STRATEGIC PLAN - ASPE - U.S. Department of Health and Human ...

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICESSTRATEGIC PLANFISCAL YEARS 2007-2012U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICESSTRATEGIC PLANFISCAL YEARS 2007-2012

“I appreciate the hard work and dedication that more than 67,000 employees throughoutthe HHS family of agencies have shown in advancing the Department’s initiativesthis year, and I look forward to working together to continue meeting expectations forthe present and the challenges of the future.”Michael O. LeavittSecretary of Health and Human Services

Secretary’sMessagemission: to help Americans live longer, healthier, and betterlives, and to do it in a way that protects our economic competitivenessas a Nation.To meet this charge, the HHS Strategic Plan, Fiscal Years 2007–2012 (Strategic Plan),will address health care; public health promotion and protection, disease prevention,--partment of Health and Human Services (HHS) and encompass its central functions.Health Care – At some point in our lives, every one of us is or will become a healthcare consumer. HHS’s strategic objectives focus on increasing the value of health careby measuring quality and cost in a standardized and comparable way, broadeningaccess to health insurance coverage and access to health care, and investing in thehealth care at lower cost for more Americans.Public Health Promotion and Protection, Disease Prevention, and Emergency Preparedness– Events such as Hurricane Katrina and the attacks of September 11, 2001, are reormanmade public health disaster. At the same time, chronic and infectious diseasesand protect public health range from a focus on healthy lifestyles, immunizations,food safety, and health literacy to developing planning tools and building stockpiles ofHuman Services –communities is fundamental to human dignity and a healthy life. HHS is dedicatedto encouraging the development of healthy and supportive families and communitiesand to promoting economic independence and social well-being across the lifespan.HHS is particularly committed to ensuring the safety, stability, and healthy developmentof the Nation’s children and youth.– In order to continue leading the world in cutting--tunity to attain more personalized health care through the marvels of modern science.HHS will continue to provide educational grants, training, and fellowship programs andto fund research and clinical trials that are ethical and have the potential to improvepublic health and well-being.Strategic Plan lays out the action steps that HHS will take to meet the President’svision for a stronger, healthier United States. I appreciate the hard work and dedicationthat more than 67,000 employees throughout the HHS family of agencies have shown inadvancing the Department’s initiatives this year, and I look forward to working togetherto continue meeting expectations for the present and the challenges of the future.Michael O. LeavittSecretaryHealth and Human Services

“The economic and social well-being of individuals,families and communities is fundamental tohuman dignity and a healthy life.”Michael O. LeavittSecretary, Health and Human Services4 HHS Strategic Plan FY 2007-2012

Table ofContentsxiExecutive Summary12 Chapter 1Introduction and OverviewMission.............................................................................................................................. 13Core Principles.................................................................................................................. 13Organization.................................................................................................................... 14Developing and Updating the Strategic Plan........................................................ 14Consultation.................................................................................................................... 15Structure........................................................................................................................... 1620 In the Spotlight:HHS Plans and PrioritiesSecretary’s 500-Day Plan.................................................................................... 20Secretary’s Health Care Priorities.................................................................... 20Departmental Objectives .................................................................................. 21Healthy People 2010............................................................................................ 2122 Chapter 2Strategic Goal 1: Health Care26 Strategic Objective 1.1Broaden health insurance and long-term care coverage.Health Insurance............................................................................................................ 27Medicare........................................................................................................................ 27Medicaid........................................................................................................................ 28Children’s Health Insurance.................................................................................... 28Affordable Choices..................................................................................................... 29Outreach To Raise Awareness................................................................................ 29Demonstrations and Waivers................................................................................. 29Indian Health Programs........................................................................................... 30Long-Term Care.............................................................................................................. 3134 Strategic Objective 1.2Increase health care service availability and accessibility.American Indians and Alaska Natives.................................................................... 35People With Disabilities.............................................................................................. 35Rural Health..................................................................................................................... 36Health Centers................................................................................................................ 36Mental Health ................................................................................................................. 36New Orleans Health System....................................................................................... 36Ryan White HIV/AIDS Program ............................................................................... 37Substance Abuse Services .......................................................................................... 37Nondiscrimination and Privacy Protection ......................................................... 3839 Strategic Objective 1.3Improve health care quality, safety, cost, and value.Health Care Transparency.......................................................................................... 40Personalized Health Care............................................................................................ 40Electronic Health Records.......................................................................................... 41Value-Based Purchasing.............................................................................................. 42Quality Improvement Efforts..................................................................................... 42Medical Product Safety................................................................................................ 43Health Disparities.......................................................................................................... 4445 Strategic Objective 1.4Recruit, develop, and retain a competent health care workforce.Recruitment /Retention Efforts................................................................................ 45HHS Strategic Plan FY 2007-20125

Workforce Support Efforts.......................................................................................... 4748 Performance Indicators50 Meeting External Challenges52 In the Spotlight:Reducing Health DisparitiesDisparities Persist.......................................................................................................... 52Changes in Disparities ................................................................................................ 53Opportunities for Improvement .............................................................................. 5354 In the Spotlight:Advancing the Development and Use of Health Information TechnologyOffice of the National Coordinator........................................................................... 54Public/Private Partnerships....................................................................................... 55Standards Harmonization.......................................................................................... 55Certification Process.................................................................................................... 55Health Information Exchange................................................................................... 55Policy Council ................................................................................................................ 56Federal Health Architecture ...................................................................................... 56Public Health Information Network........................................................................ 56Privacy and Security Solutions.................................................................................. 56The Challenge.................................................................................................................. 5758 Chapter 3Strategic Goal 2: Public Health Promotion and Protection, DiseasePrevention,and Emergency Preparedness62 Strategic Objective 2.1Prevent the spread of infectious diseases.Immunization................................................................................................................. 62HIV/AIDS.......................................................................................................................... 63Zoonotic/Vectorborne Diseases............................................................................... 64Foodborne/Waterborne Illnesses............................................................................. 64Global Health.................................................................................................................. 6466 Strategic Objective 2.2Protect the public against injuries and environmental threats.Workplace Injuries........................................................................................................ 66Fire-Related Injury Prevention.................................................................................. 67Environmental Hazards............................................................................................... 67Childhood Lead Poisoning Prevention................................................................... 67Violence Against Women............................................................................................ 67Youth Violence Prevention......................................................................................... 6768 Strategic Objective 2.3Promote and encourage preventive health care, including mental health,lifelong healthy behaviors, and recovery.Preventive Services........................................................................................................ 68Heart Disease and Stroke ........................................................................................... 69Cancer................................................................................................................................ 70Overweight and Obesity.............................................................................................. 71Diabetes............................................................................................................................ 72Oral Health....................................................................................................................... 72Substance Use/Abuse................................................................................................... 73Suicide Prevention......................................................................................................... 74Risk Reduction................................................................................................................ 746 HHS Strategic Plan FY 2007-2012

75 Strategic Objective 2.4Prepare for and respond to natural and manmade disasters.Workforce Readiness..................................................................................................... 76Emergency Preparedness............................................................................................. 77Countermeasures............................................................................................................ 77Pandemic Influenza....................................................................................................... 78People With Disabilities ...............................................................................................................78Equal Access..................................................................................................................... 79Information Technology Support.............................................................................. 7980 Performance Indicators82 Meeting External Challenges84 In the Spotlight:Emergency Preparedness, Prevention, and ResponsePublic Health/Medical Emergencies........................................................................ 84Preparedness at All Levels........................................................................................... 84Framework for Preparedness...................................................................................... 8488 In the Spotlight:Global Health InitiativesHHS’s Mandate................................................................................................................ 88Meeting its Mandate...................................................................................................... 88Achievements................................................................................................................... 88Interagency Efforts......................................................................................................... 8990 Chapter 4Strategic Goal 3: Human Services93 Strategic Objective 3.1Promote the economic independence and social well-being ofindividuals and families across the lifespan.Work and Economic Self-Sufficiency....................................................................... 93Well-Being Across the Lifespan.................................................................................. 9597 Strategic Objective 3.2Protect the safety and foster the well-being of children and youth.Child Maltreatment........................................................................................................ 97Safety and Permanency................................................................................................. 98Early Care and Education............................................................................................. 99Mentoring.......................................................................................................................... 99Abstinence Education................................................................................................. 100Collaborative Efforts for Youth................................................................................. 101102 Strategic Objective 3.3Encourage the development of strong, healthy, and supportive communities.Faith-Based and Community Initiatives................................................................ 102Capacity-Building Efforts........................................................................................... 103Comprehensive Community Initiatives................................................................. 103104 Strategic Objective 3.4Address the needs, strengths, and abilities of vulnerable populations.People With Disabilities............................................................................................. 104American Indians and Alaska Natives................................................................... 105People Affected by Disasters..................................................................................... 105Refugees and Other Entrants.................................................................................... 106Victims of Human Trafficking................................................................................... 106People Experiencing Homelessness........................................................................ 107HHS Strategic Plan FY 2007-20127

108 Performance Indicators109 Meeting External Challenges110 In the Spotlight:Demographic Changes and Their Impact on Health and Well-BeingAging Population.......................................................................................................... 110Racial/Ethnic Diversity............................................................................................... 111114 Chapter 5Strategic Goal 4: Scientific Research and Development116 Strategic Objective 4.1Strengthen the pool of qualified health and behavioral science researchers.117 Strategic Objective 4.2Increase basic scientific knowledge to improve human health and humandevelopment.Brain Research............................................................................................................... 117Alzheimer’s Disease..................................................................................................... 117Human Development.................................................................................................. 118Cancer Research ........................................................................................................... 119Asthma ............................................................................................................................ 119Pandemic Influenza..................................................................................................... 119Antimicrobial Resistance........................................................................................... 119120 Strategic Objective 4.3Conduct and oversee applied research to improve health and well-being.Birth Defects/Developmental Disabilities............................................................120Substance Abuse Treatment.....................................................................................120Lung Cancer....................................................................................................................121Obesity..............................................................................................................................121Cardiovascular Disease...............................................................................................122Public Health Protection............................................................................................122Food, Drug, and Device Safety..................................................................................123124 Strategic Objective 4.4Communicate and transfer research results into clinical, public health, andhuman service practice.Community Preventive Services..............................................................................124Clinical Preventive Services.......................................................................................125Dissemination of Findings.........................................................................................125Dissemination of Information..................................................................................125Evidence-Based Practices..........................................................................................126National Registry...........................................................................................................127128 Performance Indicators130 Meeting External ChallengesPace and Success of Research....................................................................................130Business Interests..........................................................................................................131Intellectual Property.....................................................................................................131Recruiting and Retaining Expertise.........................................................................131132 Chapter 6Responsible Stewardship and Effective ManagementEffective Human Capital Management ........................................................ 134Effective Information Technology Management ........................................ 136Effective Resource Management ................................................................... 136Effective Planning, Oversight, and Strategic Communications .............. 1378 HHS Strategic Plan FY 2007-2012

138 Appendix A:HHS Program Evaluation EffortsEvaluation Oversight....................................................................................................139Quality Assurance and Improvement.....................................................................139Program Assessment Rating Tool.............................................................................140Role of Program Evaluations in Strategic Planning............................................140Strategic Goal 1: Health Care................................................................................140Strategic Goal 2: Public Health Promotion and Protection,Disease Prevention, and Emergency Preparedness........................................140Strategic Goal 3: Human Services........................................................................141Strategic Goal 4: Scientific Research and Development..............................141Table A-1Selected Current Program Evaluation Efforts......................................................142Table A-2Selected Future Program Evaluation Efforts........................................................152156 Appendix B:Performance IndicatorsPerformance Indicators—Supplemental Information.........................................157164 Appendix C:Performance Plan LinkageHHS Strategic Plan, Annual Plan, and Annual Performance Budgets......... 165A Culture of Excellence:Comprehensive Performance Management System for Employees...............165Senior Executive Service and OrganizationalPerformance Management System..........................................................................166Performance Management Appraisal Program...................................................166168 Appendix D:Information Technology169 InitiativesSecure One HHS.............................................................................................................169Infrastructure..................................................................................................................169Health Information Technology................................................................................170HHS Data Council..........................................................................................................170Confidentiality and Data Access Committee........................................................170Web Services....................................................................................................................170171 Innovations and Future TrendsE-Government................................................................................................................171Integrated Planning......................................................................................................171Knowledge Management.............................................................................................172174 Appendix E:HHS Organizational Chart176 Appendix F:HHS Operating and Staff Divisions and Their FunctionsOperating Divisions......................................................................................................177Staff Divisions.................................................................................................................178182 Appendix G: Acronyms186 Appendix H: EndnotesHHS Strategic Plan FY 2007-20129

The Strategic Plan encompasses the major areasof focus for HHS at the goal level and lays out theprimary strategies for achieving these goals.

Chapter 1Introduction and Overview

CHAPTER 1: INTRODUCTION AND OVERVIEWMissionThe HHS mission is to enhance the health and wellbeingof Americans by providing for effective healthand human services and by fostering sound, sustainedadvances in the sciences underlying medicine, publichealth, and social services.Core Principles iThe Secretary has developed core public policyprinciples, which serve as the basis for the Department’sefforts toward achieving its mission. These principlesof governance form the philosophical backbone forhow HHS approaches and solves problems. The nineprinciples, listed to the right, are not all inclusive, butthey do provide the philosophical underpinnings for thisStrategic Plan, and they will be incorporated into otherplanning documents used by HHS.CORE PRINCIPLES• National standards, neighborhood solutions.• Collaboration, not polarization.• Solutions transcend political boundaries.• Markets before mandates.• Protect privacy.• Science for facts, process for priorities.• Reward results, not programs.• Change a heart, change a nation.• Value life.HHS Strategic Plan FY 2007-201213

CHAPTER 1: INTRODUCTION AND OVERVIEWOrganizationEleven operating divisions, including eight agenciesin the United States Public Health Service (USPHS)and three human service agencies, administer HHS’sprograms. Eighteen staff divisions provide leadership,direction, and policy and management guidance to theDepartment. (A complete list of HHS’s operating andstaff divisions and a brief description of their activitiesappear in Appendix F.) HHS works closely with State,local, and tribal governments, and many HHS-fundedservices are provided at the local level by State, county,local, or tribal agencies, or through grantees in theprivate sector, including faith-based and communitybasedorganizations.HHS accomplishes its mission through more than 300programs and initiatives that cover a wide spectrum ofactivities, including the following:• Providing Medicare (health insurance forAmericans who are 65 or older, who are disabled,or who suffer from end stage renal disease) andMedicaid (health insurance for low-incomepeople);• Assuring the safety of food and medical products;• Delivering comprehensive health care for NativeAmericans;• Promoting access to insurance for the uninsuredand necessary health services for medicallyunderserved individuals;• Creating an environment that supports the use ofhealth information technologies;• Preventing disease through immunization;• Promoting healthy lifestyles;• Promoting healthy dietary practices, goodnutrition, and regular physical activity;• Improving the oversight of imported food andmedical products;• Supporting the prevention and treatment ofsubstance abuse;• Improving maternal and infant health;• Planning and preparing for public health emergencies,including those that result from terrorism;• Providing Head Start (preschool education andservices);• Preventing child abuse and domestic violence;• Supporting faith-based and community initiatives;• Improving systems of services in communitiesto enhance the health and well-being of childrenand youth with special health care needs and theirfamilies;• Providing financial assistance and services forlow-income families;• Offering services for older Americans, includinghome-delivered meals;• Furthering access to health and human servicesby protecting health information privacy andpreventing discrimination in the delivery of theseservices; and• Conducting, supporting, and overseeing scientificand biomedical research and development relatedto health and human services.With an FY 2007 budget of $698 billion, HHS representsalmost a quarter of all Federal expenditures andadministers more grant dollars than all other Federalagencies combined. More than 67,000 people work forHHS. ii Every 3 years, HHS updates its strategic plan,which describes its operating and staff divisions thatwork individually and collectively to address complex,multifaceted, and ever-evolving health and humanservice issues.Developing and Updating the Strategic PlanAn agency strategic plan is one of three main elementsrequired by the Government Performance and ResultsAct (GPRA) of 1993 (Public Law 103-62). The basicrequirements for strategic plans appear in the Officeof Management and Budget (OMB) Circular No. A-11,Part 6, Section 210. According to OMB, “an agency’sstrategic plan keys on those programs and activitiesthat carry out the agency’s mission. Strategic planswill provide the overarching framework for an agency’sperformance budget. iiiIn constructing the Strategic Plan, HHS sought torespond to the requirements of both GPRA andOMB. At the same time, HHS incorporated prioritiesand concepts from the Secretary’s 500-Day Plan, theSecretary’s Ten Health Care Priority Activities, the14 HHS Strategic Plan FY 2007-2012

CHAPTER 1: INTRODUCTION AND OVERVIEWDepartmental Objectives, and the Healthy People 2010Objectives. Although some of these plans and prioritiesmay change from year to year, the most recent versionsappear later in this chapter, in a special section calledIn the Spotlight: HHS Plans and Priorities.Each of the Department’s operating and staff divisionscontributed to the development of this Strategic Plan,from the goals and the broad strategic objectives tothe baselines and targets for performance indicators.Representatives from HHS operating and staff divisionsprovided expert knowledge of HHS’s programs,initiatives, priorities, and performance indicators. Thisprocess emphasized creating alignment between thelong-range Strategic Plan and annual GPRA reporting inthe HHS Annual Performance Plan, Annual PerformanceBudgets, and Performance and Accountability Report.More information about this alignment appears inAppendix C, Performance Plan Linkage.In developing and selecting performance indicators,HHS sought to include broad health and humanservice impact measures as well as more intermediateprocesses and outcomes that have contributed todistal impacts. In several cases, numerous operatingand staff divisions play a role in achieving theseimpacts. Operational and staff division personnelregularly monitor thousands of additional performanceindicators to improve program processes and examineeffectiveness. However, in this Strategic Plan, HHSfocused on a limited set of broad outcomes andimpacts to demonstrate Departmental progress.ConsultationHHS regularly consults with external stakeholders,as noted in Chapters 2 through 5. In complying withOMB guidance and GPRA, HHS consulted widely withstakeholders to garner input on the Strategic Plan. HHSposted a draft on its Web site (http://www.hhs.gov),invited public comment through a notice in the FederalRegister, and briefed a number of State, local, and tribalorganizations. HHS also sought input from the U.S.Congress and OMB.HHS Strategic Plan FY 2007-201215

CHAPTER 1: INTRODUCTION AND OVERVIEWDuring its consultation process, HHS receivedcorrespondence from more than 40 individuals ororganizations, containing nearly 200 unique suggestions.Input ranged from editorial to more substantivecomments. HHS has incorporated many of thesechanges and additions to the final plan.StructureChapters 2 through 5 present the four strategic goalareas:• Health Care. Promote access to insurance forthe uninsured and necessary health services forindividuals who are medically underserved;• Public Health Promotion and Protection, DiseasePrevention, and Emergency Preparedness. Preventand control disease, injury, illness, and disabilityacross the lifespan, and protect the public frominfectious, occupational, environmental, andterrorist threats;• Human Services. Promote the economic andsocial well-being of individuals, families, andcommunities; and• Scientific Research and Development. Advancescientific and biomedical research and developmentrelated to health and human services.Chapter 2 focuses on the Health Care strategic goal.It highlights the efforts of HHS to improve the safety,quality, affordability, and accessibility of health care,including behavioral health care and long-term care.HHS’s Administration on Aging (AoA), Agency forHealthcare Research and Quality (AHRQ), Centersfor Medicare & Medicaid Services (CMS), HealthResources and Services Administration (HRSA), andthe Indian Health Service (IHS) have a significantrole to play in realizing this goal. In addition, HHS’sFood and Drug Administration (FDA), Office of theAssistant Secretary for Planning and Evaluation(ASPE), Office for Civil Rights (OCR), Office onDisability (OD), Office of Public Health and Science(OPHS), and Substance Abuse and Mental HealthServices Administration (SAMHSA) play roles inaddressing this goal.There are four broad strategic objectives under Health Care:• Broaden health insurance and long-term carecoverage;• Increase health care service availability andaccessibility;• Improve health care quality, safety, cost, and value;and• Recruit, develop, and retain a competent healthcare workforce.This chapter also highlights two sections of particularsignificance to HHS in the area of health care, both nowand over the next 5 years:• In the Spotlight: Reducing Health Disparities givesa brief overview of disparities that still exist inAmerica and outlines the HHS response to combatthese disparities.• In the Spotlight: Advancing the Development andUse of Health Information Technology provides abrief but indepth explanation of the efforts HHSwill be undertaking to promote the use of thisimportant tool.Chapter 3 explains the strategic goal of Public HealthPromotion and Protection, Disease Prevention, andEmergency Preparedness. This chapter outlines thesteps that HHS will take to prevent and control disease,injury, illness, and disability across the lifespan andto protect the public from the health consequencesof infectious, occupational, environmental, andterrorist threats. Key operating and staff divisions thatcontribute to this goal include the Centers for DiseaseControl and Prevention (CDC), FDA, HRSA, Officeof the National Coordinator for Health InformationTechnology (ONC), Office of the Assistant Secretaryfor Preparedness and Response (ASPR), and SAMHSA.In addition, AoA, CMS, OCR, OD, the Office of GlobalHealth Affairs (OGHA), and OPHS play roles inaddressing this goal.There are four broad strategic objectives under PublicHealth Promotion and Protection, Disease Prevention,and Emergency Preparedness:Prevent the spread of infectious diseases;•Protect the public against injuries and•environmental threats;16 HHS Strategic Plan FY 2007-2012

