Satellite Broadcast for Futures Initiative

April 12, 2004. CDC Director Dr. Gerberding and Deputy Director for Public Health Services Dr. Ed Thompson lead a panel discussion about CDC’s Futures Initiative for CDC’s for CDC’s myriad partners. This presentation was broadcast by CDC’s Public Health Training Network Satellite Broadcast and Webcast and you may view this Webcast, which offered more information about the Futures Initiative, the strategic planning process that will shape CDC’s future and serve as a catalyst for change in public health. This PowerPoint slide show accompanied the broadcast. A transcript is available below.

Panelists were Dr. John Agwunobi, Secretary of Health for Florida; Mr. Pat Libbey, Executive Director of the National Association of County and City Health Officials; Dr. Steven Solomon, CDC’s Associate Director for Health Systems; and Mr. James Down, the retired President of Mercer Management Consulting, who has served as a consultant helping CDC frame the strategic direction development process.

Public Health Training Network Satellite Broadcast
April 12, 2004

Office of the Director
Centers for Disease Control and Prevention (CDC)
Agency for Toxic Substances and Disease Registry (ATSDR)

Presentation

(Lead in Video) Gerberding:

We’re going to focus the entire agency’s efforts to achieve the greatest impact we can on people’s health. The good news is that we have an absolutely wonderful workforce, a group of people who have unmatched skills and energy and true passion for their work. We’ve truly earned our reputation as one of the most respected and trusted organizations in the United States. It’s now time to take the next steps of the Futures Initiative and develop specific plans to fulfill our goals.

Thompson:

Hello, I’m Dr. Ed Thompson, Deputy Director for Public Health Services at the Centers for Disease Control and Prevention. And I’d like to welcome you to our Public Health Training Network presentation about the CDC Futures Initiative. Since June of 2003, CDC has been engaged in a strategic planning process called the Futures Initiative to assure that CDC will continue to have the capacity to protect and improve the health of the American people in the 21st century. The initiative is aimed at a fresh examination of CDC’s functions, organizational structure, and communications capabilities.

Today, we’d like to give you an up-to-the-minute look at where we are in the Futures Initiative and to engage your interest in working with us as we move forward in the transformation process. So, today’s program includes:

An update on the Futures Initiative, the strategic planning process that will shape CDC’s future and serve as a catalyst for change in the public health system, tools to track the Futures Initiative and information on how you can help. We have heard from many of you over the past few weeks, and we’ll share some of those ideas and comments with you on the program today.

Please continue to send us your thoughts, at any time in the process. You can check on our progress at the Futures Initiative web site at www.CDC.gov/futures. E-mail address for the Futures Initiative is fisatellite@CDC.gov. We’ll remind you of this e-mail address at the end of the program today.

Joining me today in the program is Dr. Julie Gerberding, the Director of the CDC. Dr. Gerberding is the inspiration behind the Futures Initiative. She works now with us in transforming CDC for the future, and she’s going to share with you the purpose of our work and where we’ll go from here.
We’ll also hear from our panelists on this program. We’re joined for this panel discussion today by:

Dr. John Agwunobi, the State Health Officer of the state of Florida. And in his role as the chairman of the CDC Advisory Committee to the director as well.

In addition, we are joined by Mr. Pat Libbey, who is the Executive Director of the National Association of City and County Health Officials.

By Mr. Jim Down, who has served as a consultant with CDC in moving through the process of the Futures Initiative.

And also by Dr. Steve Solomon, who is the person who has been responsible for the organizational structure analysis that you will see later in the program.

But first, before you hear from the rest of our panelists — as you will at the end of the program — Dr. Gerberding is going to give you a description of the Futures Initiative and where we are in the process and provide you with some explanation of the Futures Initiative.

Gerberding:

Thanks, Ed. I’m really delighted to be here to have a chance to provide an update on the Futures Initiative. This is a very important process for CDC, and if there’s one thing that we want you to take home from today’s broadcast, it’s that what the Futures Initiative is really about is how we can have the best possible impact on public health.

We’re a great agency, but we know we can be even better and accomplish even more. We’re strong and we have very high ratings, so, many people have asked us, “Why change?” Well, we’ve been asking ourselves this question long before we started the process of strategic planning and we’ll continue to ask questions as we go forward.

I think this quote from Oz Nelson really is the most helpful quote in the big picture. Of course, many of you know that Mr. Oz Nelson is the Retired Chair and CEO of the United Parcel Service, or UPS, in Atlanta, and he chairs the CDC Foundation Board of Directors. Oz has sat on our steering committee for the Futures Initiative and his wisdom and insight have been absolutely invaluable to us. He has reminded us throughout the process that the best companies go through transformation when they are at their strongest.

This is a tremendous agency, not a broken down, dilapidated agency by any stretch of the imagination. We’re doing incredibly important work, and we’re doing it faster than ever before. We’ve had many successes in the past year. But we did learn, after taking six months to get input from a whole variety of constituents and stakeholders, that there are things that we can do better and we should be doing better.

