• Provides stability by preventing diseases that increase poverty
and contribute to political unrest in many countries
• Promotes economic viability by reducing disruptions in
productivity, international trade and markets caused by
illnesses and outbreaks
• Partners with ministries of health to provide training for health
officials, establish health surveillance systems, and adapt
effective public health interventions so that countries can
protect the health of their citizens
•
CDC stops epidemics and saves
lives around the world
• Immunizations
• Helped cut measles deaths and saved 10.7M lives
worldwide from 2000−2011
• Helped reduce global polio cases from 350,000 to <250
• Haiti response
• Cholera response activities helped avert >9,000 deaths
• Doubled HIV treatment, increased vaccination rates,
introduced new vaccines and treatments – all with local,
sustainable leadership
• Helped create stronger, sustainable public health and
health care systems in Haiti
• Lymphatic filariasis
• Provided mass drug administration with nearly 2B
treatments to 600M people
The world is closer than
ever to polio eradication
www.polioeradication.org
Budget proposal for FY 2014
• Builds on FY 2012 investments and administrative savings
• Continues separate appropriation structure
• Does not consolidate budget lines
• Implements Working Capital Fund
FY 2012
FY 2014
PB
FY 2014 +/–
FY 2012
Budget Authority
$5,649M
$5,217M
–$432M
PHS Eval Transfer
$371M
$618M
+$246M
Prevention Fund
$809M
$755M
–$54M
HHS Emergency Fund
$30M
$0
–$30M
$6,859M
$6,589M
–$270M
Total
Dollars rounded to nearest million; FY 2012 and 2013 amounts have been made comparable to FY 2014
CDC program level
Funding in past 5 years
$8,000
FY 2014 Budget Authority $1.2 billion
below FY 2010
$7,500
$7,000
$6,500
$6,000
$5,500
$5,000
$4,500
$0
$4,000
FY 2010
Budget Authority
FY 2011
PHS Eval Transfer
FY 2012*
ARRA
FY 2014 PB
ACA Prevention Fund
PHSSEF
Dollars in millions; FY 2012 was made comparable to FY 2014; FY 2014 does not reflect the sequester.
FY 2014 budget increases
Comparison to FY 2012
• Protecting Americans from
infectious diseases
• Advanced Molecular Detection
and response to infectious
disease outbreaks (+$40M)
• Food safety (+$17M)
• Domestic HIV/AIDS prevention
and research (+$13M)
• National Healthcare Safety
Network (+$13M)
• Protecting against global threats
• Polio eradication (+$15M)
FY 2014 budget increases
Comparison to FY 2012 (continued)
• Preventing the leading causes of disease,
disability, and death
• National Violent Death Reporting System (+$20M)
• Tobacco control (+$14M)
• Gun violence prevention research (+$10M)
• Million Hearts (+$5M)
• Rape prevention and education (+$5M)
• Monitoring health
• Health statistics (+$22M)
• Keeping Americans safe from environmental
and work-related hazards
• Healthy homes/lead poisoning prevention (+$2M)
FY 2014 key budget decreases
Comparison to FY 2012
• Community transformation grants (–$80M)
• Preventive health and health services block grant (–$80M)
• Immunization (–$61M)
• Racial and ethnic approaches to community health (–$54M)
• Occupational safety and health (–$53M)
• Breast and cervical cancer and colorectal screening (–$42M)
• Strategic national stockpile (–$38M)
• Buildings and facilities (–$10M)
• Workplace wellness (–$10M)
• State and local preparedness and response capability (–$8M)
• Environmental health tracking network (–$6M)
• Hospitals promoting breastfeeding (–$5M)
• Prevention research centers (–$4M)
CDC's ability to effectively respond to
infectious disease outbreaks is at risk
• CDC currently lacks the
cutting-edge analytical
capabilities to enable faster
and more effective infectious
disease prevention and control
• CDC labs rely on decade-old
methods to detect and diagnose microbes, leading
to slower outbreak response
• Cholera outbreak in Haiti
• PulseNet: Expands the use of molecular
technologies to improve food safety
• Drug-resistant infections
Advanced Molecular Detection combines
cutting-edge approaches
Traditional epidemiology
+
Genetic sequencing
+