CHAPTER 1: INTRODUCTION AND OVERVIEW• Promote and encourage preventive health care,including mental health, lifelong healthy behaviors,and recovery; and• Prepare for and respond to natural and manmadedisasters.This chapter also features two significant public healthefforts HHS is undertaking and will continue to developover the next 5 years:• In the Spotlight: Emergency Preparedness, Prevention,and Response explains how HHS will prepare for andrespond to public health and medical emergencies.• In the Spotlight: Global Health Initiatives explainsthe strategies to promote health and public healthbeyond our own borders.Chapter 4 details the Human Services strategic goal.This goal seeks to protect and value life, family, andhuman dignity by promoting the economic and socialwell-being of individuals, families, and communities;supporting the safety and well-being of children, youth,older people, and other vulnerable populations; andstrengthening communities. The Administration forChildren and Families (ACF), AoA, the Center for Faith-Based and Community Initiatives (CFBCI), and OD areamong the divisions primarily responsible for achievingthis strategic goal. In addition, CDC, HRSA, OCR,OPHS, and SAMHSA play important roles.There are four broad objectives under Human Services:• Promote the economic independence and socialwell-being of individuals and families across thelifespan;• Protect the safety of children and youth, and fostertheir well-being;• Encourage the development of strong, healthy,and supportive communities; and• Address the needs, strengths, and abilities ofvulnerable populations.This chapter also discusses how a changing Americawill impact HHS’s efforts and strategies in the comingyears. In the Spotlight: Demographic Changes and TheirImpact on Health and Well-Being explains how HHS isworking to meet the health, public health, and humanservice needs of a population that will grow older andincreasingly diverse in the next 5 years.HHS Strategic Plan FY 2007-201217

CHAPTER 1: INTRODUCTION AND OVERVIEWHHS’s commitment to Scientific Research andDevelopment appears in Chapter 5. The chapteroutlines efforts to advance scientific and biomedicalresearch and development related to health and humanservices. This strategic goal will be achieved throughthe contributions of AHRQ, CDC, FDA, OPHS and, mostsignificantly, the National Institutes of Health (NIH).There are four broad objectives under ScientificResearch and Development:• Strengthen the pool of qualified health andbehavioral science researchers;• Increase basic scientific knowledge to improvehuman health and development;• Conduct and oversee applied research to improvehealth and well-being; and• Communicate and transfer research resultsinto clinical, public health, and human servicepractice.Chapters 2 through 5 describe how HHS will accomplishthe goals and measure their achievement:• Strategic objectives for each broad goal organizethe activities into four distinct areas of focus.In most cases, several HHS operating and staffdivisions contribute to the realization of astrategic objective;• Narrative sections, organized by strategicobjective, illustrate some of the major strategiesand activities undertaken by HHS operatingand staff divisions. These sections presentkey intradepartmental and interdepartmentalcoordination efforts;• Specific performance indicators for each objectiveare listed, with baselines and 2012 targets.Appendix B provides a list of the data sources forthese performance indicators; and• External influences that affect successfulachievement of the goals, and HHS’s strategies inresponse to these influences, are described.Chapter 6, Responsible Stewardship and EffectiveManagement, illustrates the commitment of HHSto formulate, implement, and execute efficientadministrative support for its programs. Theseactivities do not appear as goals in the Strategic18 HHS Strategic Plan FY 2007-2012

CHAPTER 1: INTRODUCTION AND OVERVIEWPlan because they are not intended to be separatefrom the overall management process that supportsthe Department. The chapter details strategies foreffective management of human capital, informationtechnology, and resources, as well as effective planning,oversight, and strategic communications.Finally, appendixes provide additional specific informationabout supporting materials related to the Strategic Plan.HHS conducts high-quality program evaluations tolearn more about the effectiveness of its interventionsand uses the findings to improve program performance.These comprehensive, independent studies are animportant component of the HHS strategy to improveoverall effectiveness by assessing whether programs areeffective, well designed, and well managed. Appendix A,HHS Program Evaluation Efforts, describes how HHS hasused program evaluations to develop the Strategic Plan.This appendix offers examples of existing and plannedprogram evaluations that will inform decisions andactivities over the next 5 years.Appendix B, Performance Indicators—SupplementalInformation, lists the data sources for each of theperformance indicators listed in the Strategic Plan, aswell as fiscal year information for baselines and targets.This information is presented by strategic goal.Appendix C, Performance Plan Linkage, describes howthe Strategic Plan will drive the Annual PerformancePlan and Annual Performance Budgets, as well as howit will complement Secretarial priorities.Because of the rapid changes in computer technologyin recent years, HHS has included an additionalsection focused on this issue. Appendix D, InformationTechnology, details HHS’s enterprise and informationarchitecture strategies and presents insights oninnovations and future trends. Unlike In the Spotlight:Advancing the Development and Use of Health InformationTechnology, which focuses on the use of this resource tosupport the public, this appendix focuses on how HHSuses this resource internally.Finally, several appendixes offer useful reference materialfor readers: The HHS organizational chart is in AppendixE; Appendix F consists of an overview of HHS operatingand staff divisions and their primary functions; AppendixG lists acronyms used throughout the Strategic Plan; andendnotes are listed in Appendix H.HHS Strategic Plan FY 2007-201219

CHAPTER 1: INTRODUCTION AND OVERVIEWSecretary’s 500-Day PlanHHS Plans and PrioritiesThis Strategic Plan for FY 2007–2012incorporates priorities and conceptsfrom the Secretary’s 500-DayPlan, the Secretary’s Ten HealthCare Priority Activities, the DepartmentalObjectives, and the HealthyPeople 2010 Objectives. Althoughsome of these plans and prioritiesmay change from year to year, asampling of the most recent versionsis included here.Secretary Leavitt uses a 500-Day Plan, updated every200 days, as a management tool to guide his energiesin fulfilling the vision of a healthier and more hopefulAmerica. The Secretary focuses on specific strategiesthat will achieve significant progress for the Americanpeople over a 5,000-day horizon. The 500-Day Plansupports the Strategic Plan in guiding the Departmentin achieving its broad policy and program objectives.The priorities include:• Transform the Health Care System;• Modernize Medicare and Medicaid;• Advance Medical Research;• Secure the Homeland;• Protect Life, Family, and Human Dignity; and• Improve the Human Condition Around the World.Secretary’s Health Care PrioritiesIn 2006, the Secretary developed 10 HHS PriorityActivities for America’s Health Care; these too areupdated annually:• Health Care Value Incentives;• Health Information Technology;• Medicare Rx;• Medicaid Modernization;• New Orleans Health System;• Personalized Health Care;• Obesity Prevention;• Pandemic Preparedness;• Emergency Response and Commissioned CorpsRenewal; and• International Health Diplomacy.20 HHS Strategic Plan FY 2007-2012

CHAPTER 1: INTRODUCTION AND OVERVIEWDepartmental ObjectivesLast updated in 2006, 20 Departmentwide objectivesexpress the breadth and scope of the Department’sactivities. Updated annually, they expand on theSecretary’s goals from the 500-Day Plan and includeobjectives related to effective management andresponsible stewardship:1. Accelerate Personalized Health Care;2. Recruit, Develop, Retain, and Strategically Managea World-Class HHS Workforce;3. Modernize Medicaid;4. Continue Our Leadership Role and Success inCompetitive Sourcing;5. Turn Adversity to Advantage for the New OrleansHealth System;6. Improve Financial Performance;7. Promote Health Information Technology;8. Expand Electronic Government;9. Continue to Improve Medicare;10. Improve Budget and Performance Integration;11. Harness the Power of Transparent Health Care;12. Implement the Real Property Asset ManagementProgram and Strategically Manage Our RealProperty;13. Emphasize Prevention and Healthy Living;14. Broaden Health Insurance and Long-Term CareCoverage;15. Prepare for an Influenza Pandemic;16. Promote Quality, Relevance, and Performance ofResearch and Development Activities;17. Enhance Emergency Response and Renew theCommissioned Corps;18. Improve the Service of Management Functionsand Administrative Operations for the Support ofthe Department’s Mission;19. Emphasize Faith-Based and CommunitySolutions; and20. Eliminate Improper Payments.Healthy People 2010Healthy People 2010 is a comprehensive set of diseaseprevention and health promotion objectives for theNation to achieve over the first decade of the newcentury. Overarching goals are to increase quality andyears of healthy life and eliminate health disparities.There are 28 focus areas:• Access to Quality Health Services;• Arthritis, Osteoporosis, and Chronic BackConditions;• Cancer;• Chronic Kidney Disease;• Diabetes;• Disability and Secondary Conditions;• Educational and Community-Based Programs;• Environmental Health;• Family Planning;• Food Safety;• Health Communication;• Heart Disease and Stroke;• HIV;• Immunization and Infectious Diseases;• Injury and Violence Prevention;• Maternal, Infant, and Child Health;• Medical Product Safety;• Mental Health and Mental Disorders;• Nutrition and Overweight;• Occupational Safety and Health;• Oral Health;• Physical Activity and Fitness;• Public Health Infrastructure;• Respiratory Diseases;• Sexually Transmitted Diseases;• Substance Abuse;• Tobacco Use; and• Vision and Hearing.HHS Strategic Plan FY 2007-201221

Chapter 2Strategic Goal 1:Health CareImprove the safety,quality, affordability,and accessibility ofhealth care, includingbehavioral health careand long-term care.

CHAPTER 2: Health careThe system needs to make progress in providing the excellent quality ofcare that all Americans deserve.Today, disease, illness, and disability can be as much athreat to Americans’ financial well-being as they are toAmericans’ physical and mental well-being. EveryAmerican deserves reliable, high-quality, and reasonablypriced health care that will be there when it is needed.Health care has to be available, affordable, portable,transparent, and efficient.Health care in the United States is second to none,but it can be better. Although our Nation’s health carefacilities and medical professionals are the best inthe world, improving quality, constraining costs, andproviding greater access remain key priorities.Americans spend an increasing share of their incomeon health care. Health care spending in America hasincreased from 5 percent of Gross Domestic Product(GDP) in 1960 to more than 16 percent in 2006, and ispredicted to continue to rise. iv The increasing burden ofhealth spending on the U.S. economy is unsustainable.Higher spending on public programs such as Medicareand Medicaid strains Federal and State budgets. Higherinsurance premiums burden workers with higher healthcosts and pose a challenge for employers to cover bothwage increases and health insurance premiums.STRATEGIC GOAL 1: HEALTH CAREStrategic Objective 1.1:Broaden health insurance and long-termcare coverage.Strategic Objective 1.2:Increase health care service availability andaccessibility.Strategic Objective 1.3:Improve health care quality, safety, cost andvalue.Strategic Objective 1.4:Recruit, develop and retain a competenthealth care workforce.HHS Strategic Plan FY 2007-201223

CHAPTER 2: Health careThe system needs to make progress in providing theexcellent quality of care that all Americans deserve.We need to increase the rate at which patients receiverecommended services and to reduce the numberof unnecessary services. We also must eliminatepreventable medical errors.Forty-six million Americans do not have healthinsurance. v These individuals may face barriers toobtaining timely and continuous care. Because of theirlimited access to the system, their health problems maybecome more severe and further increase health carecosts in the future.One critical part of HHS’s strategy to address theseproblems is to improve transparency within the healthcare system. Because third parties such as insurancecompanies, employers, and governments finance the vastmajority of health care spending, most Americans do notknow—and do not have access to information about—thecost and quality of health care services in order to decidewhether they want to receive those services.Making health care affordable, accessible, and highquality depends on providing consumers with theknowledge they need to make informed choices abouttheir health care coverage. The Federal Governmentmust lead in accomplishing these objectives. We areencouraged that others in the private sector have joinedin such efforts; we will continue to pursue these goals,which characterize a value-driven health care system.The increasing costs of health care services, ourincreasingly older population with multiple chronicconditions, and an increasingly complex health caresystem challenge us to continue our efforts to developnew strategies to maintain safe and affordable servicesdesigned to meet Americans’ needs in their variousincome, family, and health circumstances. HHS isworking to improve the efficiency and quality of healthcare that it finances and delivers. Promoting greateruse of health information technology will ensurethat accurate and timely information on a patient’scondition is available to all providers involved in thepatient’s care and will reduce unnecessarily redundantdiagnostic tests and office visits that add to healthcare costs. Implementation of value-based purchasingsystems that include incentives to providers fortreatment outcomes, rather than just reimbursementsfor treatments, will again help move the system towardmore efficient and cost-effective provision of careaimed at improving the health and quality of life of thecitizens touched by HHS programs.At the same time, we must ensure that our effortsto reduce the cost of high-quality health care arereflected in more affordable and accessible healthinsurance coverage, to address the problem of theNation’s growing number of citizens without healthinsurance. HHS continues to explore options forincreasing the portability and accessibility of healthinsurance through innovative vehicles such as HealthSavings Accounts coupled with high-deductible healthplans, which have grown in popularity in recent years.Additionally, HHS is working to increase access toprivate health insurance for those who do not yethave it through initiatives such as Affordable Choices.Together, these initiatives will assist individuals inmaintaining their health and prevent health spendingfrom overburdening the economy.Finally, the need to rebuild the health careinfrastructure in New Orleans in the wake of HurricaneKatrina offers the Department and its State and localpartners the challenge of coordinating coverage; systemcapacity; and workforce recruitment, retention, anddevelopment in new ways that result in a revitalizedhealth care system for that community.Strategic Goal 1, Health Care, targets the needfor people to be able to obtain and maintainaffordable health care coverage; receive efficient,high-quality health care services; and accessappropriate information for informed choices. HHS’sAdministration on Aging (AoA), Agency for HealthcareResearch and Quality (AHRQ), Centers for Medicare& Medicaid Services (CMS), Health Resourcesand Services Administration (HRSA), and IndianHealth Service (IHS) have significant roles to play inrealizing this goal. In addition, the Food and DrugAdministration (FDA), Office of the Assistant Secretaryfor Planning and Evaluation (ASPE), Office for CivilRights (OCR), Office on Disability (OD), Office of Public24 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health careHealth and Science (OPHS), and Substance Abuse andMental Health Services Administration (SAMHSA) playroles in addressing this goal.There are four broad objectives under Health Care:• Broaden health insurance and long-term carecoverage;• Increase health care service availability and accessibility;• Improve health care quality, safety, cost, and value;and• Recruit, develop, and retain a competent healthcare workforce.Below is a description of each strategic objective,followed by a description of the key programs, services,and initiatives the Department is undertaking toaccomplish those objectives. Key partners andcollaborative efforts are included under each relevantobjective. The performance indicators selected for thisstrategic goal also are presented with baselines andtargets. These measures are organized by objective.Finally, this chapter discusses the major externalfactors that will influence HHS’s ability to achieve theseobjectives, and how the Department is working tomitigate those factors.HHS Strategic Plan FY 2007-201225

CHAPTER 2: Health careStrategic Objective 1.1Broaden health insurance andlong-term care coverage.HHS is committed to broadening health insuranceand long-term care coverage. The multifacetedapproach to expanding consumer choices includesstrengthening and expanding the safety net throughprograms such as Medicare, Medicaid, and the StateChildren’s Health Insurance Program (SCHIP); creatingnew, affordable health insurance options; and creatingnew options for long-term care, including State Long-Term Care Partnership Programs. The operating andstaff divisions contributing to the achievement of thisobjective include CMS, SAMHSA, AoA, HRSA, and OD.The growing availability of prescription drugs andtheir cost have had a significant impact on healthinsurance. The first selected performance indicator,at the end of this chapter, measures the percentage ofMedicare beneficiaries who have insurance coverage forprescription drugs through the Medicare drug benefit(Part D) or other coverage. This enrollment is expectedto increase. Also, health care coverage for millions ofpresent and future Medicare participants is protectedby ensuring that the level of improper payments in theMedicare Fee-For-Service program remains low.26 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health careHealth InsuranceMedicareMedicare is a health insurance program for peopleage 65 years or older, people younger than age 65 withserious disabilities, and most people of all ages withend stage renal disease (permanent kidney failurerequiring dialysis or a kidney transplant). Three majorcategories of Medicare include: Part A, which coversinpatient hospital care, skilled nursing facilities, certainhome health care, and hospice care; Part B, whichencompasses physicians’ services, outpatient hospitalcare, and many other medical services; and Part D,the newest component of Medicare, which offers avoluntary prescription drug benefit to beneficiaries.There is also a Part C for Medicare, known as MedicareAdvantage, that allows beneficiaries to choose a privatehealth insurance plan that covers the Part A and PartB services and, in most circumstances, additionalbenefits and/or lower cost-sharing payments thanunder the traditional Medicare FFS program.Medicare Part D. Part D is celebrated as the mostsignificant improvement to the program sinceMedicare was created in 1965. More than 39 millionMedicare beneficiaries now have prescription drugcoverage through Part D or another source, includingalmost 24 million beneficiaries in Part D plans. vi CMScontinues to improve program administration of theMedicare prescription drug benefit and to expandawareness of the program through relationships withStates and pharmacists, increased use of electronictechnology, and education and outreach efforts withmore than sixteen thousand partners. CMS willcontinue these efforts to ensure that beneficiaries canget the prescriptions they need. In particular, CMShas collaborated with AoA and its grassroots AgingServices Network, consisting of State agencies on aging,area agencies on aging, and local service providers, toprovide one-on-one assistance and outreach directly tobeneficiaries and their caregivers.HHS Strategic Plan FY 2007-201227

