doctor and patientEach 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 Centers for Disease Control and Prevention (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 recent 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.

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.