CDC is a strong organization, but the world is changing, and we need to change with it. Just keeping in mind, the time to change is when you’re successful. We are contending with many challenges, including: globalization; changing demographics of our population; aging in our society; information technology trends; health threats, such as emerging infectious diseases, the obesity epidemic, and health care costs; the human genome. All of these challenges present both difficulties as well as opportunities, and they certainly have an impact on our agency and its mission.

The most successful organizations are the ones that can be difficult to change. Successful organizations talk about continuous improvement and how they can be better. A barometer of that process is openness and willingness to address how we work together.

In looking at the future of CDC, we see three overarching challenges for the agency. First of all, we’ve got to provide the leadership and the resources to really build a 21st century public health system. The Institute of Medicine report addresses all critical infrastructure issues for public health, and we need to improve and have better intersection between the health systems and all aspects of governmental public health.

We’ve also got to prepare for health threats here and abroad. We need to be vigilant and thorough to be prepared.

Finally, we’ve got to transform the knowledge that we do have into true impact on the health of the people whose lives we are responsible for protecting. We need to increase our communication capacity, provide relevant information for different life stages. This information might include screenings; health tips for women of childbearing age; improve our research capacity to make a greater impact; and most importantly, take what we know will prevent or reduce the risk of disease, injury, and disability and develop the effective information and interventions that will truly make a difference at the front line.

In other words, CDC has got to take our knowledge and put it out into the front line of the community and understand how to translate that knowledge to have the biggest impact across life stages.

We have four underlying principles that affect every aspect of this process. First, the whole Futures Initiative is based on an outside-in approach. We went to you, our partners and stakeholders; and the customers, the people whose lives we’re trying to improve, to really get the kind of input that we need to be able to see ourselves through your eyes. Throughout this process, we’re keeping a customer perspective. Doing that will give us a valuable insight that we have not traditionally sought.

We also want to be driven by data. Our whole process is data-driven — that reflects the value of our science. No decisions can or should be made without a sound grounding in data.

We also want full involvement. Everyone needs to get involved in some way in the Futures Initiative because everyone has a stake in it. In addition to seeking input from external sources, we’re encouraging all levels of our organization to participate in the initiative. Innovation occurs at all levels, and we can’t afford to miss anyone’s good idea.
Another important principle is that structure follows strategy. No changes can be implemented just for the sake of change. If we’re making a structural change in our organization, it needs to be based on what would best serve the organization’s function.

Everyone will have an opportunity to provide input into this process during the first several months of the Futures Initiative, and we have talked with hundreds of people. We’ve talked with our employees, we’ve surveyed our employees. We’ve talked to people in the general public in organizations we’ve not traditionally worked with, and we’ve asked all of them: how can we be even better?

And we learned that we could be better, that the business we do could improve. Here’s some of the things we’ve learned from people. First of all, we are seen as a credible, trustworthy organization that does have an impact on health. We are unfortunately viewed primarily as a communicable disease agency and we lack a health promotion or a disease prevention identity. Most people were very forthright in indicating that if we worked harder to bring our programs together in a more integrated way, we could have an even greater impact on the nation’s health.

CDC is key to improving the public’s health, and we’ve learned that we need to listen more and improve services to our customers and our many partners and stakeholders in all sectors, whether that’s the governmental public health system, the health care delivery system, the business sector, or in our schools and educational system.

We also need to integrate across our internal silos. We simply do not have an organizational structure that leverages the incredible talent we have in our various centers into cohesive teams that truly work together synergistically.

We also need to leverage our impact on our customers by working closer with other federal agencies, both within the Department of Health and Human Services as well as in other parts of government.

And we can lead the way to a stronger governmental public health system. We know from our many partners in the public health system that we are all needing to work together to improve our cumulative capacity to make a difference.

But CDC does have a leadership role to play in moving that forward. We also can expand our impact in the various sectors by bundling products and services in ways that make sense to the individual people and provide a more integrated point of contact for these sectors.

This graphic shows one view of how the current health system is organized. When we say “health system,” we’re speaking about the broad array of organizations and agencies that play a role in health promotion. The importance of this diagram is that indicates that the far right-hand side, where we’re talking about secondary or tertiary interventions and end of life care, are the place where we make most of our national investments in health.

Those categories on the left side of the graph that deal with safer healthier people and keeping them from experiencing the vulnerabilities, whether that’s lifestyle vulnerabilities or societal vulnerabilities that places them at risk for disease, we simply are underinvested in these compartments.

One major task that CDC is intending to address is balancing this portfolio of our health system so that there is much greater emphasis placed on health protection, on making sure that we invest the same kind of intense resources into keeping people healthier or helping them return to a state of health and low vulnerability as we do to disease care and end of life care.

So now, we’ve taken all the important information from this kind of analysis and the input we’ve gotten from our partners and stakeholders and we’re using it to create some strategic imperatives. These are the big ideas that we have in front of us now. Those current big ideas are to, first of all, enhance the marketing of our input in multiple sectors so that we can truly have the health impact for all people. And in the process of doing this, we will certainly be addressing health disparities. We also feel we need to assume a more visible and a more integrated leadership role for the nation’s public health system.