CHAPTER 2: Health careA number of other initiatives to broaden access arecurrently underway or in development, such as the “MyHealth. My Medicare.” campaign and Medicare MedicalSavings Accounts.The “My Health. My Medicare.” campaign helps peoplewith Medicare maximize their understanding of thebenefits Medicare offers. CMS promotes beneficiaryawareness through mailings, media activities, a strongInternet presence, a 24-hour-a-day toll-free telephoneservice, grassroots alliances, and enhanced beneficiarycounseling with State Health Insurance AssistancePrograms. CMS partners in this effort include theNational Medicare Education Program PartnershipAlliance, AoA and its Aging Services Network, State andlocal agencies, grassroots organizations, the AARP, 1Medicare Today, the National Caucus and Center onBlack Aged, national disability provider and constituentorganizations, and other stakeholders. CMS continuesto build committed partnerships at the community level;these partnerships will ensure the agency can successfullybuild on the “My Health. My Medicare.” campaign, as wellas other health-related initiatives, in future years. Thesepartnerships are having a profound impact on helpingCMS reach the Medicare population, especially theprogram’s most vulnerable beneficiaries. For example, incollaboration with AoA, in addition to working with thegeneral Medicare population, special efforts are beingmade to target minority populations to reduce healthdisparities in the Hispanic, Asian, and African-Americancommunities, as well as in rural communities.Medicare Medical Savings Accounts. CMS isimplementing an enhanced consumer-directedMedicare Advantage product called a MedicareMedical Savings Account (MSA) plan. This type ofplan combines a high-deductible health plan with amedical savings account that beneficiaries can use tomanage their health care costs. CMS will offer regularMSA plans and new demonstration MSA plans. Theseplans will provide Medicare beneficiaries with thefreedom to exercise increased control over their health1 According to its Web site, in November 1998 the AmericanAssociation for Retired Persons officially changed its name to AARP.care utilization while providing them with importantcoverage against catastrophic health care costs. CMS isproviding increased flexibility with the demonstrationMSA plans to make the MSAs more like the popularconsumer-directed Health Savings Accounts (HSAs)available in the private sector. Examples of thetypes of flexibility being made available under thedemonstration that are not available under the regularMSA rules include coverage of preventive servicesduring the deductible period, a deductible below anout-of-pocket maximum, cost sharing up to the out-ofpocketmaximum, and cost differentials between inandout-of-network services.MedicaidMedicaid is a joint Federal- and State-funded, Stateadministeredhealth insurance program available tocertain low-income individuals and families who fitinto an eligibility group that is recognized by Federaland State law. Using a variety of State plan optionsand waivers, each State establishes its own rules andguidelines regarding eligibility and service offerings,subject to approval by CMS.CMS also offers flexible State plan options andcommunity-living incentives. In support of theseoptions and incentives, CMS and AoA will continue totarget home- and community-based long-term careservices to frail older adults who are at high risk ofnursing home placement or at risk of spending downtheir assets. SAMHSA and CMS also will continue tocollaborate on issues regarding Medicaid coverage forsubstance abuse and mental health services.Children’s Health InsuranceThe State Children’s Health Insurance Program(SCHIP), a State-administered program, addresses thegrowing problem of children without health insurance.SCHIP was designed as a Federal-State partnership,similar to Medicaid, with the goal of expanding healthinsurance to children whose families earn too muchmoney to be eligible for Medicaid, but not enoughmoney to purchase private insurance. CMS will work28 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health carewith the U.S. Congress to reauthorize SCHIP to ensurethat these vital programs continue.Affordable ChoicesHHS has begun to work with other Federaldepartments and with States to increase access toprivate health insurance for those who do not yethave it through the Affordable Choices initiative andrelated efforts. This proposal would redirect inefficientinstitutional subsidies to individuals and would needto be State based and budget neutral, not create a newentitlement, and not affect savings contained in thePresident’s Budget that are necessary to address theunsustainable growth of Federal entitlement programs.Outreach To Raise AwarenessHealth Insurance Enrollment and Long-Term CareCoverage Outreach is a collaboration of CMS, AoA,ACF, HRSA, State and local health departments, StateMedicaid and SCHIP agencies, State and area agencieson aging, child care and early education providers,and State departments of agriculture and education.This collaborative effort conducts outreach to raiseawareness of public health insurance and long-termcare benefits and provides information and accessassistance.Demonstrations and WaiversStates have many options, including Federal waivers,for broadening coverage to underserved populations.Using Health Insurance Flexibility and Accountabilitywaivers, States can develop comprehensive insurancecoverage for individuals at twice the Federal PovertyLevel (FPL) and below, using SCHIP and Medicaidfunds. These waiver programs target vulnerable,uninsured populations, such as children on Medicaidand SCHIP, and pregnant women. Emphasis is placedon broad statewide approaches that maximize bothprivate health insurance coverage and employersponsoredinsurance.HHS Strategic Plan FY 2007-201229

CHAPTER 2: Health careIndian Health ProgramsIHS provides a comprehensive health services deliverysystem for American Indians and Alaska Nativeswith opportunity for maximum tribal involvementin developing and managing programs to meet theirhealth needs. The mission of IHS, in partnership withAmerican Indian and Alaska Native (AI/AN) people,is to raise their physical, mental, social, and spiritualhealth to the highest level. The goal of IHS is to ensurethat comprehensive, culturally acceptable personal andpublic health services are available and accessible to allAmerican Indians and Alaska Natives. IHS promoteshealthy AI/AN people, communities, and cultures andhonors the inherent sovereign rights of tribes as part ofthe Federal Government’s special relationship throughtreaty obligations with tribes.In 2005, IHS provided health services to approximately1.5 million American Indians and Alaska Natives whobelong to more than 557 federally recognized tribesin 35 States. vii Both primary care physicians andnurse practitioners provide primary care. viii Thosechildren or adults in fair or poor health with only IHScoverage probably did not see a physician in the pastyear. Adults in good or excellent health with onlyIHS coverage were probably less likely to have seena physician in the past 2 years, compared to similaradults with Medicaid or private insurance. ix IHSaccess alone does not constitute health insurancecoverage. Those not served by IHS may use private orState insurance out of preference or lack of proximityto IHS or tribal facilities. Limitation of contractedhealth service funds and insurance reduces the use ofspecialty care physician services for American Indiansand Alaska Natives.In response to these and other emerging challenges,IHS is focused on expanding access for AmericanIndians and Alaska Natives to comprehensive primaryhealth care services. In addition, IHS recognizes theimportance of retinopathy screening for those withdiabetes and colorectal screening for early cancerdetection and prevention. CMS has joined in efforts toexpand access for American Indians and Alaska Nativesto health care services covered by Medicare, Medicaid,30 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health careand SCHIP. The Indian Health Care Improvement Actof 1976 (Public Law 94-437), as amended, extendedthe Federal obligation to CMS by authorizing paymentfor Medicare and Medicaid services provided throughIHS facilities. This responsibility includes servicesprovided by tribal governments administering healthprograms under authorities through the IndianSelf-Determination and Education Assistance Act of1975 (Public Law 93-638), as amended. The IndianHealth Care Improvement Act further expanded thisresponsibility by authorizing 100 percent FederalMedical Assistance Percentage to States for paymentsto IHS and tribal facilities for Medicaid services. CMSworks with IHS and the tribes to ensure they follow thePayor of Last Resort rule. According to this rule, IHSpays after Medicare or Medicaid has paid for eligibleservices, whether IHS and tribes provide servicesdirectly or a private source provides them underreferred services.Long-Term CareLong-term care can be required by individuals withdisabilities needing assistance with activities ofdaily living, individuals with frailty and/or dementiaassociated with aging, individuals with advancedchronic conditions, and other individuals at or nearthe end of life. The central vision for an efficient longtermcare system is one that is person centered, i.e.,organized around the needs of the individual ratherthan around the settings where care is delivered. Theevolving long-term care system of the future willprovide coordinated, high-quality care; optimizechoice and independence; be served by an adequateworkforce; be transparent, encouraging personalresponsibility; be financially sustainable; and utilizehealth information technology to improve access andquality of care.In an effort to facilitate this system transformation,CMS, in partnership with the U.S. Congress, providesfunding to States, territories, and tribal entities toexpand choices to persons who need long-term careservices. Real Choice Systems Change grants, MedicaidInfrastructure grants, and Systems Transformationgrants are a few examples of HHS efforts to assist Statesin building the needed infrastructure for expandingchoices.HHS also works closely with States, territories,and tribal entities to achieve more flexibility in theMedicaid program. To that end, the Money Follows thePerson Rebalancing Demonstration project builds on thePresident’s New Freedom initiative. 2The Money Follows the Person RebalancingDemonstration project will help States furtheraddress the institutional bias in coverage inherentin the Medicaid program. Selected States will beawarded additional Federal funds to pay for homeandcommunity-based services for the first year thatindividuals transition from institutional care to acommunity-based setting of their choice.The Long-Term Care Insurance Partnership Program isa federally supported, State-operated initiative thatallows individuals who purchase a qualified long-termcare insurance policy to protect a portion of their assetsthat they would typically need to spend down prior toqualifying for Medicaid coverage. Once individualspurchase a long-term care insurance partnershippolicy and use some or all of their policy benefits, theamount of the policy benefits used will be disregardedfor purposes of calculating eligibility for Medicaid. Thisstipulation means that they are able to keep their assetsup to the amount of the policy benefits they purchasedand used. For example, in a State that choosesto participate in the partnership program, onceindividuals have used part or all of their maximumlifetime benefit under their long-term care insurancecoverage, their assets would be protected up to theamount used, up to that maximum lifetime benefit.Individuals would not need to spend those assetsbefore qualifying for that State’s Medicaid program.The Aging and Disability Resource Center grant program,a cooperative effort between CMS and AoA, assists Stateswith their efforts to streamline access to long-term care.Program funding supports the development of “one-stop2 The New Freedom initiative eliminates the barriers that preventpeople with disabilities from participating fully in community life. Itprovides a comprehensive, Governmentwide framework for achievingthat goal.HHS Strategic Plan FY 2007-201231

CHAPTER 2: Health careshop” programs to serve as a single, coordinated systemof information, assistance, and access. Persons seekingknowledge about long-term care will receive informationthat will minimize confusion, enhance individual choice,and support informed decisionmaking. Persons seekingknowledge about public and private long-term careoptions will receive information that will minimizeconfusion, enhance individual choice, and supportinformed decisionmaking.Building on this effort, AoA’s Choices for Independencedemonstration project aims to provide seniors andtheir caregivers with information, assistance, andcounseling to confront the difficult decisions they faceregarding long-term independence in the community,by seeking to reduce the current systemic bias in favorof institutional care. Choices for Independence will targetpeople while they are still healthy and able to plan fortheir care and will encourage them to take positivesteps to maintain their own health. If people need care,Choices for Independence will help them to bolster theirown support system and resources before they enter anursing home and spend down to Medicaid.CMS is working with ASPE and AoA on the HHS OwnYour Future campaign, in partnership with six States(Georgia, Massachusetts, Michigan, Nebraska, SouthDakota, and Texas). Own Your Future is an aggressiveeducation and outreach effort designed to increaseconsumer awareness about planning for long-termcare. The campaign uses Federal-State partnerships tohelp individuals from ages 45 to 65 take an active rolein planning by evaluating their future long-term needsand resources. Own Your Future provides objectiveinformation and resources to help individuals andtheir families plan for future long-term care needs.32 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health careTo enhance this effort, AoA, ASPE, and CMS havelaunched the National Clearinghouse for Long-TermCare Information Web site to increase public awarenessabout the risks and costs of long-term care and thepotential need for services.CMS is working with the U.S. Department of Housingand Urban Development to explore options for theprovision of long-term care services for beneficiariesliving in affordable housing. ASPE and AoA are alsocollaborating on strategies to develop reverse mortgageprograms that will encourage homeowners to useexisting assets to acquire long-term care services in thecommunity. CMS is also collaborating with AoA, ASPE,the Administration on Developmental Disabilities(ADD) in HHS’s Administration for Children andFamilies (ACF), OD, and Federal agencies such as theU.S. Departments of Education and Labor to addresslong-term care workforce issues.HHS Strategic Plan FY 2007-201233

CHAPTER 2: Health careStrategic Objective 1.2Increase health care service availability andaccessibility.In addition to broadening health care and long-termcare coverage, HHS is committed to increasing theavailability and accessibility of health care services. Thiscommitment includes reaching out to vulnerable andunderserved populations, such as American Indiansand Alaska Natives, people with disabilities, and ruralpopulations. In addition, the Department is committedto enhancing and expanding existing services, such ashealth centers, long-term care options, substance abuseand mental health treatment programs, and HumanImmunodeficiency Virus/Acquired ImmunodeficiencySyndrome (HIV/AIDS) programs. Among the operatingand staff divisions contributing to the achievement ofthis objective are AoA, CMS, HRSA, IHS, OCR, OD, ONC,OPHS, and SAMHSA.Selected HHS performance indicators that best capturethe impact of the wide array of HHS services providedunder this strategic objective follow:• Key aspects of having regular access to a source ofongoing care for the entire population;• Receipt of services by American Indians andAlaska Natives, with whom HHS has a specialtreaty relationship;• Efforts to expand access to publicly funded healthcenters and substance abuse treatment programs;and• Rates at which programs funded by Title XXVI ofthe Public Health Service Act as amended by theRyan White HIV/AIDS Treatment ModernizationAct (Ryan White HIV/AIDS Program) serve racialand ethnic minorities, disproportionately affectedby HIV/AIDS.The joint planning initiative, Empower ConsumerAccess to Health Care, Long-Term Care, and BehavioralHealth Services, is responsible for development,implementation, and coordination of health care,long-term care, and behavioral health service policiesand programs. Ten HHS divisions partner with the U.S.Departments of Agriculture, Education, and Interior,as well as with State and local health departments,Medicaid and SCHIP State agencies, State and area34 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health careagencies on aging, child care providers, early educationproviders, and tribal governments.American Indians and Alaska NativesHealth services are provided to American Indians andAlaska Natives through several means. In FY 2006, IHSprovided health care services directly at 33 hospitals,59 health centers, and 50 health stations and supportsessential sanitation facilities (including water supply,sewage, and solid waste disposal) for American Indian/Alaska Native (AI/AN) homes and communities. IHSprofessional staff include approximately 2,700 nurses,900 physicians, 400 engineers, 500 pharmacists, 300dentists, and 150 sanitarians. IHS also employs variousallied health professionals, such as nutritionists, healthadministrators, and medical records administrators.More than half of the IHS budget is now used toprovide funding for American Indian Tribes, tribalorganizations, and Alaska Native corporations thatchoose to contract or compact with IHS to providehealth care under the Indian Self-Determination andEducation Assistance Act of 1975 (Public Law 93-638),as amended. These entities administer 15 hospitals,221 health centers, 9 residential treatment centers, 97health stations, and 176 Alaska village clinics. BothIHS and tribal entities purchase additional health careservices from private providers. xHHS and the U.S. Department of Veterans Affairs (VA)have entered into a Memorandum of Understanding toencourage cooperation and resource sharing betweenIHS and the Veterans Health Administration. The goalis to use the expertise of both organizations to deliverquality health care services and enhance the healthstatus of AI/AN veterans. An interagency advisorycommittee, involving IHS and the Office of MinorityHealth (OMH) in OPHS, identifies health disparities forAmerican Indians and Alaska Natives compared to thegeneral U.S. population.People With DisabilitiesThe four goals included in The Surgeon General’s Callto Action to Improve the Health and Wellness of Personswith Disabilities are as follows:• Increase understanding nationwide that peoplewith disabilities can lead long, healthy, andproductive lives;• Increase knowledge among health careprofessionals and provide them with tools toscreen, diagnose, and treat the whole person with adisability with dignity;• Increase awareness among people with disabilitiesof the steps they can take to develop and maintain ahealthy lifestyle; and• Increase accessible health care and supportservices to promote independence for people withdisabilities.Virtually every HHS operating and staff division hasinitiatives to support this critical effort, headed byOPHS’s Office of the Surgeon General (OSG) andOD. Moreover, a broad array of Federal agencies,including the U.S. Departments of Agriculture, Defense,Education, Housing and Urban Development, Interior,Justice, Labor, Veterans Affairs, and the NationalScience Foundation, the Office of National DrugControl Policy, and the Social Security Administration,as well as many non-Federal stakeholders, havecommitted to pursuing these goals.Of particular note is HRSA’s effort to provide healthand community resource information and peer supportto families having children and youth with specialhealth care needs. Family-to-Family Health InformationCenters, funded under the Dylan Lee James FamilyOpportunity Act, 3 will be family-run, statewide centersin every State and the District of Columbia and willbe responsible for developing partnerships with thoseorganizations serving these children and their families.They also will be charged with monitoring the progressof programs with responsibility for payment and directservices of this population through a statewide datacollection system.3 The Dylan Lee James Family Opportunity Act was passed as aprovision to the Deficit Reduction Act of 2005 (Public Law 109-171).HHS Strategic Plan FY 2007-201235

CHAPTER 2: Health careRural HealthThrough collaborative initiatives such as the HHSRural Task Force and the National Advisory Committeeon Rural Health and Human Services, HHS works toaddress the difficulties of providing health care inrural communities. A technical assistance Web siteand targeted dissemination of information aboutinnovative models for health services delivery in ruralcommunities are part of HHS’s overall strategy.The HHS Underserved Populations effort focuseson delivery of health care services for underservedpopulations in rural and urban areas and involvesCMS, HRSA, IHS, OD, SAMHSA, State and local healthdepartments, health care providers, and the TribalTechnical Advisory Group.Health CentersAt the beginning of FY 2007, HRSA’s ConsolidatedHealth Center Program was providing comprehensiveprimary and preventive health care in more than 3,800sites across the country to an estimated 14.8 millionpeople. xi Most Health Center patients have incomes ator below 200 percent of the FPL. Many Health Centerpatients have no health insurance, and most patientsare racial or ethnic minorities.Health Centers help to improve the availability ofhealth services by providing a range of essentialservices. As new or expanded sites are funded inmedically underserved communities, a major focus willbe on poor rural and urban counties consistent withthe President’s goal of establishing new Health Centersin the poorest counties in the Nation. Health Centershelp to improve the availability of health servicesby providing a range of essential services, includingpharmacy services onsite or by paid referral, preventivedental care, and mental health and substance abuseservices at most centers.Mental HealthThe final report of the President’s New FreedomCommission on Mental Health (2003) called for afundamental transformation of how mental health careis delivered in America. SAMHSA’s Center for MentalHealth Services will continue to work to transform themental health system so that Americans understandthat mental health is essential to overall health; mentalhealth care is consumer and family driven; disparitiesin mental health services are eliminated; early mentalhealth screening, assessment, and referral to servicesare common practice; excellent mental health care isdelivered and research is accelerated; and technology isused to help consumers access mental health care andinformation.New Orleans Health SystemHurricane Katrina incapacitated the Greater NewOrleans health care system, ravaged its health careinfrastructure, and severely impacted health caredelivery in a number of Louisiana parishes. Eightypercent of New Orleans Health Centers were destroyed;the teaching hospitals of New Orleans were devastated;and countless people lost all of their medical records.The Louisiana Health Care Redesign Collaborativestrives to build an efficient 21st century health caresystem implementing technology, transparency,emergency preparedness, and greater personal healthcare choices. HHS is supporting the Collaborative inits effort by helping to convene stakeholders, providingexpert assistance and other HHS resources, removingbarriers to progress, and reviewing Medicaid waiverand Medicare demonstration concepts submitted bythe Louisiana Health Care Redesign Collaborative inaccordance with the guiding principles.The goal is to improve health care by providing everycitizen with access to health care that is preventioncentered, neighborhood located, and electronicallyconnected. Health care providers could use electronichealth records and meet certain quality measures inorder to provide care. Success means that Louisianaand New Orleans will have health care systems thatcan serve as models for the Nation. More informationabout how HHS is promoting electronic healthrecords is included later in this chapter in, In theSpotlight: Advancing the Development and Use of HealthInformation Technology.36 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health careRyan White HIV/AIDS ProgramHRSA’s programs through the Ryan White HIV/AIDSProgram currently provide services to approximately531,000 individuals who have little or no insuranceand are impacted by HIV/AIDS. xii Key pieces of thisprogram include its efforts to prioritize lifesavingservices, medications, and primary care for individualsliving with HIV/AIDS. Providing more flexibility totarget resources to areas that have the greatest needs isalso a key piece of the Ryan White HIV/AIDS Program.The program also encourages the participation of anyprovider, including faith-based and other communityorganizations, that shows results, recognizes the needfor State and local planning, and ensures accountabilityby measuring progress.Substance Abuse ServicesSAMHSA’s Center for Substance Abuse Treatmentpromotes the quality and availability of communitybasedsubstance abuse treatment services forindividuals and families who need them. The Centerfor Substance Abuse Treatment works with Statesand community-based groups to improve and expandexisting substance abuse treatment services underthe Substance Abuse Prevention and Treatment BlockGrant Program. The Center also supports SAMHSA’sfree treatment referral service to link people with thecommunity-based substance abuse services they need.Among SAMHSA’s efforts to improve the health of theNation by increasing access to effective alcohol anddrug treatment is the Access to Recovery program.Access to Recovery is designed to accomplish threemain objectives: to expand capacity by increasing thenumber and types of providers, including faith-basedand community providers, who deliver clinical treatmentand/or recovery support services; to require grantees tomanage performance, based on patient outcomes; andto allow recovery to be pursued through many differentand personal pathways. Vouchers, State flexibility, andexecutive discretion combine to create profound positivechange in substance abuse treatment financing andservice delivery. The innovative and unique Access toRecovery program is focused on consumer empowerment.HHS Strategic Plan FY 2007-201237

