Information is Power

Thomas R. Frieden, M.D., M.P.H. Director, Centers for Disease Control and Prevention

With publication of this latest edition of America’s Health Rankings comes acknowledgment that information is power. Power to know where our biggest health problems lie. Power to make healthier choices. Power to improve the health of our nation.

But with that power comes responsibility. Re­sponsibility to figure out which interventions and programs will have the greatest impact. Responsi­bility to use resources wisely. Responsibility to take action at all levels of society. For if we don’t take these responsibilities, all of the information and knowledge in the world will not help us make the improvement we need to keep people healthy and our nation strong.

We are making progress using better informa­tion more effectively for decision-making and action. At the CDC, surveillance and epidemiology have always been core functions. We and others use this information to improve health here at home and around the world.

Much of our data and those of other entities are reflected here in America’s Health Rankings. The information presented here provides a detailed snapshot of our nation’s current health status and trends over time, indicates where more effort is needed, and gives us a good idea of where we will likely be headed in the future.

This latest look at the health of our nation shows that we are making significant improvements in some areas, but are not making progress in others. Declines in smoking rates have slowed. Reducing obesity remains one of our biggest challenges. Although health insurance coverage rates among children are increasing, the number of Americans without health insurance continues to rise. However, recently implemented provisions in the Affordable Care Act for insuring young adults through age 26 have increased coverage levels in this group, and even more Americans will gain access to coverage by 2014. These rankings also reveal the often sharp disparities in health status among states.

All segments of our society — the public health and health care communities, gov­ernment agencies at all levels, nonprofit organizations, the business community, educational institutions, community groups, and individuals — must join together to implement programs to improve health. It is ever more critical that coalitions of groups that have a stake in improving health come together to devise and implement solutions that will work.

Strengthening our efforts against cardiovascu­lar disease — a key measure in America’s Health Rankings — is crucially important. Cardiovascular disease kills 865,000 Americans each year and remains our nation’s leading cause of death. CDC, in partnership with the Centers for Medicare and Medicaid Services (CMS), other federal agencies, and clinical, community, and other partners, has launched a Million Hearts initiative to prevent a million heart attacks and strokes in the next five years. Million Hearts will reduce the number of people who need treatment through prevention and improve management of the ABCS — aspirin, blood pressure control, cholesterol management, and smoking cessation — which have the greatest potential to save lives of any clinical interventions.

Currently, less than half of Americans at highest risk of cardiovascular disease take daily aspirin, less than half with hypertension have it adequately controlled, only a third with high cholesterol have adequate treatment, and less than a quarter of smokers get help to quit. Focusing on the ABCS, advances in informa­ tion technology, particularly expanded use of prevention-oriented electronic health records, and increased use of team-based care will help clinicians make progress in the ABCS.

Blood pressure control in clinical practice may be the most important of these interventions, with the potential to save the most lives. Active partnerships can enhance clinical interventions. Clinicians need to check patients’ blood pressure at each visit and prescribe or adjust anti-hypertensive medications promptly as indicated. Pharmacists can monitor medication refill patterns to ensure that drugs are being taken as prescribed and more actively engage doctors and patients in blood pressure management. Home monitoring can help people know if their medications are effective. Senior centers and other community organizations can help ensure blood pressure awareness and control and improve medica­tion adherence. With many partners working together, it becomes much easier for people to keep their blood pressure controlled and prevent heart attacks and strokes.

At CDC, we are also focusing on “winnable battles.” Although we are not de-emphasizing work in other key areas, the winnable battles are health problems that present a large burden as a leading cause of illness, injury, disability, and death, and for which there are evidence-based, scalable interventions that we know will work and that we can apply today. Our efforts can make a difference and achieve measurable results within just a few years, although success will not be easy and will require substantial ef­fort by all segments of our society.

CDC has identified these six areas, all of which America’s Health Rankings measure either directly or indirectly, as key winnable battles for improving our nation’s health:

• Tobacco control.
• Nutrition, physical activity, obesity, and food safety.
• Healthcare-associated infections.
• Teen pregnancy.
• Motor vehicle injuries.
• HIV.

Tobacco is the leading preventable cause of death, killing more than 440,000 Americans each year — nearly 1 in 5 of all deaths — or more than a thousand people every day. About 46 million American adults still smoke, which costs us nearly $200 billion annually in medical expenses and lost productivity. After 40 years of steady progress in reducing smoking since the first Surgeon General’s report on the harms of was released, the decline in adult smoking rates has slowed since 2004.

More than two thirds of smokers want to quit. Many of them try, often multiple times, but need support to succeed. There are proven strategies we can use to reduce tobacco use, which form the basis of the World Health Organization’s MPOWER strategy:

• Monitoring tobacco use and preven­tion policies;
• Protecting people from tobacco smoke;
• Offering help to quit tobacco use;
• Warning about the dangers of tobacco;
• Enforcing bans on tobacco advertising, promotion, and sponsorship; and
• Raising taxes on tobacco.