We know what to do, but now it’s up to us to step up to the plate and get it done. We also need to expand our global health impact. SARS taught us about globalization, connectivity, and speed. And we know we need to maximize efficient, effective, and accountable investments in global health.

We need to focus on customers, the people whose health we’re trying to improve. And we need to align our strategy, our goals, and our actions to improve our overall health impact.

We need to expand intramural and extramural public health research to ensure excellent science and innovation remain the core of our output.

In order to meet our mission and to have the greatest impact possible on improving health, we must keep our mission in mind throughout the process. The importance of identifying measurable and achievable health impact goals cannot be overstated.

We have developed two goals. Number one, all people will achieve their optimal lifespan with the best possible quality of health in every stage of life. And number two, people in all communities will be protected from infectious, environmental, and terrorist threats.

We are in the process of working on developing these goals for each life stage, and once we have established that framework, we will be cascading the goals throughout our organization. Likewise, we’re working on defining the specific goals under the preparedness rubric and we will be cascading those goals throughout our entire organization.

These goals will set the direction for CDC, and we will be using them as a framework not only for resource allocation, but also for making decisions about our research agenda and how we prioritize the utilization of our human resources.

We’ll talk about how we’re going to implement this goal-driven strategy in a few moments, but I just wanted to conclude this overview with one very important statement. And that is, again, the take home message from all of this is that our purpose in engaging in the Futures Initiative is to respond to the input we’ve received from the folks on the outside of CDC that we are responsible for and from our customers so that we can have the best possible impact on public health. That’s our job, and we intend to do it even better.

Now I’d like to ask Dr. Steve Solomon to tell you a little bit about the prototypic models that we’ve put forward to help define the new organizational structure for CDC. We’re talking about, first, what the functions are that we need to accomplish, and then what structures will need to be developed to support those functions. Steve . . .

Solomon:

Thank you, Julie. In early 2004, we formed an organizational design team: people who came together from all parts of CDC and worked incredibly hard to do the very difficult creative work of developing a series of alternative visions for CDC’s future.

The first order of business for our organizational design team was to decide on design principles. These design principles were really what we considered to be the litmus test or assessment of the quality when we looked at any of the functional models that we designed. What you see here is a subset of the 22 organizational design principles. I’ll only mention a few of them specifically.

The first category is key capabilities. There, we wanted to be sure, for example, that any changes that we made to the organizational structure or additional functions that we added would help support the mission of CDC. Of key importance to us was to make sure that we could maintain our scientific integrity and excellence at all times. That is the most critical part of what CDC can offer to the people that we serve.

As for our functional capabilities, we really thought it was critical to do a better job of balancing the urgent issues with the really important issues, and not lose sight of those important issues whenever there’s an emergency response, and continue with the ongoing critically important work that CDC does.

In terms of communications and external relations, we wanted to make sure that CDC did not operate in a vacuum. We learned in the early phase of the Futures Initiative that many people thought that CDC should really reach out more and get more input from our partners as well as from our customers. We agreed, and we made that a key design principle.

And then with reference to our business practices, we believe that our business practices really should support all of our goals — that they need to be aligned and functioning in a way that directly supports our mission.

Our charge was to develop functional models to strengthen CDC’s ability to have the greatest impact on the health of the American people. We did that by looking at our organizational structure, but we also looked at the formal and informal processes that are necessary to carry out the day-to-day work of CDC.

It’s very important to understand that these are, in fact, functional prototypes. They’re not boxes on an organizational chart, and the activities that you see grouped together on the slides that we’ll see in just a few minutes are not fixed or static. They’re not boxes with lines connecting them. They really represent the way we work together and examples of how various combinations of functions and activities could work together. Other examples are possible. And in the end, we may want to draw on parts or modifications of these models in developing a basis for CDC’s future.

The common characteristics that link the models are those things that we thought were most important. We talked about developing overarching goals, which are currently under development in the Futures Initiative. It’s not enough for us to just measure our health impact goals; we also need to measure our processes internally.

For example, are we providing the best technical assistance to our partners in public health that would lead to the achievement of our mutual goals? These are the kind of performance measures that we would start to look at as an agency to ensure that we are, in fact, doing the best job possible, with our partners and for the people that we serve.

Strategic analysis is a function that we think is also very important. This is the determination of how we get to where we’re going, with achieving our goals. We need to review and decide on how to achieve those goals and develop the mechanisms and the priorities for getting us to a successful end point. We need to foster creativity and encourage trying out new ideas. We want able to experiment with those ideas while maintaining the tried and true research and program activities for which so many of our customers and partners rely on us.

Health protection marketing encompasses a wide variety of activities in place at CDC, as well as adding new areas of expertise for us. Health marketing includes the translation of research into interventions and into the implementations of products and services for the people that we serve. It includes the bundling of those products and services to make them more effective in their delivery. It includes reaching out to our public, to our customers, and it includes reaching out and working very closely with all of our partners in public health.