CHAPTER 2: Health careUnder Access to Recovery, consumers will continue to havethe ability to choose the path that is personally best forthem and to choose the provider that best meets theirneeds, whether physical, mental, emotional, or spiritual.Nondiscrimination and Privacy ProtectionOCR ensures compliance with the nondiscriminationrequirements of Title VI of the Civil Rights Act of 1964(Public Law 88-352), as amended, requiring recipientsof HHS Federal financial assistance to ensure that theirpolicies and procedures do not exclude or limit, or havethe effect of excluding or limiting, the participationof beneficiaries on the basis of race, color, or nationalorigin. These efforts, which reach beneficiaries of allhealth and human service programs that HHS funds,seek to achieve voluntary compliance and correctiveefforts when violations are found. OCR has collaboratedwith the U.S. Departments of Agriculture and Justice toproduce a video and informational brochure in multiplelanguages to advise service providers and consumers withlimited English proficiency about their responsibilitiesand rights under Title VI. OCR also enforces the federalprivacy protections for individually identifiable healthinformation provided by the Health Insurance Portabilityand Accountability Act (HIPAA) Privacy Rule. Privacyenforcement activities provide consumer confidence inthe confidentiality of their health information so thatprivacy concerns are not a deterrent to accessing care andfull and accurate information is provided at treatment andpayment encounters.OCR will continue to work with Federal and Statepartners and with providers and consumer groups,including faith-based and community organizations, toensure nondiscriminatory access to health and humanservices, to eliminate health disparities, and to protectthe privacy of identifiable health information.38 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health careStrategic Objective 1.3Improve health care quality, safety, cost, and value.In the future, American health care will be shapedinto a system in which doctors and hospitals succeedby providing the best value for their patients. Valuein health care means delivering the right health careto the right person, at the right time, for the rightprice. Providing reliable health care cost and qualityinformation can empower consumer choice at all levels.Systemwide improvements can occur as providers andpayers can track how their practice, service, or plancompares to others. As value in health care becomestransparent to consumers and providers alike, HHSanticipates the following benefits: Costs will stabilize;more people will acquire insurance; more peoplewill get access to better health care; and economiccompetitiveness will be preserved. Ultimately, this is aprescription for a value-driven system—a prescriptionof good medicine that works for everyone. HHS willwork to achieve this value-based system over the next5 years.Several HHS operating and staff divisions contributeto this goal of improving the quality, safety, cost and,ultimately, the value of health care, including AHRQ,AoA, CMS, FDA, HRSA, IHS, NIH, ONC, OPHS, andSAMHSA.The performance indicators for this strategic objective,listed in full at the end of this chapter, measure:• Adoption of electronic health care records, whichaffect the long-term quality, value, and safety ofhealth care;• Quality of care that residents receive in nursinghome facilities; and• Number of States implementing specificapproaches to improve the quality of Medicaidfundedhealth care, on which many low-incomepeople depend.HHS Strategic Plan FY 2007-201239

CHAPTER 2: Health careHealth Care TransparencyHealth care transparency may restrain the growth ofhealth care costs because consumers will know thecomparative costs and quality of their health care—andthey will have a financial incentive to seek out qualitycare at the lowest cost. Consumers will gain controlof their health care and have the knowledge to makeinformed decisions. Health care transparency is builton four interconnected cornerstones:• Connect the System. Every medical provider has asystem for keeping health records. Increasingly,those systems are electronic. Standards need tobe identified so that all health information systemscan quickly and securely communicate andexchange data.• Measure and Publish Data on Quality. Every case,every procedure, has an outcome. Some outcomesare better than others are. To measurequality, HHS must work with doctors and hospitalsto define benchmarks for what constitutesquality care.• Measure and Publish Data on Price. Price informationis useless unless cost is calculated foridentical services. Agreement is needed on whatprocedures and services are covered in each “episodeof care.”• Create Positive Incentives. All parties—providers,patients, insurance companies, and payers—should participate in arrangements that rewardboth those who offer and those who purchasehigh-quality, competitively priced health care.Employers committing to these cornerstones wouldagree to collect quality and price information throughits health plan or benefit administrator, using theconsensus standards. Employers committing to thegoals also would be encouraged to share quality andprice information with regional collaboratives, whereinformation from many sources could be aggregated,thus producing the most broad-based and reliableinformation possible. The employer or its health planwould share quality information with enrollees andwould provide specific costs the enrollee would expectto pay under the plan.Six pilot programs to demonstrate how transparencycan promote improvements in health care areunderway, with support from CMS and AHRQ. Thesepilot programs are being coordinated under the BetterQuality Information Data Aggregation and Reportingproject, through a contract with the MarylandMedicare Quality Improvement Organization. Thecommunities were selected using a set of criteria by arepresentative committee of the public/private entityAmbulatory Care Quality Alliance, which consists of135 physician organizations, consumers, employers,and health plan representatives. The Alliance makesavailable quality information about physician care. Thepurpose is to measure and report on physician practicein a meaningful and transparent way for consumersand purchasers of health care.Personalized Health CareThe future of health care in America is one in whichcare will be personalized, predictive, preemptive,and participatory. Advances in basic research havepositioned us to begin to harness new and increasinglyaffordable potential in medical and scientifictechnology. With clinical tools that are increasinglytargeted to the individual, our health care system cangive consumers and providers the means to makemore informed, individualized, and effective choices.Emphasis on personalized health care could makehealth care safer and more effective for every patient,especially when we are able to use the power of geneticinformation and health information technology tobetter understand each patient’s needs and moreprecisely target therapies. This may mean that thesame medical condition requires different treatmentfor men and women, or for older persons, or for otherswhose inherited traits may put them at particular risk.Ongoing activities across HHS are working toward thelong-term goals of personalized health care, and theconvergence of these efforts will act as a powerful forceto educate both the patient and the health care providerto improve clinical outcomes. Basic research at NIH isimproving the foundational knowledge of diseases; FDA’sCritical Path Initiative is improving the speed and safetyof product development; and CDC will use populationdata to understand the genetic basis of diseases.40 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health careFDA has initiated the Critical Path to PersonalizedMedicine, a program designed to modernize and ensuremore efficient development and clinical use of medicalproducts. Under the Critical Path Initiative, HHSanticipates being able to dramatically increase the successrate in providing patients with innovative solutions thatstrike an optimal balance of high benefit and low riskbecause they are “personalized.” Once both the diseaseand the person are understood at the molecular level,physicians will be able to provide treatment optionsuniquely suited to a patient’s particular needs.Electronic Health RecordsPatients cannot receive appropriate and efficient careunless clinical information about them is available at thepoint of care. When patients’ health information is notaccessible to providers as they transition through thecontinuum of care, clinical decisions often must be madewithout full knowledge of patients’ history and healthstatus. The absence of needed clinical information canlead to a requirement to duplicate tests that not onlyincrease the costs of health care, but also subject patientsto unneeded clinical interventions that always carry adegree of risk. Similarly, the absence of needed informationcould lead to incorrect decisions or medical errors thatcould result in adverse clinical outcomes. Over time, moreadvanced electronic health records will have integratedclinical decision support with the latest scientific evidenceguiding clinical interventions at the point of care alongwith environmental data that should also influencemany treatment decisions. Increasing the adoption ofinteroperable electronic health records will decreasethese risks to both the efficiency and efficacy of care.Through the collaborative activities of the American HealthInformation Community, chaired by the Secretary of HHS,much work is underway to identify the functionality andstandards that will support the development and adoptionof interoperable electronic health records to achieve thePresident’s vision of making electronic health recordsavailable to most Americans by 2014.More information about this effort can be foundlater in this chapter in In the Spotlight: Advancing theDevelopment and Use of Health Information Technology.HHS Strategic Plan FY 2007-201241

CHAPTER 2: Health careValue-Based PurchasingValue-based purchasing is the use of payment methodsand other incentives to encourage substantiveimprovement for patient-focused, high-value care.At HHS, value-based purchasing is in its early stagesof development. The Tax Relief and Health Care Actof 2006 (H.R. 6111) lays the groundwork for CMS toestablish many models for financial and nonfinancialincentives used in value-based purchasing programsor strategies. Programs such as Medicare Hospital Payfor Performance, Medicare Demonstration Project toPermit Gainsharing, and the Premier demonstrationare viewed as one component of a broader strategyof promoting health care quality. At least 12 Statesthroughout the country have already implemented awide range of value-based purchasing initiatives underMedicaid. States are using both payment differentialsand nonfinancial incentives, such as auto-enrollmentand public reporting, to reward performance. CMSwill provide technical assistance to those States thatvoluntarily elect to implement value-based programs.CMS also will encourage States to include an evaluationcomponent to provide evidence of the effectiveness ofthis methodology.Quality Improvement EffortsMedicare Quality Improvement Efforts. Improvingquality of care and reducing medical errors areimportant goals in modernizing Medicare. TheMedicare Web site will continue to display qualitydata that allow consumers to make informed choicesby comparing the performance of hospitals, nursinghomes, home health agencies, and dialysis facilities.Medicaid Quality Improvement Efforts. Statescontinue to advance efforts to improve overallquality of care as they seek new approaches toimprove and expand insurance coverage. In manyinstances, State Medicaid programs have led the wayin quality initiatives that have the potential to shapeactivities of other public and private payers acrossthe country. Several States have implemented valuebasedpurchasing programs with the objective ofredesigning the payment structures to promote andreward the provision of high-quality care. At least 13States now publicly report performance measurementdata that can be used by State agencies, beneficiaries,policymakers, and others to promote transparency andpersonal responsibility in the care provided. CMS alsohas launched a Neonatal Care Outcomes Improvementproject with an objective of decreasing infant morbidityand mortality.Nursing Home Quality Initiatives. The CMS NursingHome Quality Initiative is a broad-based effort thatincludes continuing regulatory and enforcementsystems. New and improved consumer information isavailable through the 1–800–MEDICARE (1-800-633-42273) line and at the Medicare Web site. In addition,community-based nursing home quality improvementprograms, and partnerships and collaborative effortsto promote awareness and support, are underway.The first goal of the initiative is to provide consumerswith an additional source of information about thequality of nursing home care by establishing qualitymeasures based on the Minimum Data Set and bypublishing information on Medicare’s Nursing HomeCompare Web site. The second goal is to help providersimprove the quality of care for their residents bygiving them complementary clinical resources, qualityimprovement materials, and assistance from theQuality Improvement Organizations in every State.Collaborative Quality Improvement Initiatives.Two joint planning efforts focus on quality andimprovement initiatives. With representation fromCMS, CDC, AHRQ, and a number of non-Federalorganizations, one effort experiments with approachesto create incentives for hospitals and physiciansto provide both high-quality and efficient care(e.g., Gainsharing, Hospital Compare, Surgical CareImprovement Project, and others). The second effort,the Quality Workgroup, consists of CMS, AHRQ, IHS,ONC, the Office of Personnel Management, and avariety of non-Federal organizations representing labor,insurers, hospitals, and other stakeholders. The QualityWorkgroup makes recommendations to the AmericanHealth Information Community (AHIC) so that healthinformation technology can provide the data needed42 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health carefor the development of quality measures that are usefulto patients and others in the health care industry. TheQuality Workgroup seeks to automate the measurementand reporting of a comprehensive current and futureset of quality measures and to accelerate the use ofclinical decision support that can improve performanceon those quality measures. In addition, this workgroupmakes recommendations on how performanceindicators should align with the capabilities andlimitations of health information technology. Moreinformation about the AHIC’s work is included in theMeeting External Challenges section of this chapter.Medical Home Quality Improvement Initiative.A medical home is primary care that is accessible,continuous, comprehensive, family centered, coordinated,compassionate, and culturally effective. In a medicalhome, a pediatric clinician works in partnership withthe patient and his or her family to assure that all themedical and nonmedical needs of the patient are met.Through this partnership, the pediatric clinician canhelp the patient and family access and coordinatespecialty care, educational services, out-of-home care,family support, and other public and private communityservices that are important to the overall health of thechild or youth and family. A HRSA initiative will identifyeffective strategies currently being used in collaborationwith Title V Children with Special Needs programs in theStates and will implement quality improvement activitieswithin their medical home activities. The purpose is toenhance infrastructure development, provide qualitycare, and foster exchange of strategies among families,communities, and State and Federal leaders.Medical Product SafetyFDA is responsible for addressing concerns regardingthe safety of medical products, in particular, drugs.As the science of drug development continues toevolve, FDA will continually improve the approachto drug regulation to ensure that care providersand patients can make optimal decisions aboutthe medicines they use to improve their health.FDA’s reform effort will include developing newtools for communicating information to patientsand improving the management of the process forHHS Strategic Plan FY 2007-201243

CHAPTER 2: Health carehow FDA uncovers and communicates importantdrug safety issues. For example, FDA will focus onimproving the safety of drugs on the market in partthrough its plans to modernize the Adverse EventReporting System (AERS) and establish “AERS II” asthe primary source for drug product adverse eventdata. These resources also will allow FDA to augmentAERS data and further its efforts with CMS to obtainaccess to valuable drug safety information housed inCMS population-based databases. This collaborationwith CMS will be integrated with the Sentinel System,a seamless platform for gathering and evaluatinginformation about adverse events related to the use ofmedical products. This integration will enable FDA togather more information from the point of care aboutpotential safety problems and will provide a frameworkfor turning these raw data into useful knowledge aboutthe safe use of medical products.In order to improve current processes and systemsfor collection of adverse events and errors, FDA isdeveloping MedWatch Plus. This program will providea single internet portal for anyone needing to reportan adverse event resulting from an FDA regulatedproduct, including product complaint reporting. Thisinitiative will improve the collection and processingof adverse event information for all FDA regulatedproducts. The user-friendly electronic submissioncapability will facilitate submission of adverse eventsreports to better allow FDA to efficiently and effectivelyuse the information to promote and protect publichealth. Through these modernization efforts, FDAwill continue to ensure that the medical products itregulates are the safest in the world.OPHS coordinates vaccine safety activities amongHHS agencies which conduct a broad range ofactivities aimed at ensuring the safety of vaccines.NIH conducts and funds basic research that leads tothe development of vaccines with a major emphasis onsafety. FDA has statutory responsibility for licensingvaccines. Additionally, the FDA coadministers theVaccine Adverse Event Reporting System (VAERS),a passive surveillance system, with CDC. CDC alsoconducts active surveillance of vaccine associatedadverse events through the Brighton Collaboration,and examines vaccine adverse events on the practicelevel through Clinical Immunization Safety Assessment(CISA) centers. HRSA compensates individualswho may have been injured by vaccines through theVaccine Injury Compensation Program (VICP). TheFederal government has a heightened responsibilityto ensure that vaccines are optimally safe as vaccinesare recommended for nearly ever child in the U.S. andchildren are required by state laws to receive vaccinesin order to enter school. OPHS is coordinating aninteragency strategic plan to enhance HHS vaccinesafety activities. Vaccine safety activities will beenhanced in the areas of research and development,post-licensure surveillance, and risk communication.Generic Drugs. Part of FDA’s mission is to make surethat the generic drugs approved for use in the UnitedStates are just as safe and effective as the brand-nameversions of the drugs. Generic drugs can be very helpfulfor patients because their price is typically much lower:For the average price of a brand-name prescriptiondrug that is $72, the average price of a generic versionis about $17. xiii This is an especially important sourceof drug savings at this time, because a growing numberof important brand-name medications—more than 200in the next few years—are coming off patent, pavingthe way for the development of generic versions. FDA’snew final regulation to improve how and when genericdrugs can compete with brand-name drugs will lead tosaving billions of dollars in drug costs each year.Health DisparitiesThe Racial and Ethnic Health Disparities Outreach jointplanning effort focuses on outreach to raise awarenessamong minority communities about major healthrisks prevalent in their specific populations and toprovide access to information on how to reduce theserisks. AoA, CDC, IHS, NIH, OCR, and OPHS partnerwith media, State and local health departments, Stateand area agencies on aging, and tribal governments onthis effort. Additional information on HHS’s efforts onthis topic can be found later in this chapter in In theSpotlight: Reducing Health Disparities.44 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health careStrategic Objective 1.4Recruit, develop, and retain a competenthealth care workforce.In the coming years, the Nation faces shortages of criticalhealth care workers, including nurses and long-termcare providers. In addition, all health care workerswill need to be flexible and responsive enough to acton new challenges and maximize the potential of newtechnologies. In addition to strategies to develop itsown workforce, HHS is committed to helping the fieldrecruit and retain, as well as train, develop, and support,a competent professional and paraprofessional healthcare workforce. Among the operating and staff divisionscontributing to the achievement of this objective areAoA, ASPE, CMS, HRSA, IHS, OPHS, and SAMHSA.HHS, in the health care programs it operates, faces thesame recruitment and retention challenges encounteredby health care providers nationwide. The first performanceindicator measures HHS’s success in meeting its goal torecruit and retain the Commissioned Corps membersneeded to provide ongoing health care. The secondmeasures the Corps’ readiness to rapidly respond tomedical emergencies and urgent public health needs.Recruitment /Retention EffortsCommissioned Corps. The mission of theCommissioned Corps of the United States Public HealthService (USPHS; Commissioned Corps) is protecting,promoting, and advancing the health and safety ofthe Nation. The Commissioned Corps achieves itsmission through rapid and effective response to publichealth needs, leadership and excellence in publichealth practices, and the advancement of public healthscience. As one of the seven Uniformed Services of theUnited States, the Commissioned Corps is a specializedcareer system designed to attract, develop, and retainhealth professionals who may be assigned to Federal,State, or local agencies or international organizations.The Commissioned Corps will continue to offer twoexcellent opportunities for students through the highlycompetitive Junior Commissioned Officer Student Trainingand Extern Program and Senior Commissioned OfficerStudent Training and Extern Program.HHS Strategic Plan FY 2007-201245

CHAPTER 2: Health careIndian Health Service. The Indian Health CareImprovement Act of 1976 (Public Law 94-437), asamended, authorized IHS to administer interrelatedscholarship programs to meet the health professionalstaffing needs of IHS and other health programs servingIndian people. In addition, IHS administers a LoanRepayment Program for the purpose of recruiting andretaining highly qualified health professionals to meetstaffing needs. The Indian Health Professions Programprovides scholarships, loans, and summer employmentin return for agreements by students to serve inhealth facilities serving American Indians and AlaskaNatives in medically underserved areas. As a matterof law and policy, IHS gives preference to qualifiedAmerican Indians in applicant selection and in careerdevelopment training.National Health Service Corps. Currently, 35 millionpeople live in communities without adequate access toprimary health care because of financial, geographic,cultural, language, and other barriers. Since itsinception, the National Health Service Corps (NHSC),managed by HRSA, has placed more than 27,000primary care clinicians, including dental, mental,and behavioral health professionals, in underservedareas across the country including communities withHealth Centers. In FY 2007, field strength for theNHSC is estimated to be more than 3,400 people. xivApproximately half of NHSC clinicians are assigned toservice in Health Center sites.Nurses. The Bureau of Labor Statistics estimatesthat by 2020 the Nation will have a shortfall of upto 1 million nurses, which includes new jobs and“replacement” jobs that are open when today’s nursesretire and leave the field. xv As the population continuesto grow and age and medical services advance, the needfor nurses will continue to increase. A report developedby HHS, What is Behind HRSA’s Projected Supply,Demand, and Shortage of Registered Nurses, predictedthat the nursing shortage is expected to grow to morethan 1 million by 2020. In 2007, HHS nursing programswill support recruitment, education, and retention ofnursing students, emphasizing new loan repaymentsand scholarships.46 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health careWorkforce Support EffortsCultural Competence. OPHS’s OMH is mandated todevelop the capacity of health care professionals toaddress the cultural and linguistic barriers to healthcare delivery and increase access to health care forpeople with limited English proficiency. The Center forLinguistic and Cultural Competence in Health Care wasestablished in FY 1995 as a vehicle to address the healthneeds of populations with limited English proficiency.National Standards on Culturally and LinguisticallyAppropriate Services. These standards have beendeveloped and are primarily directed at healthcare organizations; however, individual providersalso are encouraged to use the standards to maketheir practices more culturally and linguisticallyaccessible. The principles and activities of culturallyand linguistically appropriate services should beintegrated throughout an organization and undertakenin partnership with the communities being served. Thestandards are organized by three themes: CulturallyCompetent Care, Language Access Services, andOrganizational Supports for Cultural Competence.Mental Health and Substance Use DisordersPrevention and Treatment. SAMHSA supportsefforts to identify and articulate key workforcedevelopment issues in the mental health and substanceuse disorders prevention and treatment fields andto encourage the retention and recruitment of aneffective compassionate workforce. These effortsinclude support for programs that train behavioralhealth professionals to work with underserved minoritypopulations, training for mental health and substanceabuse providers, and leadership training programs.Support to Family Caregivers. The National FamilyCaregiver Support Program, developed by AoA, callsfor all States working in partnership with local areaagencies on aging, faith- and community-serviceproviders, and tribes to offer five direct services thatbest meet the range of family and informal caregivers’needs: information about available services; assistancein gaining access to supportive services; individualcounseling, organization of support groups, andtraining to assist caregivers in making decisions andsolving problems relating to their roles; respite care toenable caregivers to be temporarily relieved from theircaregiving responsibilities; and supplemental services,on a limited basis, to complement the care provided.Direct Support Workforce. To address the emerging“care gap” between the number of long-term careworkers and growing demand, providers, policymakers,and consumers are likely to consider a broad range ofstrategies: improving wages and benefits of direct careworkers, tapping new worker pools, strengthening theskills that new workers bring at job entry, and providingmore relevant and useful continuing education andtraining. A key strategy in this mix will be a focus onworkforce development—providing workers with theknowledge and skills they need to perform their jobs. Inaddition, ASPE and its partners in and outside HHS areengaged in a series of research projects aimed at moreaccurately enumerating the long-term care workforce,describing the types of tasks performed and assessingthe impact of workforce development programs.HHS Strategic Plan FY 2007-201247

