Director's perspective—Jeffrey P. Koplan, M.D., M.P.H., 1998-2002

Morbidity and Mortality Weekly Report, August 24, 2007 by Jeffrey P. Koplan

Meeting New Public Health Challenges

By 1998, CDC had long since extended its public health mandate to noninfectious conditions. The formation of the National Center for Chronic Disease Prevention and Health Promotion a decade before was a formal acknowledgement of the growing importance of noncommunicable conditions, behaviors, and changing environments as major contributors to death and disability. New programs targeted multiple levels (individual, institutional, community, state, national, and international) to address chronic diseases and their risk factors.

Obesity. CDC was a vanguard in recognizing the nation's growing obesity epidemic, creating solutions based on scientific data and disseminating and popularizing these solutions for maximum impact. Although today the consequences of unhealthy dietary choices, sedentary lifestyles, and "supersized" food portions are familiar, in the late 1990s their potential for harm was underestimated. CDC research published in 1999 documented for the first time the nation's rapidly increasing obesity rates and impending epidemic in all U.S. states, regions, and demographic groups (10).

One novel prevention approach was a campaign to tackle the societal and health problems of inactivity and obesity among U.S. children. In 2001, Congress appropriated $125 million for CDC to develop a national media campaign to change children's health behaviors. CDC's response to this broad mandate was to address the sedentary lifestyle of "tweens" (i.e., children aged 9-13 years) through VERB, an innovative and expansive campaign based on behavioral science theory and contemporary principles of marketing, which produced measurable positive results (11).

Tobacco. Despite considerable achievements in reducing smoking prevalence, tobacco use was still responsible for one of every five U.S. deaths at the end of the 20th century. In 1999, CDC's Office on Smoking and Health created the National Tobacco Control Program to encourage coordinated efforts to reduce tobacco-related diseases and deaths. The National Youth Tobacco Survey measured the tobacco-related beliefs, attitudes, and behavior of youth and was the first to gather data from both high-school and middle-school students. Findings were used to design strategies for youth-focused anti-tobacco campaigns.

Violence. After nearly a decade of work, CDC's injury- and violence-prevention programs also were expanding their reach and impact. With the national homicide rate for youth aged <19 years averaging nine deaths per day, CDC issued Best-Practices of Youth Violence Prevention: A Sourcebook for Community Action (12), the first publication of its kind to draw on real-world experiences to prevent violence among children and adolescents. CDC also supported a series of unique academic centers of excellence in youth violence prevention at U.S. colleges and universities.

Disparities. As these programs started to reap benefits, rates of decline in adverse health outcomes among certain racial and ethnic groups lagged behind overall declines. Work done by David Satcher as previous CDC director and then as Surgeon General contributed to a new initiative, Racial and Ethnic Approaches to Community Health (REACH). Through the REACH cooperative agreement, CDC began funding frontline coalitions to design, implement, and evaluate community-driven strategies to reduce disparities in cardiovascular disease, diabetes, infant mortality, breast and cervical cancer, immunizations, and HIV/AIDS.