We think there are a number of benefits to consolidating business and other cross-cutting scientific services. But we need to be very careful in doing this to make sure that in every case, we’re maximizing efficiency through these consolidations while maintaining the highest quality of service.

We also talked a lot about the distinguishing characteristics between these prototypes. What is different about them? Most of the prototypes have some concentration or a diffusion of the health marketing function. Whether that health marketing function is consolidated or embedded throughout different parts of the organization is something that, you’ll see in a moment, differentiates these models.

In addition, as we either centralize and sometimes diffuse those functions, other parts of our functions are embedded into the different operating units. You’ll see that variation in consolidation versus diffusion in a number of priority setting and decision making activities as well. There is a clear intention to set agency-wide goals, and the responsibility for making sure that these goals are achieved rests with the Office of the Director.

But there are other decisions to make and other processes that need to be managed. These could be centralized or consolidated in some models, or, again, diffused throughout the organization in other prototypes.

Organizing around operational units is represented in a variety of ways among these prototypes. Sometimes, that organizing principle is a content area. In others, it’s represented by a professional discipline or a public health function, or even the health determinants as they were described through the Healthy People 2010 process.

And then, I want to talk a little bit about the complexity of networking. Let me explain to you a little bit by what we mean by the term “networking.” If you think about it, in any organizational structure, there are times when you need to pull together teams to work on different issues. Each of these functional prototypes—that we’ll look at in a moment—for each of these, we thought a lot about the process of bringing people together. If you need multidisciplinary expertise, if you need people with different types of backgrounds, different types of ability to reach out, how easy or how difficult would it be, and how would we operationalize that within a prototype?

Looking at Prototype A, you’ll see that at the top, there’s agency direction and a large priority setting and program evaluation component. This is true in all of our models. Priority setting and program evaluation becomes a major function of the agency and goal setting and measurement of the achievement of those goals is something that carries throughout the organization. Again, this is part of what the agency does on an ongoing basis.

You’ll also see at the top of this diagram an illustration of the health marketing function. All of the models have a health marketing function, but as I just said, you’ll see that, in some places, it’s more centralized and consolidated. In this model, I hope you’ll see that health marketing is embedded throughout all parts of the organization.
At the bottom of the diagram, you can see the cross-cutting functions I referred to earlier: the science and innovation support and the business support for all of CDC’s activities. And so, we can follow through this mechanism how activities are tracked from problem identification on through health marketing. These are some of the common themes in all of the models. These common themes are, again: priority setting, health marketing, and the cross-cutting functions.
What you’ll see in the differences are the organization of the operating units in these different ellipses. They’re called “centers” here, but they may be called centers or operating units or organizations, and these are the places where risk identification, risk assessment occurs, research and intervention development occurs, and where evaluation occurs.

When products are produced and they’re ready to be brought to market, when they’re ready to be delivered to our public health customers, this occurs through the health marketing units that are embedded throughout the agency but are coordinated by the health marketing unit, the consolidated unit, up at the top of the diagram. These health marketing units report to that executive health marketing function and they are coordinated by that health marketing function, as you’ll see in the next slide.

The next slide shows the other prototype, our second, Prototype B. In which a centralized goal management function links research and development activities and the health marketing function. The goal managers are located in the goal management unit. These goal managers would help monitor, coordinate, and address the question of bringing together these operational teams for achieving the public health goals. So we have defined accountability for delivery of each component of these public health goals.

The cross-cutting functions, the innovation and evaluation function, are also represented on this diagram. And as you can see, agency direction and priority setting is also clearly elaborated in this prototype.

Moving on to Prototype C, you’ll see that we have a series of vertical ellipses, which do follow the Healthy People 2010 health determinants. There again is agency direction, priority setting and goal management. But what you see here is that a number of functions, cross-cutting functions — such as data collection and analysis, research and intervention development, implementation and capacity building, and program evaluation — move across all of the vertical ellipses, which are centers.

Our staff are located in the cross-cutting bars, but goal management and the achievement of goals, again, is networked as you work down the ellipses. Again, delivery occurs in the health marketing unit, where these products and services are delivered in the most optimum, effective manner to the people that we serve. Again, you see cross-cutting business functions and an innovation function represented as well. Julie, that’s where we’ve gotten to in our work to date.

Gerberding:

Thank you very much for that hard work. And just to say it one more time, this is the functional presentation of an organizational structure, but we will have to work through these functions and eventually create some kind of a structural organization that will make a more familiar impression on people.

Thompson:

Thank you, Julie and Steve. Now, we’d like our panelists to give us their perspective on CDC’s Futures Initiative and their reactions to it and what we’re trying to achieve. We’ll start with Dr. Agwunobi.

Agwunobi:

Thank you, Ed and thank you, Julie, for allowing me to participate. You know, as a member of the advisory panel that works with you, I have to applaud how inclusive this process has been. I know that the panel and I look forward to participating on an ongoing basis in what appears to be a very comprehensive and open process. As a state health officer, I have to tell you that I also applaud the fact that this is something that you seem to be reaching out, outside of the organization, outside of the traditional interactions that occur. I look forward to being a conversant in this and a participant — I thank you.