CHAPTER 2: Health carePerformance IndicatorsMost RecentResultFY 2012 TargetStrategic Objective 1.1Broaden health insurance and long-term care coverage.1.1.11.1.2Implement the Medicare Prescription Drug Benefit– increase percentage of Medicare beneficiaries withPrescription Drug Coverage from Part D or other sources.Reduce the percentage of improper payments made underthe Medicare FFS Program.90% 93%4.4% Available 2009Strategic Objective 1.2Increase health care service availability and accessibility.1.2.11.2.2Increase the number of persons (all ages) with access to asource of ongoing care.Expand access to health screenings for American Indiansand Alaskan Natives:a) Increase the proportion of patients with diagnoseddiabetes who receive an annual retinal examination;andb) Increase the proportion of eligible patients who havehad appropriate colorectal cancer screening.87% 96%a) 49%; and a) 75%; andb) 22%. b) 50%.1.2.3 Increase the number of patients served by Health Centers. 14.1 million 16.4 million1.2.41.2.5Serve the proportion of racial/ethnic minorities in programsfunded by Ryan White CARE Act at a rate that exceeds theirrepresentation in national AIDS prevalence data.Increase the number of client admissions to substance abusetreatment programs receiving public funding.72% 5 percentage pointsabove CDC data onnational prevalence1,875,026 2,005,22048 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health careMost RecentResultFY 2012 TargetStrategic Objective 1.3Improve health care quality, safety, cost, and value.1.3.1Increase physician adoption of electronic health records. 10% 40%1.3.2Decrease the prevalence of restraints in nursing homes. 6.1% 5.8%1.3.3Increase the number of States that have the ability to assessimprovements in access and quality of health care throughimplementation of the Medicaid Quality Strategy.0 States 12 StatesStrategic Objective 1.4Recruit, develop, and retain a competent health care workforce.1.4.1Increase the number of Commissioned Corps responseteams formed.10 teams 36 teams1.4.2 Increase the number of Commissioned Corps officers. 5,906 6,600Note: Additional information about performance indicators is included in Appendix B.HHS Strategic Plan FY 2007-201249

CHAPTER 2: Health careMeeting External ChallengesHHS faces a number of challenges in improving thesafety, quality, affordability, and accessibility of healthcare, including shifting demographics, changing trendsin demand, increasing costs, and continuing concernsabout implementing new technologies.Demographic changes include the aging of the Nation’spopulation and increasing life expectancy, a growingnumber of persons with disabilities, and an increasingnumber of populations who do not speak Englishand have low literacy. HHS is working to meet thechallenge by targeting its outreach materials and mediaresponses to these populations, monitoring trends inaccess and availability of care for these populations,and continuing to design and implement innovativedemonstration programs and initiatives aimed atreducing disparities. For more information about thistopic, see Chapter 4’s In the Spotlight: DemographicChanges and Their Impact on Health and Well-Being.With these demographic changes, changes in demandare expected to follow. Enhanced outreach to newpopulations means that HHS may need to thinkdifferently about responding to demands for high-quality,high-value, and accessible health care; behavioral healthcare; and long-term care. Surges in the Medicare-eligiblepopulation related to the aging of the Baby Boomersmay strain the ability of the health care delivery systemto respond appropriately. Even consumer perceptionsabout their need for preventive screenings or servicesimpact overall demand. HHS is working to analyzebackground data from services provided to react tochanging beneficiary needs. Evidence-based processesare being utilized to address coverage issues. Educationcampaigns are being conducted to raise awarenessabout beneficiary screening services and preventive care,with particular attention to growing racial and ethnicminority populations.Although the above is true, one cannot assume thatall costs are avoidable. Some of these costs substitutefor the costs of excess mortality or morbidity. TheUnited States continues to have the highest percapita health care spending among industrialized50 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health carecountries. The health care cost per capita for personsaged 65 years or older in the United States is three tofive times greater than the cost for persons youngerthan 65, and the rapid growth in the number of olderpersons, coupled with continued advances in medicaltechnology, is expected to create upward pressure onhealth care and long-term care spending. Medicalinflation also contributes to the rising cost of providingappropriate quality health services, widening the gapbetween increased need and available resources. Aneconomic downturn could increase demand for healthcare and long-term care services from safety netproviders and strain the ability of current providersto meet the demand. In response to these concerns,HHS will continue to monitor trends in access to careamong uninsured, underinsured, and low-incomeindividuals, and to design and implement innovativedemonstration programs that seek to improve healthand access to care among these groups. HHS willidentify new resources to meet increased demands,focusing on efficiency and effectiveness of health careservice delivery. HHS will also continue to cultivate astrong focus on prevention and wellness services (seeStrategic Goal 2, Objective 2.3, for more detail).Improving health care and the health of the populationthrough the adoption of health information technology(health IT) is clearly a priority for HHS (see In the Spotlight:Advancing the Development and Use of Health InformationTechnology). The nationwide implementation of aninteroperable health IT infrastructure has the potential tolower costs, reduce medical errors, improve the quality ofcare, and provide patients and physicians with new waysto interact. However, nationwide health IT adoption canbe accomplished only through a coordinated effort ofmany stakeholders, from State and Federal governmentsand the private sector. HHS has taken great care to engagerepresentatives from all of these sectors in all of our healthIT initiatives—an effort that involves many processes andthe work of many hundreds of participants. In September2005, HHS formed a Federal Advisory Committee(subject to the Federal Advisory Committee Act 4 of 1972(Public Law 92-463), as amended), the American HealthInformation Community (AHIC), to advise the Secretaryon how to accelerate the development and adoption ofhealth IT and help advance efforts needed to achieve thePresident’s goal for most Americans to have access tosecure electronic health records by 2014. Additionally, theAHIC provides input and recommendations to HHS onhow to make health records digital and interoperable andhow to protect the privacy and security of those records, ina smooth, market-led way.4 In 1972, the Federal Advisory Committee Act (Public Law 92-463) was enacted by the U.S. Congress. Its purpose was to ensurethat advice rendered to the executive branch by the various advisorycommittees, task forces, boards, and commissions formed overthe years by the Congress and the President be both objective andaccessible to the public. The act formalized a process for establishing,operating, overseeing, and terminating these advisory bodies.HHS Strategic Plan FY 2007-201251

CHAPTER 2: Health careReducing Health DisparitiesThe United States health care delivery systemencompasses outstanding providers, facilities, andtechnology. Many Americans enjoy easy access to care.However, not all Americans have full access to highqualityhealth care.The National Healthcare Disparities Report (2006Disparities Report), published annually by the Agencyfor Healthcare Research and Quality (AHRQ), providesa comprehensive national overview of disparities inhealth care in America and tracks the Nation’s progresstoward the elimination of health care disparities. xviMeasures of health care access are unique to this reportand encompass two dimensions of access: facilitatorsand barriers to care, and health care utilization.Three key themes are highlighted for those who seekinformation to improve health care services for allAmericans:• Disparities remain prevalent;• Some disparities are diminishing, while others areincreasing; and• Opportunities for reducing disparities remain.HHS is undertaking numerous initiatives aimed atreducing health care disparities and improving overallhealth care quality. These include, for example:• Activities coordinated by OCR, OPHS, and theHHS Disparities Council;• AHRQ’s “ Asthma Care Quality Improvement: AResource Guide for State Action”;• AHRQ’s “ Diabetes Care Quality Improvement: AResource Guide for State Action,” which providesbackground information on why States shouldconsider diabetes as a priority for State action,presents analysis of State and national data andmeasures of diabetes quality and disparities, andgives guidance for developing a State quality improvementplan;• AHRQ’s “State snapshots” of data, which are madeavailable to State officials and their public sectorand private sector partners to understand healthcare disparities;• AHRQ’s national health plan learning collaborativeto reduce disparities and improve diabetes care;• CDC’s National Breast and Cervical Cancer EarlyDetection Program;• CMS’s Hospital, Nursing Home, Home Health, andEnd Stage Renal Disease Quality Initiatives;• HRSA’s C.W. Bill Young Cell TransplantationProgram and National Cord Blood Inventory toincrease access to sources of high-quality bloodstem cells for transplantation for patients withouta suitable related blood stem cell donor;• HRSA’s Health Disparities Collaborative Initiative,which seeks to generate and document improvedhealth outcomes for underserved populations;• HRSA’s Healthy Start program, which works in97 communities with high annual rates of infantmortality to reduce disparities and improve healthoutcomes for mothers and infants from pregnancyto at least 2 years after delivery;• HRSA’s Maternal and Child Health Block Grant, aimedat improving care for all mothers and children; and• HRSA’s Organ Donation Collaborative, aimed atincreasing the number of organ donations andtransplants.Disparities PersistFindings in the 2006 Disparities Report are consistentwith those of previous reports: Disparities related torace, ethnicity, and socioeconomic status still pervadethe health care system, and are observed in almost allaspects of health care, including:• Across all dimensions of quality of care, includingeffectiveness, patient safety, timeliness, andpatient centeredness;• Across all dimensions of access to care, includingfacilitators and barriers to care and health careutilization;• Across many levels and types of care, includingpreventive care, treatment of acute conditions,and management of chronic disease;• Across many clinical conditions, including cancer,diabetes, end stage renal disease, heart disease,HIV disease, mental health, substance abuse, andrespiratory diseases;• Across many care settings, including primary care,home health care, hospice care, emergency de-52 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health carepartments, hospitals, and nursing homes; and• Within many subpopulations, including women,children, older adults, residents of rural areas,and individuals with disabilities and other specialhealth care needs.Changes in DisparitiesFor racial and ethnic minorities, some disparities inquality of care are improving and some are worsening.Of disparities in quality experienced by Blacks orAfrican-Americans, Asians, American Indians andAlaska Natives, and Hispanics, 5 about a quarter wereimproving and about a third were worsening; twothirdsof disparities in quality experienced by poorpeople were worsening.Some examples of changes in differences related to thequality of health care follow:• From 2000–2003, the proportion of adults whoreceived care for illness or injury as soon as wanteddecreased for Whites but increased for Blacks or African-Americans.From 2000–2004, the rate of newAIDS cases remained about the same for Whitesbut decreased for Blacks or African-Americans.• From 1999–2004, the proportion of adults age65 and over who did not receive a pneumoniavaccine decreased for Whites but increased forAsians. From 1998–2004, the proportion of childrenages 19 to 35 months who did not receive allrecommended vaccines decreased somewhat forWhites but even more for Asians.• From 2000–2003, the proportion of adults whohad not received a recommended screening forcolorectal cancer decreased for Whites but increasedfor American Indians and Alaska Natives.From 2002–2003, the proportion of adults whoreported communication problems with providersdecreased somewhat for Whites but even more forAmerican Indians and Alaska Natives.• From 2001–2003, the rate of pediatric asthmahospitalizations remained the same for non-His-5 In this section, the terms used for specific racial and ethnicminorities are consistent with the categories used in the 2006Disparities Report. The 2006 Disparities Report officially uses theterm “Blacks or African Americans” in accordance with the Office ofManagement and Budget (OMB). “Asian” includes “Asian or PacificIslander” when information is not collected separately for eachgroup. For all measures, Blacks, Asians, and American Indians andAlaska Natives are compared with Whites; Hispanics are comparedwith non-Hispanic Whites; and poor individuals are compared withhigh-income individuals.•panic Whites but increased for Hispanics. From2001–2003, the proportion of children without avision check decreased somewhat for non-HispanicWhites but even more for Hispanics.From 2000–2003, the proportion of adults age 40and older who did not receive three recommendedservices for diabetes decreased substantially forhigh-income persons but less for poor persons.From 2001–2003, the proportion of children whoseparents reported communication problems withproviders remained about the same for high-incomepersons but decreased for poor persons.Opportunities for ImprovementAlthough some inequalities are diminishing, there aremany opportunities for improvement. For all groups,measures could be identified for which the group notonly received worse care than the reference group but forwhich this difference was getting worse rather than better.All groups had several measures for which theyreceived worse care and for which the difference wasgetting worse. For Blacks or African-Americans, Asians,and Hispanics, imbalances in health care deliveryinvolved all the following domains of quality that couldbe tracked: preventive services, treatment of acuteillness, management of chronic disease and disability,timeliness, and patient-centeredness. For AmericanIndians and Alaska Natives, these negative factorsappeared concentrated in the treatment of acute illnessand the management of chronic disease and disability.Hispanics and the poor faced many inequalities inaccess to care that were getting worse:• For Hispanics, not having health insurance and ausual source of care worsened; and• For the poor, not having a usual source of care andexperiencing delays in care worsened.Some disparities in quality of care were prominentfor multiple groups, such as colorectal cancerscreening, vaccinations, hospital treatment of heartattack, hospital treatment of pneumonia, services fordiabetes, children hospitalized for asthma, treatmentof tuberculosis, nursing home care, problems withtimeliness, and problems with patient-providercommunication.HHS Strategic Plan FY 2007-201253

CHAPTER 2: Health careClearly, health IT is the critical tool that can significantlyreduce medical error, engage consumers and patients intheir own health and care, and provide information in acoordinated fashion. In addition, public health andbioterrorism surveillance can be seamlessly integratedinto care, and clinical research will be accelerated andpostmarketing surveillance expanded. Interoperablehealth IT is the key to transforming our health care system.Advancing the Development and Useof Health Information TechnologyHealth information technology isdefined as systems and productsthat electronically create, store,transmit, and present personal healthinformation for multiple purposes,most notably for patient care.The Institute of Medicine estimates that 44,000 to98,000 Americans die each year from medical errors.Many more die or have permanent disability becauseof inappropriate treatments, mistreatments, or missedtreatments in ambulatory settings. Predictive modelshave projected that as much as $300 billion is spenteach year on health care that is the result of ourfragmented, uninformed, and uncoordinated healthcare system. According to the National Coalition onHealth Care, in 2004 health care spending in the UnitedStates reached $1.9 trillion and was projected to reach$2.9 trillion in 2009, if the current system does notchange. In order for health care in the United States tobe safe, timely, effective, efficient, equitable, and patientcentered, three elements will be necessary:• All relevant information (about a patient, the latestscientific evidence, and environmental factors)must be available electronically at the time ofpatient care;• Patients must be informed and engaged in theirown health; and• Care must be considered, assessed, and coordinatedacross multiple sites and settings.Office of the National CoordinatorThe Office of the National Coordinator for HealthInformation Technology (ONC) provides leadershipfor the development and nationwide implementationof interoperable health information technology, whichhas the potential to lower costs, reduce medical errors,improve the quality of care, and provide patients andphysicians with new ways to interact. The NationalCoordinator is the Secretary’s principal advisor onthe development, application, and use of health IT;coordinates HHS’s health IT programs; ensures thatHHS health IT policy and programs are coordinatedwith those of other relevant executive branch agencies;and coordinates public/private partnerships focusedon the health IT agenda.ONC’s principal goal is the achievement ofinteroperable electronic health records available tomost Americans by 2014. Achieving this goal requiresactivities across a broad range of areas includingstandards development, certification processes,piloting of health information exchanges across anumber of clinical domains and markets, and solidsurvey techniques to track progress in adoption. Inaddition to addressing the technical issues, the Office isfocused on privacy and security concerns; medicolegalissues; incentives, financial alignments, and businesscases; and workforce/cultural needs. These activitieswill be undertaken through coordinating large,collaborative partnerships between public andprivate organizations to receive the breadth of inputnecessary to change the course and outcome of ourNation’s health care system. A number of operatingand staff divisions within HHS have a successfulhistory of designing and delivering successful health IT54 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health caresolutions; these include AHRQ, CMS, and HRSA. ONC’scoordinating role will serve to support these existingstrengths and help identify synergies that can beachievable through leveraging these organizations andothers toward a unified health IT strategy not only forHHS, but also for the Nation as a whole.Public/Private PartnershipsOn September 13, 2005, Secretary Leavitt announcedthe membership for the American Health InformationCommunity. The original purpose of the Communitywas to help advance efforts to reach President Bush’scall for most Americans to have electronic healthrecords within 10 years. The Community, a federallychartered advisory committee, provides input andrecommendations to HHS on how to make healthrecords digital and interoperable and how to assurethe privacy and security of those records, in a smooth,market-led way.The Community has 18 members including theSecretary of HHS serving as the Chair. The remaining17 members are a combination of key leaders in thepublic and private sectors who represent stakeholderinterests in advancing the mission of the Communityand who have strong peer support. The Communityis chartered for 2 years, with the option to renew forno more than 5 years. The Department intends for theCommunity to be succeeded within 5 years by a privatesectorhealth information community initiative that,among other activities, would set additional neededstandards, certify new health IT, and provide long-termgovernance for health care transformation.Standards HarmonizationMany electronic health records have strongfunctionality, but no portability. The patient’s healthinformation cannot be transferred to other electronicsystems, thus precluding availability of that informationin multiple care settings.The standards harmonization process carried out bythe Health Information Technology Standards Panel(HITSP) has created a unique and unprecedentedopportunity to bring together the intellectual assetsof more than 200 organizations with a stake in healthdata standards that will increase the portability andsecurity of data among electronic health records. Thepanel guides the collaboration of these organizationsthrough a health IT standards harmonization processthat leverages the work and membership of multiplestandards development organizations. The panelengages in a consensus-based process to select themost appropriate standard from existing standardswhere available and to identify gaps in standards wherethere are none to assure effective interoperability. Oncestandards have been identified to support specificclinical use cases, the HITSP develops implementationguides to support system developers’ activities inpursuing interoperable electronic health records.Certification ProcessHealth IT is considered a normal cost of doing businessto ensure patients receive high-quality care whileprotecting patients’ privacy and personal information.In the same way, the certification process ensures thatcertain criteria are met with regard to functionality,interoperability, and security, thus assuring thepurchaser that the product will meet these needs.The Certification Commission for Health CareInformation Technology (CCHIT) has created anefficient, credible, and sustainable product certificationprogram. The CCHIT membership includes privatesector representatives from physicians and otherhealth care providers, payers and purchasers, healthIT vendors, and consumer groups—all focused onaccelerating the adoption of interoperable healthIT. In addition to developing criteria and evaluationprocesses for certifying ambulatory and inpatientelectronic health records, the CCHIT will certifyinfrastructure or network components through whichelectronic health records interoperate.Health Information ExchangeMuch like the Automated Teller Machine networks orcellular telephone networks, the ability to move neededpatient information regionally and nationwide in supportof their care should be transparent to patients and theirproviders. Linking previously disparate health careHHS Strategic Plan FY 2007-201255