Strengthening tobacco control will reduce smoking by discouraging smoking initiation and encouraging cessation. We are making important progress, both nationally and at the state and local levels, to implement proven tobacco control policies. The number of Americans protected by comprehensive smoke-free laws is growing each year. Tobacco tax increases at the federal level as well as by some states and localities are encouraging people to quit smoking or not start in the first place. New graphic health warning labels mandated by the Food and Drug Administration pursuant to new federal legislation will be introduced next year, as will expanded use of anti-smoking mass media campaigns. The Centers for Medicare and Medicaid Services is taking steps to increase the coverage of smoking cessation services in public and private insurance programs. Progress shows that success is possible wherever tobacco control is made a priority.

Obesity is one of the few health problems that continues to worsen. Since the 1960s, obesity rates have doubled for adults and tripled for children, so that now more than 1 in 3 adults and 1 in 6 children are obese. We are still working to develop effective interventions to reduce obesity. Among these include policies to increase the availability of healthier foods and beverages and to reduce less healthy food in schools, government facilities, health care facilities and other places. Menu labeling guidelines for chain restaurants will encourage people to make healthier choices. Outbreaks of foodborne illness are both common and costly. Each year, there are about a thousand such outbreaks in this country, which sicken 1 out of 6 Americans and kill 3,000 people. The annual a thousand costs to our society are es timated as high as $152 billion in health care expenses and lost productivity. With passage of the Food Safety Modernization Act, the Food and Drug Administration, CDC, the Department of Agriculture and other partners at federal, and state and local levels are identifying these outbreaks and stopping them more quickly, tracking trends in food-borne illness and outbreaks more closely, conducting applied research for better diagnosis and prevention, and tracking the effectiveness of policies to reduce the spread of these illnesses. PulseNet, a national network of public health and food regulatory agency laboratories that is coordinated by CDC, is central to our ability to quickly identify which of many types of bacteria caused an outbreak, facilitating more rapid response.

About 1 in 20 patients who are hospitalized contracts a healthcare-associated infection (HAI), which kill 100,000 Americans and cost us roughly $30 billion each year. At least a third of these infections can be prevented with simple tools and procedures that already exist but are currently underutilized. There has recently been a decline in some types of HAIs, in part because more than half of states now require reporting of HAIs, and nearly 5,000 health care facilities throughout the country are enrolled in the internet-based National Healthcare Safety Network (NHSN) surveillance system. The Centers for Medicare and Medicaid Services uses this NHSN surveillance data to improve the quality of hospital care, and the Partnership for Patients is a new public-private partnership to improve patient safety and reduce health care costs.

More than 400,000 of our nation’s teen girls age 15-19 years give birth each year. Pregnancy can have immediate and long-term negative effects for teen parents and their children, and can perpetuate social, economic, and educa­tional disadvantage. Although teen pregnancy rates have declined significantly over the past two decades, to the lowest levels since records started being kept, rates are still far too high. Considerable disparities persist in rates of teen pregnancy and birth among our nation’s racial and ethnic groups. The public costs associated with teen pregnancy, including health care and foster care, are more than $9 billion annually. Areas that expand access to information and services can substantially reduce teen pregnancy and reduce health disparities.

Although there has recently been a sharp decline in motor vehicle deaths, crashes kill more than 33,000 people and send more than 4 million to emergency departments every year, and remain the leading cause of death among Americans between ages 5 and 34 years. Motor vehicle-related deaths cost our nation $41 billion annually in medical expenses and productiv­ity losses. These rates could be reduced through simple, low-cost measures, and CDC is working with states to adopt and enforce laws requiring use of seat belts, helmets, and child restraints; reduce drunk driving; and introduce and improve graduated drivers licenses for teens.

Despite being preventable, HIV continues to spread among Americans, with more than 50,000 newly infected each year joining a million already living with HIV. Rates are increasing among younger men who have sex with men. We are expanding prevention programs, including testing more people for HIV, and linking those who are infected with treatment as early as possible. CDC is also working with other federal agencies to implement the National HIV/AIDS Strategy, which is designed to achieve a more coordinated national response to the HIV epidemic to reduce new HIV infections, increase access to care and improve health outcomes, and reduce HIV-related disparities and health inequities. Suppression of viral load on a community basis and in clinical practice have emerged as critical indicators of program effectiveness.

As we continue to expand and strengthen our collection and use of data, we gain greater knowledge and insight about the extent of our biggest health problems, which populations are most af­fected by them, and what we need to do to solve them. Information is power — and this power makes it possible for us to implement programs that fulfill our promise to keep Americans healthy and our nation strong.