Gerberding:

Thank you.

Thompson:

Thank you, John. Next, we’d like to ask Mr. Pat Libbey to give us some perspective of his involvement in the Futures Initiative and why he thinks it’s a positive direction for CDC. Pat . . .

Libbey:

Thank you. Excuse me. Thank you, Ed, and thank you, Julie, for the opportunity. It’s clear, as you describe your customer, you share the same people that the public health system in this country has been working with for some time. It’s also clear that the notion that it takes more than the governmental public health system to assure a safe and healthy population is the same principle that we’ve been working with at the local level and at the state level for these last number of years.

The country’s health departments are located at the community and the state level throughout the nation. And we are going to be better able to protect and promote the health and well being of the members of those communities and those states by being served by a competent and strong national organization like the CDC. More than stakeholders, typically, governmental public health, we have a different and a unique relationship that we have to make sure that we sustain. The nation’s public health departments, together with CDC, using our respective powers and authorities, and our resources, comprise what the IOM report referred to as the backbone of the health system, public health system, of this country.

And we’re collectively charged by the people that we serve to protect and promote the well being and safety and health of all of our communities. I think in a number of ways, a strengthened, responsive CDC, as envisioned in the Futures Initiative, will better enable the country’s health departments to serve the public for whom they are responsible and to whom they are accountable.

Health departments rely on CDC’s science and its credibility. In turn, there’s an increased trust on the part of the people and the policy makers alike when they know that their health department is linked with the CDC. Areas where we can co-brand and share our respective public health identities. Improvements in CDC’s business practices will increase efficiency and effectiveness, especially those that focus on cross-cutting issues. A strengthened public health research agenda, which is part of the Futures Initiative, with emphasis on systems and field-based research, will contribute improved practice and improved organizations within the country’s public health departments.

Consultation, guidance, and leadership from CDC in our mobile and global society will contribute to an improved level of performance across the country’s health departments, and will help ensure the country as a whole is being served by an improved governmental public health system.

And last, CDC’s work with other partners, mentioned several times — businesses, schools, faith community, and others — at a national level will parallel and reinforce the country’s health departments’ efforts with those same partners at the level where people work, live, worship, and recreate. This contributes to the complex overall public health network that was envisioned in the Institute of Medicine report.

We in the governmental public health part of the system look forward to working with the CDC in making the vision that’s embodied in the Futures Initiative a reality.

Thompson:

Thank you, Pat. We’ve been receiving questions and comments from many people — inside of CDC and our partners and customers. I have a few of these questions and comments with me, and I’d like to pose them now to our panel for response or reaction.

First, I’d like to address this question from a health department representative to Julie. “Will CDC take on the issue of health disparities as part of its newly defined goals?”

Gerberding:

Thank you for that question, Ed. One of the most rewarding aspects of this process when we were first sitting down with the leadership of CDC and trying to frame overarching goals for the agency — to a letter, every person in the room made it very clear that putting the improvement in health disparities front and center was an absolutely core value and one of the overarching priorities for all of us. So you’ll see the emphasis on health disparities emanating from the goal that accounts for health promotion and disease, injury, and disability prevention. But it’s also an important part of preparedness, because we know there are ways in which preparedness planning also can be vulnerable to health disparities. So it’s absolutely critical.

Thompson:

I have a question I’d like to direct to Jim Down. The questioner says, Jim, “I’m hearing CDC starting to use the language traditionally used in business settings, like ‘marketing’ and ‘customers.’ Does this mean that CDC will start acting more like a business than a government agency? And will this take away from the public health mission, or will it add something of value to CDC’s services?”

Down:

Ed, I’d hate to think that the concepts of customer and marketing are unique to business — I think all organizations have customers. And understanding who those customers are and how you can serve them and how you can be more customer-focused, I think, can only enhance CDC’s public health mission. Similarly, when I think about applying marketing and the concept of marketing to understanding how to segment customers and partners and how to think through their needs and how to develop products and services to work with them, again, can only enhance the mission. So I think these are positives. They should not be considered to be negatives at all. And again, I think all organizations, whether in the for-profit or the nonprofit or the public sectors, all apply these to varying degrees. I think maybe using the terminology is a bit new here at CDC, but many of the concepts have been used for quite some time.

Thompson:

Thank you, Jim. I’d like to direct this next question to Dr. Agwunobi, since I know that the state of Florida is addressing this as an issue as well. John, “Explain your thoughts on why CDC is changing or needs to change its focus to directly address the general public as its customers and how will this affect your — our — relationship with state and local health departments?”