CHAPTER 2: Health careinformation systems involves more than communicationstandards because the movement of information from onelocation to another implies moving from one authorizedprovider to another authorized provider in a securefashion while ensuring that the correct patients’ data arelinked. Patient identity, authorization, authentication,and other standards are necessary to ensure that patients’needed health information is available at the right timeand place.Policy CouncilThe mission of the Interagency Health InformationTechnology Policy Council is to coordinate Federalhealth IT policy decisions across Federal departmentsand entities that will drive Federal action necessaryto realize the President’s goals of widespread healthIT adoption. The Policy Council will address healthIT policy issues raised by its members, the AmericanHealth Information Community, the NationalCommittee on Vital and Health Statistics, andothers. The initial focus of the Policy Council is toestablish a strategic direction for Federal policy andidentify accelerators to support breakthroughs of theCommunity. To accelerate health IT initiatives, thePolicy Council will consider Federal policy levers suchas procurement, reimbursement, new or modifiedregulation, program guidance, incentives for privatesector activity, and research.Federal Health ArchitectureUnder the leadership of ONC, Federal Health Architecture(FHA) will provide the structure “architecture” forcollaboration and interoperability among Federal healthefforts. FHA is one of five Lines of Business supportingthe President’s Management Agenda goal to expandelectronic government. FHA will create a consistentFederal framework to facilitate communication andcollaboration among all health care entities to improvecitizen access to health-related information and highqualityservices. It will link health business processesto their enabling technology solutions and standardsto demonstrate how these solutions achieve improvedhealth performance outcomes. It also will provide theability to identify cross-functional processes, redundantsystems, areas for collaboration, and opportunities toenhance interoperability in critical information systemsand infrastructure.Public Health Information NetworkSupporting the national health IT agenda and FHA isthe Public Health Information Network (PHIN), a nationalinitiative to implement a multiorganizational businessand technical architecture for public health informationsystems. With the acceptance of IT as a core element ofpublic health, public health professionals are activelyseeking essential tools capable of addressing andmeeting the needs of the community.PHIN will elevate and integrate the capabilities ofpublic health information systems across the widevariety of organizations that participate in publichealth and across the wide variety of interrelated publichealth functional needs. PHIN targets the support andintegration of systems for disease surveillance, nationalhealth status indicators, data analysis, public healthdecision support, information resources and knowledgemanagement, alerting and communications, and themanagement of public health response.PHIN includes a portfolio of software solutions andartifacts necessary in building and maintaininginterconnected information systems throughout publichealth at the local, State, and Federal levels. PHINadvances the Nationwide Health Information Networkand the national health IT agenda by embracingthe standards identified by the Health InformationTechnology Standards Panel.Privacy and Security SolutionsThe Privacy and Security Solutions for InteroperableHealth Information Exchange contract is comanagedby AHRQ and ONC. This contract has fostered anenvironment in which States and territories havebeen able to assess variations in organization-levelbusiness policies and State laws that affect healthinformation exchange, identify and propose practicalsolutions while preserving the privacy and securityrequirements in applicable Federal and State laws,and develop detailed plans to implement solutions56 HHS Strategic Plan FY 2007-2012

CHAPTER 2: Health careto identified privacy and security challenges. Theseimplementation plans will not only benefit the Statesand territories that have created them, but otherONC-coordinated efforts, such as the State Alliance forE-Health’s Health Information Protection Taskforce, inwhich interstate health information exchange issuescan be harmonized nationwide.In addition, the American Health InformationCommunity has formed the Confidentiality, Privacyand Security Workgroup, and the Office for Civil Rights(OCR) participates in the workgroup to ensure thatprivacy protections are embedded in the health ITinfrastructure.The State Alliance for eHealth (State Alliance), acontract awarded by ONC to the National GovernorsAssociation Center for Best Practices, is an initiativedesigned to improve the Nation’s health care systemthrough the formation of a collaborative body ofgovernors and high level state executives. The StateAlliance is charged to develop consensus solutions tobarriers to health information exchange and adoptionof health IT while preserving privacy, security, andconsumer protections. It also builds consensus inseeking the harmonization of the variations in Statepolicies, regulations, and laws.The ChallengeProviding interoperable health records for mostAmericans by 2014 will require the dedicatedperseverance of most divisions within HHS and manydepartments outside HHS. The great number of broad,collaborative public/private groups mentioned aboveis essential to identify our direction and realize ourvision. Assembling the major groups has largely beenaccomplished, and a number of goals and objectiveshave been defined. The task before us now is tosynergize our efforts through these collaborativeprocesses and to move methodically forward inachieving these goals.HHS Strategic Plan FY 2007-201257

Chapter 3Strategic Goal 2:Public Health Promotion and Protection,Disease Prevention,and Emergency PreparednessPrevent and control disease, injury, illness, and disabilityacross the lifespan, and protect the public from infectious,occupational, environmental, and terrorist threats.

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessThroughout the 20th century, advances in public healthand medicine resulted in reduced morbidity and mortalityfrom infectious diseases, including influenza, polio, andfoodborne and waterborne illnesses. Chronic diseases,such as heart disease, stroke, cancer, and diabetes,replaced infectious diseases as the major cause of illnessand death in the United States in the latter part of the 20thcentury. In the new millennium, the Nation continues toface the challenge of chronic disease because of unhealthyand risky behaviors, environmental exposures, and anaging population.STRATEGIC GOAL 2:PUBLIC HEALTH PROMOTION AND PROTECTION,DISEASE PREVENTION, AND EMERGENCYPREPAREDNESSStrategic Objective 2.1:Prevent the spread of infectious diseases.Strategic Objective 2.2:Protect the public against injuries andenvironmental threats.Strategic Objective 2.3:Promote and encourage preventive healthcare, including mental health, lifelong healthybehaviors, and recovery.Strategic Objective 2.4:Prepare for and respond to natural and manmadedisasters.HHS Strategic Plan FY 2007-201259

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessToday, chronic diseases continue to be significant healthproblems that face Americans. As HHS works to addressthese health issues, infectious diseases have reemergedas a priority for public health in the United States. Forexample, risky behaviors such as unprotected sex andinjecting drug use continue to result in new HIV/AIDSinfections. At the end of 2003, an estimated 1,039,000to 1,185,000 persons in the United States were livingwith HIV/AIDS. xvii According to the Centers for DiseaseControl and Prevention (CDC), approximately 40,000persons are infected with HIV each year. Injecting druguse is also a common current risk factor for hepatitisC virus (HCV) infection. About 30,000 Americansare infected with HCV each year, and about 3 millionare chronically infected with this virus, which is aleading indication for liver transplants and hastens theprogression of HIV in those who are coinfected.Foodborne diseases cause an estimated 76 millionillnesses, 325,000 hospitalizations, and 5,000 deaths inthe United States each year. Other known pathogensaccount for an estimated 14 million illnesses, 60,000hospitalizations, and 1,800 deaths annually. xviii Morbidityand mortality from injuries and environmental hazardexposures also continue to affect the health and wellbeingof Americans.Over the past century, public health advances in drinkingwater, wastewater, and recreational water quality havedramatically improved the health of the American people.However, drinking water from public water systems causesan estimated 4 to 16 million cases of gastrointestinalillness per year. During 2003–2004, 62 waterborne diseaseoutbreaks associated with recreational water were reportedby 26 States and Guam. Illness occurred in 2,698 persons,resulting in 58 hospitalizations and 1 death. xixAlthough malaria is technically preventable and curableif recognized and treated promptly, it remains oneof the world’s greatest threats to human health andeconomic welfare. Each year, malaria kills more than 1million people—the majority, young children in Africa.In a retrospective analysis, it has been estimated thateconomic growth per year of countries with intensivemalaria was 1.3 percent lower than that of countrieswithout malaria. xxThe 21st century is also marked by the threat of publichealth emergencies. These threats have become asignificant focus for public health at the Federal, State,and local levels. Public health threats and emergenciescan ensue from myriad causes—bioterrorism; naturalepidemics of infectious disease; terrorist acts that involveconventional explosives, toxic chemicals, or radiologicalor nuclear devices; industrial or transportationaccidents; and climatological catastrophes.Strategic Goal 2, Public Health Promotion and Protection,Disease Prevention, and Emergency Preparedness, seeks toaddress these problems. There are four broad objectivesunder Public Health:• Prevent the spread of infectious diseases;• Protect the public against injuries andenvironmental threats;• Promote and encourage preventive health care,including mental health, lifelong health behaviors,and recovery; and• Prepare for and respond to natural and manmadedisasters.HHS is positioned to address the public health problemsof infectious diseases, injuries and environmentalhazards, chronic diseases and behavioral healthproblems, and public health emergencies througha comprehensive set of strategies. HHS providesleadership on these health issues within the FederalGovernment and collaborates with numerous partnersacross the Federal Government to achieve theseobjectives. These partners include the U.S. Departmentsof Homeland Security and Defense for public healthemergency preparedness; the U.S. EnvironmentalProtection Agency (EPA) and U.S. Department of Laborfor environmental and occupational health issues; andthe U.S. Departments of Agriculture and Commerce, andEPA, for food safety.Within HHS, multiple operating and staff divisionswork together to develop and implement strategies toachieve the goal of preventing and controlling disease,injury, illness, and disability across the lifespan and ofprotecting the public from infectious, occupational,environmental, and terrorist threats. Key operatingand staff divisions that contribute to this goal includethe Centers for Disease Control and Prevention60 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency Preparedness(CDC), Food and Drug Administration (FDA), HealthResources and Services Administration (HRSA), Officeof the National Coordinator for Health InformationTechnology (ONC), Office of the Assistant Secretaryfor Preparedness and Response (ASPR), and SubstanceAbuse and Mental Health Services Administration(SAMHSA). In addition, HHS’s Administration onAging (AoA), Centers for Medicare & Medicaid Services(CMS), Office for Civil Rights (OCR), Office on Disability(OD), Office of Global Health Affairs (OGHA), and Officeof Public Health and Science (OPHS) play importantroles in addressing this goal.Below is a description of each strategic objective, followedby a description of the key programs, services, andinitiatives the Department is undertaking to accomplishthose objectives. Key partners and collaborativeefforts are included under each relevant objective. Theperformance indicators selected for this strategic goal arealso presented with baselines and targets. These measuresare organized by objective. Finally, this chapter discussesthe major external factors that will influence HHS’s abilityto achieve these objectives, and how the Department isworking to mitigate those factors.HHS Strategic Plan FY 2007-201261

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessStrategic Objective 2.1Prevent the spread of infectious diseases.Although modern advances have conquered somediseases, infectious diseases continue to threatenthe Nation’s health. Outbreaks of Severe AcuteRespiratory Syndrome (SARS), avian influenza, WestNile Virus, and monkeypox are recent reminders ofthe extraordinary ability of microbes to adapt andevolve to infect humans. Earlier predictions of theelimination of infectious diseases often did not takeinto account changes in demographics, migrationpatterns, and human behaviors, as well as the abilityof microbes to adapt, evolve, and develop resistance todrugs. Infectious disease can have significant medicaland economic consequences. Addressing foodborneillnesses, vectorborne pathogens, viral hepatitis,HIV/AIDS and other sexually transmitted infections,tuberculosis, antimicrobial resistance, and a possibleinfluenza pandemic is a significant priority for HHS.Although these diseases affect all Americans, manyoften hit hardest the most vulnerable populations—thelow-income population, minorities, children and youth,immigrants, persons who are incarcerated, and otherdisenfranchised populations. The selected performanceindicators at the end of this chapter were chosen toreflect the impact HHS has on these populations.ImmunizationHHS has identified several key strategies for addressingthe threat of infectious diseases. One of the primarystrategies is the use of vaccines. HHS’s vaccine enterpriseincludes outreach activities and funding support forchildhood and adult immunization. HHS, throughCDC, will protect Americans from vaccine-preventablediseases by providing health communication messagesabout vaccination and supporting efforts to increaseimmunization coverage rates for both children and atriskadults. OPHS coordinates and ensures collaborationamong the many Federal agencies involved in vaccineand immunization activities. The Assistant Secretaryfor Health (ASH) provides leadership and coordinationamong Federal agencies, as they work together to carryout the goals of the National Vaccine Plan. The National62 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessVaccine Plan provides a framework, including goals,objectives, and strategies, for pursuing the preventionof infectious diseases through immunizations. In 2007–2008, HHS will review and revise the existing NationalVaccine Plan to ensure that it addresses new scientificand safety issues that have emerged since the first planwas developed. HHS also will continue existing effortsto increase immunization rates for vaccine-preventableillness. Specifically, HHS, through CDC, will develop anddisseminate health communication messages aboutvaccination and support efforts to increase immunizationcoverage rates for both children and adults.The Vaccines for Children Program (VFC), whichprovides immunizations for eligible children 6 at theirdoctors’ offices, will continue to be a cornerstoneof the HHS infectious disease prevention strategy.VFC also helps children whose insurance doesnot cover vaccinations when they receive them atparticipating Federally Qualified Health Centersand Rural Health Clinics. HHS also will work toincrease rates of vaccination against influenza andpneumococcal viruses through its National Influenzaand Pneumococcal Vaccination Campaign. This jointinitiative involves CDC, CMS, FDA, HRSA, IHS, andNIH along with State and local health departments,Medicaid agencies, tribal representatives, healthcare providers, and the National Coalition for AdultImmunization. It aims to provide vaccinations forinfluenza and pneumonia to beneficiary populations.HIV/AIDSOPHS coordinates all HIV/AIDS-related scientific andpolicy matters, such as new developments and programactivities within the areas of research, HIV prevention,HIV care and treatment, and budget development.OPHS also ensures the effective and accountablemanagement of the Department’s HIV/AIDS programs.6 Children 18 years of age and younger who meet at least oneof the following criteria are eligible: (1) a child who is eligible forthe Medicaid program; (2) a child who has no health insurancecoverage; (3) American Indian or Alaska Native; (4) a child, if servedby a Federally Qualified Health Center or Rural Health Clinic, whosehealth insurance benefit plan does not include vaccinations.Building on its existing surveillance, research, andscreening activities, CDC applies well-integrated,multidisciplinary programs of research, surveillance, riskfactor, and disease intervention to prevent and control thespread of HIV infection. For example, CDC is the sourceof national data on the epidemic and supports preventionprograms in every State, guided by community planning.These programs reach those at highest risk for acquiringor transmitting infection with effective interventions toreduce their risk and protect their health. CDC and HRSAwill support efforts to increase knowledge of communitycapacity to respond to HIV and increase HIV testingstatus, focusing especially on groups and communitiesat the highest risk of infection. FDA is responsiblefor ensuring the safety of the Nation’s blood supply byminimizing the risks of infectious disease transmissionand other hazards while facilitating an adequate supply ofblood and blood products.Routine and targeted HIV testing will be key strategiesfor preventing new HIV infections and improvingoutcomes for those who test positive. Individualsinfected with HIV who are aware of their infection areless likely to engage in risky behaviors and are more likelyto take steps to protect their partners. Additionally,individuals infected with HIV who are aware of theirinfection can take advantage of the therapies that cankeep them healthy and extend their lives.Additionally, FDA will continue its work withinternational drug regulatory authorities to promoteexpedited review of generic antiretroviral drugs underthe President’s Emergency Plan for AIDS Relief (PEPFAR).HHS, through its operating divisions, especially CDCand HRSA, is one of the major implementing partnersfor PEPFAR, and manages prevention, treatment,and care activities in the 15 focus countries of theEmergency Plan and more than 20 others. HHS alsoprovides part of the Federal Government’s financialcontribution to the Global Fund to fight AIDS,tuberculosis, and malaria, and is part of the interagencyteam that guides U.S. policy toward the fund.HHS Strategic Plan FY 2007-201263

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessZoonotic 7 /Vectorborne DiseasesTo address zoonotic and vectorborne diseases, HHSwill develop plans to respond to a disease outbreakthat encompasses animal, vector, and human expertsworking in synergy. CDC will develop diseasesurveillance systems that incorporate animal, vector,and human data to provide an effective public healthresponse that will mitigate the impact of a multispeciesoutbreak. CDC will develop, test, and deploy improvedmethods for the detection and control of insectborneviruses and bacteria and will improve the capacity todetect the intentional release of plague, Rabbit Fever(tularemia), and other agents with bioterror potential.FDA will foster the development of preventive vaccinesfor malaria, dengue fever, and other vector-borneand zoonotic diseases by working with industry andacademia. In addition, surveillance, detection, andresponse systems will be developed and tested toaddress domestic and international epidemics ofvectorborne pathogens with the potential to harm theU.S. population.Foodborne/Waterborne IllnessesTo combat foodborne illness, FDA and CDC willwork together to protect public health throughpreventive strategies that improve surveillance,inspection, tracking, detection, investigation,control, and prevention of foodborne outbreaks anddisease; strengthen the enforcement of regulations;and broaden education about these problems. HHSwill improve the important national collaborativesurveillance and response networks of the FoodNet,PulseNet, and OutbreakNet to make them faster,more responsive, and capable of more detailedinvestigations. FDA and CDC, along with the U.S.Department of Agriculture, and other organizations,will continue to participate in the Council to ImproveFoodborne Outbreak Response, a group created todevelop tools that facilitate the investigation andcontrol of foodborne disease outbreaks. Over thenext several years, the Council will develop multistate7 Zoonotic diseases are caused by infectious agents (such asmosquitoes) that can be transmitted between (or are shared by)animals and humans.outbreak guidelines, a repository for resources andtools, and performance indicators for the response toenteric disease.To address waterborne diseases, CDC will continue topartner with EPA to fill critical data gaps by providingimproved disease surveillance data, creating evidencebasedguidelines and training for investigations,expanding access to water-related information,collecting data to define the magnitude and burdenof waterborne illness, evaluating water-relatedinterventions to improve public health, and developinglaboratory sampling and detection methodologies. Aspart of its preparedness effort, CDC will also develop,improve, and deploy rapid sampling and detectionmethods for potential waterborne threats. Providingcomprehensive public health protection to allcommunity users of water will create a more effectiveFederal response aimed at reducing the burden ofwaterborne disease in the United States.Global HealthOne key strategy for preventing the spread of infectiousdisease is preventing it from reaching the UnitedStates. HHS will collaborate with the World HealthOrganization (WHO) and other international partnersto provide epidemiologic and laboratory support toassist countries in addressing disease threats throughimproved disease detection. HHS also will provideprogrammatic expertise, training, and funding supportto assist with surveillance, control, elimination, anderadication activities for diseases such as measles,polio, avian influenza, and HIV/AIDS, as well as theprovision of technical assistance with safe and healthywater and improved sanitation.Immunization has revolutionized child health incountries throughout the world. WHO estimates thatalmost 40 percent of child deaths for children youngerthan 5 years of age are potentially preventable byvaccines. xxi HHS has been a major supporter of globalinitiatives to eradicate polio; control measles; andintroduce new vaccines for pneumoccocal diseases,rotavirus, and possibly in the near future, malariaand even HIV. HHS remains committed to achieving64 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency Preparednessglobal polio eradication and meeting the global targetto achieve a 90 percent reduction in measles mortalityby 2010 as compared to 2000. Efforts to combatvaccine- preventable diseases overseas not only assistglobal efforts at lowering child mortality, but also helpto protect U.S. children from susceptibility to thesedebilitating diseases.One specific set of activities that HHS will continuein support of its global health strategy is in the areaof malaria prevention. CDC supports prevention andcontrol of malaria throughout the world in partnershipwith local, State, and Federal agencies in the UnitedStates; medical and public health professionals;national and international organizations; and foreigngovernments. Specific strategies include conductingmalaria surveillance, prevention, and control activitiesin the United States; providing consultation, technicalassistance, and training to malaria-endemic countriesto change and implement proven policies to decreasemalaria burden; conducting multidisciplinary researchin the laboratory and in the field, to develop new toolsand improve existing interventions against malariaworldwide; and translating research findings intoappropriate global policies and effective practicesthrough the Roll Back Malaria Partnership and otherinternational partners.HHS will continue to work with other Federalpartners to control malaria through participationin the President’s Malaria Initiative (PMI), anintergovernmental initiative led by the United StatesAgency for International Development (USAID), CDC,NIH, the U.S. Departments of State and Defense, andthe National Security Council. The goal of PMI is toreduce malaria deaths by half in each target countryafter 3 years of full implementation. The initiativehelps national governments deliver proven, effectiveinterventions—insecticide-treated bed nets, indoorresidual spraying, prompt and effective treatmentwith artemisinin-based combination therapies, andintermittent preventive treatment to people at greatestrisk, pregnant women and children younger than 5years old. As of June 2007, work is ongoing in the firstthree PMI countries (Angola, Tanzania, and Uganda) aswell as the four added in 2006 (Malawi, Mozambique,Rwanda, and Senegal). Later in 2007, activities willbegin in the final eight countries (Benin, Ethiopia,Ghana, Kenya, Liberia, Madagascar, Mali, and Zambia),which will bring the program to its full complement of15 countries with a high burden of malaria in Africa.Additional information about HHS’s efforts in globalhealth can be found later in this chapter in In theSpotlight: Global Health Initiatives.HHS Strategic Plan FY 2007-201265