Bioinformatics
=
Advanced Molecular Detection
Advanced Molecular Detection
saves lives, time, and money
• Revolutionizes how CDC investigates and controls outbreaks
• Detects disease outbreaks faster, in just hours or days
• Better protects Americans from killer microbes
• Detects and stops drug resistant, emerging, and important
pathogens faster
• Protects U.S. economy
• U.S. lives and economic
stability depend on CDC
detecting and responding
quickly to superbugs
• Creates healthier
workforce and stronger
economy
Improving public health through
AMD technologies
Advanced Molecular Detection
will allow CDC to detect outbreaks
sooner, respond more effectively,
saving lives and reducing cost
IMPROVED
DETECTION
IMPROVED
SURVEILLANCE
Faster, more accurate disease
diagnoses and enhanced
recognition of antimicrobial
resistance
Improved surveillance
information on the
transmission of infections and
the extent and spread of
outbreaks
Better targeting of prevention
and treatment measures
Faster, more effective
control efforts
Prevent the leading causes of death
Prevention Fund successes
Community prevention is key to prevent disease and
reduce growth in long-term health care and other costs
• Tips From Former Smokers campaign 1st-year successes
• Projected to result in >100,000 successful quits
• >200,000 additional calls to 800-QUIT-Now
• Thousands of lives and millions of health
care dollars will be saved
• Community Transformation Grant
recipient have proven successes
• South Carolina: 450,000 patients will receive recommended high
blood pressure and high cholesterol care
• Provided comprehensive workplace health training to
employers nationwide, with >2,000 participants
• Reached 90% or higher vaccine coverage for measles,
mumps, rubella; hepatitis B; poliovirus; and varicella
Building essential public health
detection and response
Prevention Fund successes
Critical to stop outbreaks and safeguard
communities from natural and man-made threats
• Fungal meningitis outbreak: tracked down 14,000 exposed
patients; assured removal of contaminated product from facilities;
saved lives and solved this urgent threat in concert with local public
health authorities
• NJ improved efficiency of reporting influenza results and cut lag
time from 2–3 weeks to 2–3 days
• Listeria: 146 infected in 28 states and 30 deaths; outbreak solved
in 2 weeks, rather than in months
• Fellows: Supported 320 CDC applied epidemiology and lab trained
public health fellows; supported 74% of CDC’s
trainees placed in the field
Information for action
Prevention Fund Successes
Strengthen health systems that gather, analyze,
and communicate data to produce timely and
accurate information for action
• Determined financial burden of care, use of Emergency
Department for usual care, insurance coverage rates and
difficulties obtaining insurance, and barriers to care
• NHIS: state-level data will be available for the first-time ever and
80 new ACA-focused questions were added
• Massachusetts used BRFSS data to analyze short-term effects of
legislation on health insurance coverage to target outreach efforts
for health insurance enrollment and health care access
FY 2014 key programmatic change
Working Capital Fund
• Incentivize efficiency and
collaboration
• Greater efficiency and
transparency of business
support services
• Operates on revenues
collected for services;
multi-year
• Distributes business services support funds across
programs’ budget lines
• Estimate amounts based on past use of business services
• CDC will provide updated information based on consumption
• FY 2012 levels made comparable to FY 2014
FY 2014 program level
FY11
enacted
FY12
enacted*
FY14 PB
FY14+/FY12
Budget Authority
$5,649M
$5,649M
$5,217M
–$432M
PHS Eval Transfer
$352M
$371M
$618M
+$246M
ATSDR
$77M
$76M
$76M
$0
HHS Emergency
Fund
$225M
$30M
$0M
–$30M
Prevention Fund
$611M
$809M
$755M
–$54M
Other User Fees
$2M
$2M
$2M
$0
$6,916M
$6,937M
$6,668
–$270M
TOTAL
Dollars in millions; pre-sequester
*FY 2012 made comparable to FY 2014.
For more budget
information
www.cdc.gov/budget