Agwunobi:

Ed, you know, it’s an important question, but I do want to stress that I don’t know that this is necessarily changing the focus. I think what this is about, and my understanding of it is, it’s about adding to those portfolio of priorities that exist within this organization. You know, I agree completely with you, Jim, when you talk about the fact that these are values that every organization that has maintained. A focus on the customer, an understanding that with change, with movement of an organization over time, that’s how you acquire excellence. So I believe that this is an addition to the portfolio. In terms of our relationship, the relationship between state health offices and the centers for disease control and prevention, I have to tell you, I think this is something that’s going to take to us the next level. The relationship — my understanding as I talk to my peers and colleagues across the country, not just in the state of Florida, are that the relationship between the state health office and this organization have never been better than they are right now. And yet, here, with this priority, we have an opportunity to take it to a whole new level. It’s exciting for me. I know that my colleagues and I look forward to continuing this work. I think it’s a good thing.

Thompson:

Thank you, John. Our next inquiry is from a nonprofit organization. I’ll direct this to Dr. Solomon. Steve, they ask, “We’re still not clear about the meaning of ‘bundling’ and how this would affect future program implementation. Could you comment on this, and how it would affect the chronic disease program in particular?”

Solomon:

Certainly, Ed. By “bundling,” we’re talking about linking together products, information, services that we deliver to the people that we serve. Our feeling is that those people will be more receptive and the delivery of those products and services and that information and those programs will be more effective when they’re linked together and joined together. You saw that each of the prototypes that I described has a health marketing function. This health marketing function would bring together these activities so that tobacco cessation, diet and exercise, cancer screening, could all be linked together and delivered in addition to injury prevention, adult immunization, and a variety of other activities and public health functions, information, products, services, that we need to help people protect their own health and to offer them the opportunity to improve their health. Linking those together, we think, will greatly improve the uptake of those services and products and really help us have a greater impact on health.

Thompson:

Thank you, Steve. Did anybody else want to comment on this one before we move to the next? It’s a pretty broad issue.

Gerberding:

I can tell a story on myself because I went to our web site to try to find out what would be the health priorities for someone my age and my demographic category. And the CDC web site has all of this information, but you have to really know our organizational structure in order to find it. I think one of the key aspects of bundling is that you pull all the things together that people need to understand their own health decisions. Or, if you’re creating tools for, let’s say, someone in the health care delivery system, you’re giving the clinician, who is in front of the patient in the clinic, the information they need for that particular patient in a format and a package that works well for them on the spot.

Agwunobi:

If I could just add to that, I think it also allows you to use unique channels to — we’re talking about disparities and how do you reach populations. And for example, faith-based operations or other channels into communities, you can more effectively use them when you bundle the message, bundle the opportunity.

Thompson:

Thanks, to all of you. We have a comment and a question here from a local health department representative who is concerned about workforce development. I would like for both Julie and Pat to comment on this one. Let me read the question first. And then, Pat if you could elaborate on the issue and how you think CDC could best provide support. And then, Julie, would you comment on what ideas have surfaced in the CDC’s Futures Initiative about that?

Here’s the question. “There’s a growing need for training the public health workforce. First, we need to find qualified people who want to do this kind of work. We need to help to train our employees, not only on emergency preparedness procedures, but also with day-to-day public health practices. What will CDC be doing in the future to help us?” Pat, why don’t you start us?

Libbey:

Ed, thanks. The question really does speak to a number of the challenges, but positive challenges that we’re facing in workforce and workforce development. There’s the issue of where is the future workforce coming from. The public’s expectation of having in place a public health system able to protect and help promote health is there, but we are seeing, increasingly, difficulty in recruiting the kinds of people that we need. We also have the challenge: public health is a broad field; it’s not a specific discipline. We bring people from a variety of backgrounds and experience: laboratorians, sanitarians, nurses, health educators, physicians. The question is, how do you also infuse in their development a sense of public health and the role that public health plays in a community, state, and national level? And last, we have the challenge, given the changes that we have faced even in the last two years and we are sure to face in the future, how do we assure that our work force is staying current once hired, once on board? Many people, in a sense, come into public health looking for a job, and perhaps it’s our responsibility to give them a career and a vocation with the means of continuing education, means of rewarding that education, both in the nature of the work and other ways.

Gerberding:

Yeah, I think I would add to that by, first of all, a reflection. Right now, one of the most remarkable things about CDC and the whole public health system is the incredible passion and commitment and energy of the workforce. I mean, in the last couple of years, we’ve seen true acts of heroism throughout the system. But the challenge is, how do we not just keep the status quo, but how do we build the skills and capacities and the pipeline for the future? And I think all of us around this panel have a role to play in that. We need to make it very clear that public health is exciting, that it’s important, that it makes a difference in the world. And certainly it does, but that may be another component of marketing. That is, letting people know how very, very important this work really is. Another dimension to that is also engaging our academic environments in this from school-aged kids all the way through post-graduate training. One of the new initiatives we’ve addressed this year is to put some research dollars out for public health research and to invest some of those dollars in training programs that create new models for public health research that help bridge that gap between the science we have today, the science we need for tomorrow, and the talented best and brightest people that we want to bring in to that pipeline.