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessStrategic Objective 2.2Protect the public against injuries andenvironmental threats.Injuries are the leading cause of death among childrenand adults younger than 44 years of age in the UnitedStates. About 160,000 people die each year in theUnited States from injuries; millions more are injuredand survive xxii ; and nearly 30 million people sustainedinjuries serious enough to require treatment in anemergency room. Many injured people are left withlong-term disabilities.HHS has a particular responsibility to provide thescience base needed to reduce occupational injuries;the performance indicators at the end of this chaptermeasure this progress. CDC conducts the majority ofinjury prevention activities that support this objective.CDC focuses on strategies to address interpersonalviolence, residential fires, falls, and workplaceinjuries and mortality. These include identifying riskfactors, conducting surveillance, and supportingimplementation activities.Workplace InjuriesCDC promotes safe and healthy workplaces throughinterventions, recommendations, and capacity building.To achieve the objective of protection against injuriesin the workforce population, CDC actively engagesemployers to promote commercial motor vehicle safetyby providing technical assistance and disseminatingHazard Alerts and Fact Sheets that present practicalprevention strategies in both English and Spanish.CDC also works with the Mine Safety and HealthAdministration on the joint committee examining howthe newly developed personal dust monitor (PDM) canbe utilized on a daily basis in underground coal mines.The PDM, recently developed by CDC in collaborationwith manufacturers, labor, and industry, assesses coalminers’ exposure to coal dust in underground mines andrepresents the first advancement in more than 30 yearsfor monitoring exposures.66 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessFire-Related Injury PreventionCDC will continue to support State programs tomonitor, identify, and track fire-related injuries andto expand smoke alarm installation and fire safetyeducation programs in communities at high risk.Environmental HazardsInteractions between people and their environmentalso pose a risk to their health. Environmentalhealth hazards include water pollutants, chemicalpollutants, air pollutants, mold, and radiation fromnatural, technologic, or terrorist events. HHS works incollaboration with other Departmental-level agencies,including EPA and the U.S. Department of Labor’sOccupational Safety and Health Administration, toaddress environmental hazards. To support this largerFederal effort, HHS will conduct targeted preventionand surveillance activities aimed at raising awarenessof, monitoring, and mitigating threats. CDC and FDAwill support this effort by using existing technologiesand methods to measure the exposure to environmentalchemicals in humans and the food supply. CDC also willinvestigate new technologies and methods to expand thenumber of chemicals measured in humans.Childhood Lead Poisoning PreventionCDC is addressing the problem of childhood leadpoisoning through provision of funding and technicalassistance to State and local childhood lead poisoningprevention programs. These programs are working toensure that screening, lead-hazard reduction, modellegislation, and other prevention mechanisms occurthroughout the country. CDC will build on these effortsby developing and disseminating guidance for theproper treatment of children after they are identified ashaving elevated blood levels.Violence Against WomenHHS has developed a Violence Against Women SteeringCommittee, which coordinates the HHS response toissues related to violence against women and theirchildren. This committee, led by ASH, comprisesrepresentatives from ACF, AoA, CDC, FDA, HRSA, NIH,OPHS, the Office of the Secretary, and SAMHSA. Thecommittee is also responsible for coordinating HHSviolence-related activities with those of other Federalagencies. This steering committee will work to refineand focus HHS’s activities on addressing violenceagainst women. More information about HHS’s effortsto address family violence can be found in StrategicGoal 3, Objective 3.1.Youth Violence PreventionCDC funds Academic Centers of Excellence to developand implement community response plans to preventyouth violence. These Centers also train healthprofessionals and conduct youth violence preventionresearch projects. CDC will continue funding theseCenters. The agency also will identify modifiablerisk factors that protect adolescents from becomingvictims or perpetrators of violence and will increasepublic awareness regarding dating violence amongadolescents through interactive programs such asChoose Respect.HHS Strategic Plan FY 2007-201267

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessStrategic Objective 2.3Promote and encourage preventive healthcare, including mental health, lifelong healthybehaviors, and recovery.Chronic diseases—such as heart disease, cancer, anddiabetes—are among the leading causes of death anddisability in the United States. These diseases accountfor 7 of every 10 deaths and affect the quality of life of90 million Americans. xxiii Although chronic diseases areamong the most common and costly health problems,they are also among the most preventable.AHRQ, AoA, CDC, CMS, FDA, HRSA, IHS, OD, OPHS,and SAMHSA currently support a variety of programsand initiatives aimed at reducing the prevalence ofchronic diseases and helping people with chronicconditions manage their diseases more effectively.State and local health departments, national andinternational health organizations, philanthropicfoundations, and professional, voluntary, andcommunity organizations are key partners in thesehealth promotion and disease prevention activities.In the period of 2007–2012, these agencies willcontinue to support these activities and will work toexpand, enhance, and improve their effectiveness.The Department selected key performance indicatorsthat represent a broad array of activities, includingcardiovascular health, cancer screening, and programsto reduce substance abuse and suicide.Preventive ServicesA paradigm shift has occurred in health care, resulting ina renewed emphasis on prevention. To reap the benefitsof prevention, both health care providers and health careconsumers must first understand what those benefitsare. The Medicare Prescription Drug, Improvement, andModernization Act (MMA) of 2003 (Public Law 108-173)expanded Medicare’s menu of preventive benefits bycovering an initial preventive physical examination. Thisbenefit, also referred to as the “Welcome to Medicare”visit, allows new Medicare beneficiaries to get up-to-dateinformation on important screenings and vaccinations,as well as to talk with their health care provider about68 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency Preparednesstheir medical history and how to stay healthy. Allbeneficiaries enrolled in Medicare Part B with effectivedates that begin on or after January 1, 2005, will becovered for this benefit.The Welcome to Medicare visit enables the health careprovider to provide a comprehensive review of his orher patient’s health, to identify risk factors that maybe associated with various diseases, and to detectdiseases early when outcomes are best. The healthcare provider is also able to educate his or her patientabout the Medicare-covered services they need in orderto prevent, detect, and manage disease; to counselthem on identified risk factors and possible lifestylechanges that could have a positive impact on theirhealth; and to make referrals or followup appointmentsfor necessary care. CMS will continue to support andconduct outreach related to the Welcome to Medicarebenefit to increase beneficiaries’ utilization.Although Medicare pays for many critical preventivescreenings, fewer than 1 in 10 adults aged 65 orolder receive all recommended screenings andimmunizations. CDC’s Healthy Aging Program willcontinue to support a model program, SicknessPrevention Achieved through Regional Collaboration(SPARC), which has shown significant success inbroadening the use of preventive services. SPARCpromotes public access to services, helps medicalpractices provide preventive services, and strengthenslocal accountability for service delivery.AHRQ accomplishes adoption and delivery of evidencebasedclinical prevention services to improve thehealth of Americans through two main avenues: workin support of the United States Preventive ServicesTask Force (USPSTF) and Prevention Portfolio effortsaimed at dissemination and implementation of theTask Force’s recommendations. As the USPSTF makesevidence-based recommendations, it is the job ofAHRQ to get the word out to clinicians and the generalpublic as rapidly as possible. Accomplishing this goalmore quickly puts actionable information into thehands of clinicians, guiding them to perform indicatedservices and not to perform services for which theevidence indicates more harm than benefit. Getting theword out increases the delivery of appropriate clinicalpreventive services. Clinicians and policymakers acrossthe Nation hold the work of the USPSTF in high regard.Heart Disease and StrokeHeart disease and stroke are the most commoncardiovascular diseases. For both men and womenin the United States, heart disease and stroke are thefirst and third leading causes of death, respectively,accounting for nearly 40 percent of annual deaths. xxivAlthough these largely preventable conditions are morecommon among people 65 years or older, the numberof sudden deaths from heart disease among peopleaged 15 years to 24 years has increased. The economicimpact of cardiovascular disease on the Nation’s healthcare system continues to grow as the population ages.A key strategy for HHS in addressing heart diseaseand stroke and its risk factors is educating healthpractitioners and the public about the importanceof prevention, about the signs and symptoms ofheart attack and stroke, and about the importance ofcalling 911 quickly. To make women more aware ofthe danger of heart disease, the National Heart, Lung,and Blood Institute at NIH has collaborated withother organizations to sponsor a national campaigncalled The Heart Truth. The campaign’s goal is to raisewomen’s awareness about their risk of heart disease,and has resulted in striking improvements in women’sawareness of heart disease and their acknowledgmentof personal risk. CDC’s Heart Disease and StrokePrevention Program will continue to help States controlhigh blood pressure and high blood cholesterol, bothof which are risk factors for cardiovascular diseases,among residents; increase awareness of the signsand symptoms of heart attack and stroke; improveemergency response; improve quality of care; andeliminate health disparities. Medicare’s preventiveservices cover cardiovascular disease screenings.HHS will continue to provide national leadership toprevent death and disability from heart disease andstroke and to expand support to State cardiovasculardisease prevention efforts. FDA also contributes toprevention of heart disease through its food labelingHHS Strategic Plan FY 2007-201269

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency Preparednessregulations. For example, the recent requirementfor trans-fat information on food labels providesconsumers with additional information on the fatcontent of packaged foods. Reductions in consumptionof trans-fatty acids are expected to reduce the risk ofheart disease significantly.CancerCancer is the second leading cause of death in theUnited States and costs approximately $210 billionannually. xxv Cancer does not affect all racial or ethnicgroups equally. African-Americans are more likely todie of cancer than any other racial or ethnic group,revealing a large health disparity related to this disease.CDC’s National Comprehensive Cancer Control Programfunds States, territories, and tribes to build coalitions,assess the burden of cancer, determine priorities, anddevelop and implement comprehensive cancer controlprograms. These programs help communities acrossthe country to reduce cancer risks, detect cancersearlier, improve cancer treatment, and enhance qualityof life for cancer patients. CDC is supporting theseprograms to ensure that cancer prevention and controlreaches those at highest risk of developing cancer andin the greatest need of assistance.CDC’s National Program of Cancer Registries collectsdata on the occurrence of cancers through Stateand territorial registries. CDC is supporting cancerregistries throughout the United States to enable publichealth professionals to better understand and addresscancer and its causes.Making cancer screening, information, and referralservices available and accessible to all Americans isessential for reducing the high rates of cancer andcancer deaths. CDC’s National Breast and CervicalCancer Early Detection Program will continue tosupport screening and diagnostic exams for lowincomewomen with little or no health insurance. Theprogram will also support education and outreach,and case management services. CDC’s prostate cancercontrol initiatives support information disseminationto the public, physicians, and policymakers about therisks and benefits of prostate cancer screening.70 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessFDA advances cancer prevention through thedevelopment and licensure of cancer preventionvaccines.Included in Medicare’s menu of preventive services arescreenings for colorectal and prostate cancer, as well asannual mammograms for women 40 years and older.Overweight and ObesityOver the last 20 years, rates for overweight and obesityhave increased dramatically in the United States.Obesity has now reached epidemic proportions. CDCreports that two-thirds of noninstitutionalized U.S.adults age 20 and older are overweight or obese; a thirdare obese. xxvi The epidemic is not limited to adults,however. The percentage of young people who areoverweight has more than doubled in the last 20 years.People who are obese are at increased risk for heartdisease, high blood pressure, diabetes, and some cancers.CDC, FDA, and OPHS are the primary HHS operatingdivisions working to reduce obesity and overweight inthe United States, with a focus on improving nutritionand increasing physical activity. CDC will continue tosupport efforts to address obesity through provisionof technical assistance, training, and consultationto funded State programs. CDC and its partnerscreate, evaluate, and monitor programs, policies, andpractices to prevent and control obesity. CDC willexpand communication efforts to promote physicalactivity and good nutrition in worksites, schools, andhealth care settings.FDA also contributes to obesity control through itsfood labeling regulations and education programs.For example, Make Your Calories Count, FDA’s Webbasedlearning program, helps consumers makeinformed choices that contribute to lifelong healthyeating habits.The OD physical fitness program, I Can Do It, You CanDo It, targets the obesity and overweight challenges ofchildren and youth through physical exercise basedon the awards system of the President’s Committeeon Physical Fitness and Sports Program. The programincludes a mentee-mentor relationship and anevaluation component.HHS Strategic Plan FY 2007-201271

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessIn addition, Dietary Guidelines for Americans providesscience-based advice to promote health and to reducerisk for major chronic diseases and conditions, throughdiet and physical activity. Major causes of morbidity andmortality in the United States are related to poor diet anda sedentary lifestyle. Combined with physical activity,following a diet that does not provide excess calories,according to the recommendations in this document,should enhance the health of most individuals.As a companion to the Dietary Guidelines for Americans,HHS will work over the next 2 years to developcomprehensive guidelines, drawn from science, tohelp Americans fit physical activity into their lives.The Physical Activity Guidelines for Americans will beissued in late 2008. The Physical Activity Guidelineswill summarize the latest knowledge about activityand health, with depth and flexibility targeting specificpopulation subgroups, such as older adults and children.This work is inspired by the President’s personaldedication to physical fitness and his desire that everyAmerican have access to science-based guidelines.DiabetesIn the last 15 years, the number of people in theUnited States with diagnosed diabetes has more thandoubled, reaching 14.6 million in 2005. xxvii Diabetes,which is also associated with overweight and obesity,can cause heart disease, stroke, blindness, kidneyfailure, pregnancy complications, lower extremityamputations, and deaths related to influenza andpneumonia. In addition to the millions of Americanswith diabetes, an estimated 41 million adults aged 40to 74 are prediabetic and are at high risk of developingdiabetes. xxviii The increasing burden of diabetes andits complications is alarming. However, much ofthis burden could be prevented with early detection,improved delivery of care, and better education ondiabetes self-management.CDC monitors the burden of diabetes nationally andwill continue to explore better ways to collect diabetesdata on groups most at risk. CDC also provides fundingfor capacity building and program implementationto States and territories for diabetes prevention andcontrol programs. Over the next 5 years, CDC willexpand the number of implementation grants afterfirst developing grantee capacity through phase onecapacity grants.CDC also works with NIH to support diabeteseducation. These operating divisions will continueto collaborate to enhance the network of more than200 public and private partners who work to increaseknowledge about diabetes and its control amonghealth care providers and people with or at risk fordiabetes. IHS also will support diabetes preventionand control through mobilizing and involvingAmerican Indian/Alaska Native communities topromote diabetes management strategies. ForMedicare beneficiaries diagnosed with prediabetesand those previously tested who have not beendiagnosed with prediabetes, or those who have neverbeen tested for the disease, diagnostic screeningtests are available. For Medicare beneficiaries withdiabetes, Medicare offers Diabetes Self-ManagementTraining and Medical Nutrition Training.Oral HealthMouth and throat diseases, which range from cavitiesto cancer, cause pain and disability for millions ofAmericans each year. This fact is disturbing becausealmost all oral diseases can be prevented. For children,cavities are a common problem that begins at an earlyage. Tooth decay is also a problem for U.S. adults,especially for the increasing number of older adultswho have retained most of their teeth. Despite thisincrease in tooth retention, tooth loss remains aproblem among older adults.CDC is the lead Federal agency responsible forpromoting oral health through public healthinterventions. CDC has and will continue to assistStates in strengthening their oral health programs,reaching people hardest hit by oral diseases, andexpanding the use of measures that are proven effectivein preventing oral diseases. CDC currently provides 12States with funds, technical assistance, and trainingto build strong oral health programs. Eight of the12 States receive funding to develop and coordinate72 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency Preparednesscommunity water fluoridation programs or schoolbaseddental sealant programs. With CDC support,States can better promote oral health, monitor oralhealth behaviors and problems, and conduct andevaluate prevention programs.Substance Use/AbuseThe use of alcohol, tobacco, and illicit drugs exacts asignificant health and economic toll on individualsand communities in the United States. In 2005, 19.7million (8.1 percent) Americans aged 12 years and olderused an illicit drug, 71.5 million (29.4 percent) used atobacco product, and 126 million (51.8 percent) usedalcohol. xxix Tobacco use is the leading preventablecause of death in the United States, resulting inapproximately 440,000 deaths each year. xxxCDC supports basic implementation programsto prevent and control tobacco use in the States,territories, and tribal areas. CDC also works witha variety of national and international partners topromote action through partnership in tobacco controlefforts with WHO and WHO Member States. Buildingon these existing activities and partnerships, CDCwill work to engage business sectors in supportingcomprehensive tobacco prevention and controlprograms, including the benefits of tobacco-freeworkplaces and the importance of access to cessationservices to employees who are trying to quit smoking.For Medicare beneficiaries who use tobacco, cessationcounseling is a covered preventive service.As part of its efforts to reengineer its approach tosubstance abuse prevention, SAMHSA has createda strategic framework that is built on science-basedtheory, evidence-based practices, and the knowledgethat effective prevention programs must engageindividuals, families, and entire communities. SAMHSA’snew Strategic Prevention Framework (SPF) sets intoplace a step-by-step process that empowers States andcommunities to identify their unique substance useproblems, build or enhance infrastructure to supportsolutions, and implement the most effective preventionefforts for their specific needs. It also includesmonitoring and evaluation to ensure accountabilityHHS Strategic Plan FY 2007-201273

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency Preparednessand effectiveness of the program effort. SAMHSA willcontinue to utilize the SPF and expand its use through itsState and local grant programs.Suicide PreventionFor every two victims of homicide in the United States,there are three Americans who take their own lives.Suicide is a potentially preventable public healthproblem. Studies of youth who have committed suicidehave found that 90 percent had a diagnosable mentaland/or substance abuse disorder at the time of theirdeath. xxxi SAMHSA supports activities authorized by theGarrett Lee Smith Memorial Act of 2004 (Public Law 108-355), which support statewide youth suicide interventionand prevention strategies in schools, institutions ofhigher education, juvenile justice systems, substanceabuse and mental health programs, foster care systems,and other youth support organizations. Additionally,OD is working on an initiative to understand and helpprevent suicide among persons with disabilities andthose who incur disabilities.Risk ReductionChronic conditions currently limit activities for 12million older people living in community settings inthe United States; 25 percent of these individuals areunable to perform basic activities of daily living, suchas bathing, shopping, dressing, or eating. Furthermore,falls are the leading cause of injury-related deaths andhospital admission among older people and account forbetween 20 billion and 30 billion health care dollars inthe United States each year. These numbers will increasedramatically in the coming years with the aging of theBaby Boom Generation. AHRQ, AoA, CDC, CMS, andNIH contribute to research, demonstrations, the settingof national standards and guidelines, and the provisionof grants and technical assistance to help older adultsmanage their chronic diseases and prevent falls and toencourage them to live healthy and active lifestyles.For example, AoA funds an Evidence-Based Disabilityand Disease Prevention grant program and public/private partnership which deploys proven disabilityand disease prevention programs at the communitylevel that empower older individuals to makebehavioral changes that will reduce their risk of disease,disability, and injury. AHRQ and AoA, in collaborationwith CDC, CMS, and NIH, are developing and testinga special Knowledge Transfer program targeted atState and local agency staff to promote and facilitatethe utilization of evidence-based disease preventionprograms for older people at the community level. CDCfunds fall prevention research, research dissemination,and research translation and implementation that helpdecrease falls and increase stability in mobile olderadults. CMS is demonstrating a health promotion anddisease prevention program through the MedicareSenior Risk Reduction Demonstration to determinewhether health risk reduction programs that have beendeveloped, tested, and shown to be effective in theprivate sector can be tailored to the Medicare programto help beneficiaries improve their health and thusreduce the need for health care services.74 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessStrategic Objective 2.4Prepare for and respond to natural andmanmade disasters.The Pandemic and All-Hazards Preparedness Act of2006 (PAHPA; Public Law 109-417) codified the HHSSecretary’s role as lead for the Federal public health andmedical response to emergencies and incidents coveredby the National Response Plan (NRP), and authorizesHHS’s operational control of Federal public healthand medical response assets during these events. 8 Inaddition, the development of the Homeland SecurityCouncil’s National Strategy for Pandemic Influenza hasstressed the importance of preparedness for naturaland manmade disasters that have public health impact.Many of the strategies undertaken by HHS to achievepreparedness and response capability are done inconcert with or in support of other Federal departmentsand agencies, State and local governments, and privatesector entities. This collaborative approach is vitalgiven that public health emergencies have the potentialto affect nearly every sector of society. One of HHS’slargest investments is to develop and stockpile thecountermeasures needed to respond to the most seriousdisasters. Consequently, a performance indicator listedat the end of this chapter assesses the readiness of Statesto utilize these supplies. A second indicator focuses onthe extent to which State emergency management planscover the broad array of individuals with special needs,specifically measuring plans for those with disabilities.The Office of the Assistant Secretary for Preparednessand Response (ASPR) is the single office responsible forpreparedness and response activities within HHS. As theprincipal advisor to the Secretary on all matters relatedto public health and medical preparedness and responseemergencies, ASPR leads and promotes a collaborativeapproach with many partners, including ACF, AoA, CDC,CMS, FDA, HRSA, OPHS, and SAMHSA. For additionalinformation on this topic, see In the Spotlight: EmergencyPreparedness, Prevention, and Response.8 An exception to this authorization is those assets under thecontrol of the U.S. Department of Defense.HHS Strategic Plan FY 2007-201275