Thompson:

Thank you, Julie and Pat. I have another question here for Dr. Agwunobi, and I’d like to ask Jim Down to comment on this one, too. John, first, “Why is CDC talking more about connections with the business community? How will CDC benefit from working with business and industry?” And John, first, will you talk about the benefit and connections between public health and the private health care industry? And then, Jim, I’ll ask you for some comments as well. John.

Agwunobi:

Yeah, I think working with public health at the state level, I’ve begun to realize over the years that the true strength of public health relies heavily on the relationships that exist between the professionals and the infrastructure of public health and the community itself. Picking up on what Julie was just saying, we can’t afford to be invisible as we move forward. We have to get engaged in the community at a level that allows them to see what we do on a day-to-day basis, allows them to participate in what we do on a day-to-day basis. And related to the Futures Initiative, allows them to help forge the direction for the future — that’s what makes public health exciting. So in answer to your question, I think there’s a direct important link that has to be forged and strengthened where it exists between public health and the private sector, public health and business. The principles of business — I get to sit on both sides as a public healther who also has training in business, and I understand when all is said and done, this truly is about taking best practice from wherever we can find it.

Thompson:

Jim, could you give us your thoughts about how CDC connecting with the business community could positively affect public health?

Down:

I can see a number of different connections. First of all, if you think about this from a business’s standpoint, one of their major issues is the rising cost of health care. So it is on their radar screen. And they’re struggling with what to do about that. But we need to make the connection with the public health community and with CDC, because that’s not the place that businesses would naturally look to. In fact, in our initial research, when we talked to businesses about this issue, they said it’s a huge issue for them. Then when we talked to them about CDC — going back to the research that Julie was mentioning earlier — they tend to think of CDC as an infectious disease organization. So there’s a gap between the rising cost of health care, but do I turn to an infectious disease organization to help me with that? Because they don’t understand all the wonderful things that CDC is doing and they don’t understand the public health community. In fact, based on research I’ve seen, I’m not sure that many people in the general public understand public health. I think there was a survey done that indicated 85 percent of the people in the United States didn’t feel that their lives had been impacted significantly by their state and local health departments. And I know when I mentioned that to Pat, he said, “Well, then, those people don’t drink water and they don’t eat in restaurants.” But people don’t naturally make that connection, so there needs to be some help with that. But that’s one dimension where CDC can connect with business.

The second is that, if you look at where a lot of people in this country spend a very significant amount of their time, it’s in their place of work. So it’s a great place to connect with people, and if you have messages that we want to get out, there are connections where most of these companies have web sites or they have company newsletters. And a lot of them are beginning to talk about health issues, so there’s a natural connection there also. And then, finally, there are certain segments of the business community that have a very strong interest in health. And whether that’s companies that have products and services related to exercise or the food and beverage industry, but there are a lot of segments that also have a different dimension. So I see a number of different levels that CDC can connect with business, with this common ground to really improve health.

Thompson:

Thank you, Jim and John. I have a question here from a community-based organization. Julie, could you help us with this one? They say, “There’s a greater need for health information all the time.” And this is a community-based organization, now. “We need training materials. We need materials that are more user-friendly. We need clear guidance and recommendations from CDC that we can share with our communities. How will these changes in CDC’s structure improve these services to us?”

Gerberding:

Thank you. As I said before, the overarching goal of this entire process is to improve the impact on people’s health. And information is one of the major products that CDC creates to do exactly that. So what we’re focusing on in futures is, how do we get that information from the scientists who create it or acquire it from NIH or other research agencies and get that information out into the hands of either the individual who needs to benefit from it or the contextual environment: the school system, the health care delivery system, the employer? How do we actually move that information out in the best possible way? One aspect of that is the science of information management — informatics. And we know we need to have a much more strategic approach to informatics and we need to make sure that our information flows to people in the way that allows them the decision support they need to make the choices that hopefully will help improve health. Another aspect of this is to listen, and we need to understand specifically what does a community-based organization need? Where do they most conveniently get their information? How would they like it packaged? And to constantly listen, adjust, try again, and keep that cycle of improvement going on an ongoing basis. It has to be adaptive, because information needs change over time. But also, I think we’ve taken some giant steps forward, we’re on a better track now than ever before, and I think we’re learning that that information is incredibly useful. I think right now, we’re receiving more than 10 million unique visitors to our web site every month, and that’s a giant increase over where we were even two years ago. So we’ve got more to do, but i think we’re all optimistic that we’re on the right track.

Thompson:

Thank you, Julie. Steve, could you respond to this question? We talked about life stages a good bit. “How will issues that cross the life stages be addressed by CDC in this new life stage approach?”

Solomon:

Certainly, Ed. We think that life stages is one way of addressing the needs that our customers and our constituents have. People think about their life and their health holistically. They don’t think about chronic diseases or infectious diseases. We believe that people approach their health as a single entity. We operate, often and for very good reason, according to an infectious disease or a chronic disease approach, but when we reach out to those people, when we reach out to the people that we serve and who depend on us for our activities, our services, our public health functions, we need to be reaching out to them in a way that’s most convenient for them to understand, that’s most convenient for them and most amenable to them for them to receive the information, to receive the programs and services that we want to give them. So what we need to do is to convert the work that we do internally, which may be categorical, it may be according to type of disease. We need to convert that and translate that into the way that people can receive it, hear about it, learn about it, and accept it in the kind of holistic way that they think about their health. So that’s an activity that we have to do internally so that people can receive their health in this bundled or life stage manner. And that’s something that we do for them as part of our service.

Thompson:

Thanks, Steve. Here’s a question that’s frequently asked, and I think Julie needs to answer this one. “Will the Futures Initiative affect the CDC funding to health departments, academic institutions, and community organizations?”

Gerberding:

I think the short answer is, I hope so. If you look at how we’re currently allocating resources, there are a couple points to make — first of all, we’re in the hole. There has been underinvestment in public health for decades and we’ve got to have sustained investments over time. So, of course the Futures Initiative is designed to try to get the maximum impact out of the resources that we have. And that means getting those dollars out to the front line, where they will do the most good. But we also recognize that some of the ways that we present resources to state and local health departments is not necessarily optimized for efficiency. What we’d like to see is how we can take the resources that we have and deliver them in ways that get the job done and address the goals that we’ve designed for public health, but at the same time reduce the kinds of unnecessary administrative expenses or oversight expenses that don’t necessarily contribute to health impact, but do detract from the bottom line dollars available for program. So the goal is to get the most dollars that we can to address the health impact requirements and to do this in a way that is as efficient and as supportive of our partners in the public health system as we possibly can.

Thompson:

Thank you, Julie. I’d like for Pat and John to respond to the issues in this question first, and then ask Julie for a response from the CDC perspective. Pat, John, do you have or have you heard expressed this concern? “How will CDC maintain its existing programmatic relationships with state and local health departments?” Pat, do you want to start us?

Libbey:

We have heard some concern, perhaps less on the programmatic in the sense of the silos or the specific centers and more on a basis of the communication and engagement at state and local levels with the partners that we’re working with. And a concern that the communication occur in a way that is supportive of overall system. The example Julie used a moment ago, from the question working with a community-based organization. It’s also important that that be communicated and that that context of that community be understood and that a connection that that is occurring happen with the public health system as well. So it’s a concern as much about sharing the information, sharing who you’re communicating with, as it is about programmatic-specific issues. I think there’s less concern in that regard.

Agwunobi:

Yeah, I’ve actually heard very few concerns. I think some of the key issues that I think obviously have to be taken into consideration — and I hear this from my colleagues and from those that I work with — are that we have to recognize that there are three levels to public health, and perhaps more, but three official levels: the local, the state, and the Centers for Disease Control, the federal level. They all need to participate. There needs to be coordination as we move forward. I think the big concern has already been addressed, and that is that from the state level, there’s a desire to participate, to be a part of the process. And Julie and others, I sense that’s already been taken care of, we’ve already been invited to the table, and I look forward to continuing with that.

Thompson:

Thank you, John. We have one more question here, and this is clearly one for Julie. “CDC is known and trusted for its subject matter expertise. How will CDC maintain its subject matter expertise while promoting cross-agency action and focusing on broader health goals?”

Gerberding:

Well, this is an important question, but one of the aspects of the futures that I feel the most optimistic about. Because you know, we’ve proven, time and time again in the last couple of years, that we can do exactly this. Look at SARS. We did not have corona virologists at CDC the week before SARS occurred, and by a three-week timeframe, we had not only established the etiologic agent of SARS but it had been sequenced and the first prototype diagnostic tests were ready for preliminary deployment. So we have a tremendous capacity here, and what we really need to do is to engage our scientists in the important work necessary to address the gaps in knowledge that are necessary to be addressed if we’re going to accomplish our health goals. And at the same time, recognize that we need the flexibility and the innovation and the creativity to respond to emerging threats or new problems, wherever and whenever they pop up. We have to have a critical mass of scientists. Everything about the Futures Initiative is designed to protect our scientists and to ensure that that fundamental basis of our credibility survives and thrives at CDC. And that’s part of the reason why I’m so invested in expanding public health research. But at the same time, we need to get all of us in alignment because if we are all working together to accomplish those goals, I know we’re going to have more impact. And again, the bottom line is that this is all about impact on people’s health.

Thompson:

Thank you, Julie. We’re at the end our program today. So I’ll thank our viewers for sharing their time with us. And we also hope you’ll continue to share with this dialogue with us as we continue through the Futures Initiative. Your input to this process is vitally important to us. You’ll be hearing more from us about CDC’s Futures Initiative. But you can send us your thoughts and ideas right now through our web site at www.cdc.gov/futures/. And you can always send us e-mail messages directly at fisatellite@cdc.gov.

This is an ongoing process. When you think about your organization, how do you see these directions and changes at CDC affecting you? Are there other things that you would like for us to consider in the process of our Futures Initiative? Let us hear from you. Thank you again for joining us today, and we look forward to talking with you again about CDC’s future.

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Centers for Disease Control & Prevention
Office of the Director

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