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessKey strategies that will be used to enhance publichealth and medical emergency preparedness andresponse include:• Developing the National Health Security Strategy,starting in 2009;• Awarding cooperative agreements to States orother eligible entities to conduct the activities ofthe National Health Security Strategy; and• Reintegrating the National Disaster MedicalSystem within HHS.A major focus of preparedness activities will bethe implementation of the Biomedical AdvancedResearch and Development Authority (BARDA), andcountermeasures development. The internationalpreparedness activities include the InternationalHealth Regulations, which will come into force inJune 2007. These regulations require members todevelop, strengthen, and maintain core surveillanceand response capacities to detect, assess, notify, andreport public health events to WHO and respond topublic health risks and public health emergencies.WHO, in turn, will evaluate members’ public healthcapacities, promote technical cooperation, offerlogistical support, and facilitate the mobilizationof financial resources for building capacity insurveillance and response.Workforce ReadinessHHS will identify, put on a roster, and train deployableteams of medical and public health providers, includingHHS personnel (both commissioned officers and civilservice employees), other Federal employees, andvoluntary staff. HHS meets regularly with its ESF-8 9Federal partners to identify missions, form teamswith the skills needed to meet the missions, identifytraining and equipment requirements, and initiate9 Emergency Support Function (ESF)-8—Health and MedicalServices. ESF-8 provides coordinated Federal assistance tosupplement State and local resources in response to public healthand medical care needs after a major disaster or emergency, or duringa developing potential medical situation. Assistance provided underESF-8 is directed by HHS through its executive agent, ASPR.76 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency Preparednesstraining. HHS has identified the logistical supportneeds for these teams and has developed specific tasksfor meeting these logistical needs. Examples of theseneeds include medical supplies, equipment, housing,and food requirements.This activity builds upon the transformationactivities of the Commissioned Corps of the USPHS(Commissioned Corps). The Commissioned Corpsprovides a unique source of well-trained, highlyqualified, dedicated public health professionals whoare available to respond rapidly to urgent publichealth challenges and health care emergencies.The Commissioned Corps’ response to HurricaneKatrina is a powerful example of what its officerscan do. In response to Hurricane Katrina, theCommissioned Corps deployed more than 2,000officers—the largest deployment in its history—andstill has personnel in the field providing care inLouisiana today. The transformation will facilitateforce management improvements that are necessaryfor the Commissioned Corps to function even moreefficiently and effectively. The current activity usingrosters is aimed at structuring officers into teams,and then training them as a team. This approachdefines clarity of roles and expectations, and assuresthat leadership and management of the officers in thedeployed situation are well understood and their rolesare executable.These teams will interface with the DisasterMedical Assistance Teams (DMATs) fielded underthe National Disaster Medical System (NDMS).The greatest utility of the DMATs is in immediateemergency response, and they are considered theinitial responders for emergency medical needsduring the first 72 hours after an event. HHSand other Federal agencies will be responsiblefor the other requirements in the continuum ofhealth needs, including some aspects of healthservices delivery during evacuation, hospital care,low-intensity facility-based care for populationswith special needs (such as chronic diseases anddisability), and other health outreach activities.Threat Agent IdentificationCDC and FDA will continue to develop and supportlaboratory capacity expansion to improve analysisof biological or toxic substances that uses validated,proven methods for different sample matrices.CDC and FDA will also support the developmentand validation of laboratory methods for prioritybiological and toxic substances through theLaboratory Response Network.Emergency PreparednessHHS administers two major grant programs thatsupport State and local capacities, as well ascapabilities to prepare for and respond to public healthemergencies. Over the next 5 years, these programs willshift dramatically, from a focus on capacity building toimproving targeted capabilities.ASPR administers the National Bioterrorism HospitalPreparedness Program, which, through States, enhancesthe ability of the health care system, includinghospitals, to prepare for and respond to bioterrorismand other public health emergencies. Program priorityareas over the next 5 years include improving bed andpersonnel surge capacity, decontamination capabilities,isolation capacity, and pharmaceutical supplies, as wellas supporting training, education, drills, and exercises.CDC administers the Public Health Emergency PreparednessCooperative Agreement Program, which provides fundsto States and localities for State and community-levelpreparedness. Over the next 5 years, HHS will placeincreased emphasis on achieving benchmarks andstandards for preparedness by recipients of both fundingstreams as required by PAHPA.CountermeasuresHHS, through all of its operating divisions, seeksto shape and execute a comprehensive medicalcountermeasures program to protect our citizensagainst the threats of today and into the future. Thismission encompasses the breadth of activities requiredto accomplish that goal, including threat agentmonitoring and disease surveillance and detection,as well as research, development, acquisition,HHS Strategic Plan FY 2007-201277

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency Preparednessstorage, deployment, and utilization of medicalcountermeasures. NIH leads the effort for medicalcountermeasure basic research, early stage productdevelopment, and clinical research. FDA is committedto facilitating the development and availability of safeand effective medical countermeasures. CDC hasresponsibilities including disease monitoring throughits infectious disease surveillance program and medicalcountermeasure storage and deployment throughits Strategic National Stockpile (SNS) program. TheSNS procures and stores large quantities of medicineand medical supplies to protect the Americanpublic if there is an emergency (e.g., terrorist attack,influenza pandemic, or earthquake) severe enoughto cause local supplies to run out. HHS will continueto invest in research and development of medicalcountermeasures, procure safe and effective materialsfor the SNS, and work with States to ensure thatthey are prepared to request, receive, and utilize SNSmaterials in the case of a public health emergency.Pandemic InfluenzaHHS pandemic influenza implementation activitiessupport the larger National Strategy for PandemicInfluenza, and many are conducted in concert with orin support of other Federal departments and agencies.The key strategies for pandemic influenza preparednessfocus on international activities; domestic surveillance;public health interventions; medical response; vaccines,antivirals, diagnostics, and personal protective equipment;passive and active surveillance for vaccine safety;communication; and support for State, local, and tribalpreparedness. HHS, primarily through ASPR, CDC, FDA,NIH, and OPHS, will continue to support the NationalStrategy by completing actions in these strategy areas.One major area of focus will be building the prepandemicand pandemic influenza vaccine production capacity andvaccine supply. In April 2007, FDA approved the first U.S.vaccine for humans against the H5N1 influenza virus. FDAwill continue to facilitate advanced product developmentof both seasonal and pandemic influenza medicalcountermeasures, including novel vaccines, antivirals,and rapid diagnostics. This will be accomplished byproviding assistance to industry partners on domesticmanufacturing capabilities, accelerating the reviews ofseasonal and pandemic influenza related products, andissuing guidance to external stakeholders on variousregulatory subjects, including clinical requirements forlicensure of seasonal and pandemic influenza vaccines.HHS agencies also will work closely with other Federalagencies and international partners, such as WHO and theministries of health in target countries. HHS has forwarddeployeda quantity of Tamiflu in Asia for the purposesof mounting a containment operation to attempt tohalt a potential influenza pandemic. In addition, HHSis engaged in a number of international pandemicpreparedness activities, through the InternationalPartnerships on Avian and Pandemic Influenza, the Securityand Prosperity Partnership of North America, and theGlobal Health Security Initiative.People With DisabilitiesUnder Executive Order 13347, all Federal emergencypreparedness efforts must address the needs ofindividuals with disabilities and other vulnerablepopulations. HHS has taken a leadership role inengaging the disability community and providingguidance to partners to address the unique healthneeds of individuals with disabilities and othervulnerable populations, including children and youthwith special health care needs. In 2006, HHS and theU.S. Department of Homeland Security cosponsored aworking conference for State emergency preparedness,public health, aging, and disability agencies to facilitatedialog and collaboration among these organizationstoward the common goal embodied in the ExecutiveOrder. The result has been a living laboratory for Stateand Federal cooperation and shared learning aroundthe issue of emergency preparedness for vulnerablepopulations. OD and ASPR will implement andmonitor the use of the disability-based preparednesstoolkit and public health staff training modules—developed by a broad-based HHS workgroup—toensure that the needs of children, youth, and adultswith disabilities and chronic conditions are fullyunderstood by first responders and other emergencyresponse providers at the Federal, tribal, State, andlocal levels during all emergency situations.78 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessASPR, OD, and OCR are working with the AmericanRed Cross to develop an intake and assessment toolthat will be used at shelters to evaluate the functionalneeds of all individuals, including individuals withdisabilities. This tool will help ensure that individualswith disabilities have equal access to shelter servicesand are served in the most integrated settingappropriate. On the local level, OCR’s 10 regionaloffices are working with other offices in HHS and Statesto provide technical assistance and resources to planfor and respond to needs of individuals with disabilitiesin the event of an emergency.Protected Health Information. In its review of Stateand local emergency plans issued in the summer of 2006,the U.S. Department of Homeland Security identifiedmisunderstanding and confusion surrounding theapplication of the HIPAA Privacy Rule protections toinformation sought for emergency response planningpurposes. OCR has implemented a new Web-basedinteractive decision tool designed to assist emergencypreparedness and recovery planners in determininghow to access and use health information consistentwith the HIPAA Privacy Rule. The tool guides emergencypreparedness and recovery planners through a seriesof questions regarding how to apply the HIPAA PrivacyRule. The tool is available on OCR’s Web site alongwith bulletins containing information for emergencyproviders on the disclosure of protected healthinformation to assist with disaster relief efforts.Equal AccessOCR has taken steps, consistent with a FederalGovernmentwide effort, to help ensure that individualswith Limited English Proficiency (LEP) have equal accessto information, shelters, and other evacuation and reliefefforts. For example, OCR is working with ASPR and theAmerican Red Cross to develop an intake and assessmenttool that will be used at shelters to identify and addresscommunication needs of individuals with LEP. On thelocal level, OCR’s regional offices are working with HHSpartners and States to provide technical assistanceand resources to plan for and respond to the needs ofindividuals with LEP in the event of an emergency.Information Technology SupportHHS will be developing a deployable, interoperable firstresponder electronic health record system. The electronichealth record system for disasters will maintain thesecurity and confidentiality of health information. Theintention is to field test possible platforms during the 2007hurricane season to gain insight into their benefits andlimitations. There are few existing systems and standardsin the broader health environment to interact with at thistime, so the expected benefits are to ensure quality of careand continuity of information sharing during a publichealth emergency and its aftermath. Wider health sectorstandards development and endorsement by the HealthInformation Technology Standards Panel and the Secretarywill be completed to capitalize on the desired benefits ofthis approach toward continuity and quality of care.HHS Strategic Plan FY 2007-201279

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessPerformance IndicatorsMost Recent ResultFY 2012 TargetStrategic Objective 2.1Prevent the spread of infectious diseases.2.1.1Achieve or sustain immunization coverage ofat least 90% in children 19 to 35 months of agefor:a) 4 doses of Diphtheria-Tetanus-Pertussis(DtaP) vaccine;b) 3 doses of polio vaccine;c) 1 dose of Measles-Mumps-Rubella (MMR)vaccine;d) 3 doses of hepatitis B vaccine;e) 3 doses of Haemophilus influenzae type b(Hib) vaccine;f) 1 dose of varicella vaccine; andg) 4 doses of pneumococcal conjugatevaccine (PCV7).a) DTaP: 86%;b) Polio: 92%;c) MMR: 92%;d) Hepatitis B: 93%;e) Hib: 94%;f) Varicella: 88%; andg) PCV7: 83%.At least 90%2.1.2Increase the proportion of people with HIVdiagnosed before progression to AIDS.76.5% 81%Reduce the incidence of infection with keyfoodborne pathogens:Cases/100,000:Cases/100,000:2.1.3a) Campylobacter;b) Escherichia coli O157:H7;a) 12.72;b) 1.06;a) 12.30;b) 1.00;c) Listeria monocytogenes; andc) 0.30; andc) 0.23; andd) Salmonella species.d) 14.55.d) 6.80.Increase the rate of influenza vaccination:2.1.4a) in persons 65 years of age and older; andb) Among noninstitutionalized adults andhigh risk, aged 18 to 64.a) 59.6%; andb) 25.3%.a) 90%; andb) 60%.80 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessMost Recent ResultFY 2012 TargetStrategic Objective 2.2Protect the public against injuries and environmental threats.2.2.1a) Reduce nonfatal work-related injuriesamong youth ages 15 to 17; andb) Reduce fatal work-related injuries amongyouth ages 15 to 17.a) 4.4/100 FTE 10 ; and a) 4.2/100 FTE; andb) 2.7/100,000 FTE. b) 2.8/100,000 FTEStrategic Objective 2.3Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery.2.3.1Reduce complications of diabetes amongAmerican Indians and Alaska Natives byincreasing the proportion of patients withdiagnosed diabetes that have achieved bloodpressure control (

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessMeeting External ChallengesWithin the Public Health Promotion and Protection,Disease Prevention, and Emergency Preparedness goal,changes in population demographics, shifts in burdenof disease, uncertainty related to the scope and timingof public health emergencies, and the potential threat ofzoonotic diseases will significantly influence the abilityof HHS to achieve the objectives related to this goal.As the Nation’s population ages, a greater proportionof Americans will be older and expected to livelonger. These shifts will result in an increased chronicdisease burden and a greater need for public healthinterventions to prevent or control these diseases. HHSwill work to mitigate these effects by promoting thetranslation of the evidence base for health promotionand disease prevention for older adults at thecommunity level. HHS also will continue to developand implement cost-effective models to supportincreasingly frail older adults in their homes.A shifting distribution in disease burden also affects theability of HHS to achieve its public health objectives.For example, HIV-related disease and affectedpopulations will result in an expansion of the numberof HIV-infected individuals who need treatment andrelated care. Infections in new subpopulations could bedifficult to identify, reach, and serve. HHS is developingimproved disease surveillance and outreach strategiesto identify and reach newly affected populations inthe United States. HHS also is providing assistance toservice providers in planning and capacity-buildingefforts to meet these changes.In the public health emergency preparednessarena, external factors represent both threatsand opportunities. First, the unexpected scope ofemergencies in terms of probability of occurrence,place, time, and type makes resource allocation andtargeting a significant challenge. A hurricane can resultin significant public health consequences as HurricaneKatrina did in 2005, or may result in little or no healthimpact. A bioterrorist attack could be widespread,occur simultaneously in multiple locations, or belimited to one room in one building. HHS is addressing82 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency Preparednessthis uncertainty by planning for multiple scenariosin its all-hazards preparedness program. HHS alsois providing guidance to help States and localitiesenhance their capacity to respond to natural ormanmade disasters of varying severity and scope.Second, external factors also provide opportunities forshared planning, response, and evaluation. By workingwith our Federal, State, local, and tribal partners,we can leverage resources and personnel to improveoverall level and quality of both preparedness andresponse.Emerging pathogens, many of which are zoonotic inorigin, also affect emergency preparedness. Becausethe habitats of animals and people are inextricablylinked, there is an increased possibility for exposureto zoonotic diseases. HHS understands this link,and is coordinating strategies to mitigate zoonoticdiseases that originate in animals in order to protectboth animal and human health. HHS collaborateswith other Federal departments and agencies andinternational organizations that focus on animalhealth, as well as with State governments and academicinstitutions, to address zoonotic diseases.HHS Strategic Plan FY 2007-201283

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessEmergency Preparedness,Prevention, and ResponsePublic Health/Medical EmergenciesThe last several years have seen an increased emphasison preparing for and responding to public healthemergencies. The September 11, 2001, terrorist attacksand the anthrax incidents later that year generatedsignificant change at the Federal, State, and locallevels in terms of public health law, infrastructure,programming, and coordination to address preparednessand response issues. Infectious disease outbreaks suchas SARS and the fear of an influenza pandemic have onlyamplified interest in public health preparedness.The range of potential public health emergencies isbroad—terrorist attacks using chemical, biological,radiological, and nuclear agents; emergingand reemerging infectious diseases; accidentalcontamination of food and water supplies; andnatural disasters, including hurricanes, earthquakes,and tornadoes. The varying nature and scope ofpublic health emergencies requires an all-hazardsapproach to planning and response.Preparedness at All LevelsHHS serves as the primary agency for EmergencySupport Function (ESF)-8— preparedness andresponse to the health consequences of disasters,including terrorist incidents involving weapons of massdestruction—under the National Response Plan (NRP).The NRP is designed to engage the response assets ofmultiple public and private partners and bring themto bear in a coordinated way at one or a few incidentsites. HHS conducts the ESF-8 activities in support ofthe Federal incident management system, led by theU.S. Department of Homeland Security in its role asthe domestic incident manager, pursuant to HomelandSecurity Presidential Directives and the HomelandSecurity Act of 2002 (Public Law 107-296).Carrying out HHS’s responsibility as the primaryagency for medical and public health preparednessrequires the diverse and unique skills of scientists,public health experts, and health care providers atAHRQ, CDC, FDA, HRSA, NIH, OCR, OD, and SAMHSA.Given the complexity of and need for coordinationaround these preparedness activities, HHS has createda coordination and oversight function for emergencypreparedness within the Office of the Secretary. TheOffice of the Assistant Secretary for Preparednessand Response (ASPR) focuses the activities ofthese operating and staff divisions, develops andcoordinates national policies and plans, providesprogram oversight, and is the Secretary’s public healthemergency representative to other Federal, State, andlocal organizations.Although significant preparedness activities areundertaken at the Federal level, States and localities areprimarily responsible for responding to public healthemergencies in their jurisdictions. HHS conductsbasic and applied research to improve planning for andservice provision in public health emergencies. HHSalso offers technical assistance, guidance, and fundingsupport to State and local governments to aid in thedevelopment and implementation of public healthemergency preparedness plans.Framework for PreparednessHHS leads the Federal public health and medicalemergency response to acts of terrorism or nature andto other public health and medical emergencies. ASPRis responsible for ensuring that HHS’s family of agencieswork together to develop public health and medicalpreparedness and response capabilities and that theylead and coordinate the relevant activities of the HHSoperating divisions.84 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessPreparedness strategies focus on ensuring thatindividuals, families, vulnerable populations, andcommunities are prepared for public health emergenciesand disasters. Response strategies focus on promotingresiliency and responsibility in communities and amongthe citizenry in response to a public health emergency.These strategies include:Developing and using policies and plans. HHS isdeveloping national and Departmental policies andplans for response to public health and medical threatsand emergencies. Areas of planning include developingand maintaining the National Health Security Strategy, acoordinated strategy, and the implementation plan forpublic health emergency preparedness and responsethat includes an evaluation of progress of Federal, State,local, and tribal entities, based on evidence-basedbenchmarks and objective standards that measure levelsof preparedness. This response also includes developinga strategic plan to integrate biodefense and emerginginfectious disease requirements with advanced researchand development, strategic initiatives for innovation,and the procurement of qualified countermeasures(within the purview of the Biomedical AdvancedResearch and Development Authority, or BARDA 11 ).Aligning resources and building partnerships. HHSis aligning Departmental entities to support the ASPRpreparedness, prevention, and response mission andis building productive strategic partnerships—at thedomestic and international levels, within the privateand public sectors—to combat bioterrorism and otherpublic health threats and emergencies.Coordinating emergency preparedness and responseactivities. Activities include coordinating theacceleration of advanced research, development, andprocurement of qualified countermeasures, includingpandemic or epidemic products (within the purviewof BARDA). HHS also coordinates public health andmedical response systems with relevant Federal, State,local, and tribal officials and with the EmergencyMedical Assistance Compact to ensure integrationof preparedness and response activities for public11 This agency would lead in the development of new medicalcountermeasures against bioterrorism and natural disease outbreaks.HHS Strategic Plan FY 2007-201285

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency Preparednesshealth emergencies. HHS also works to ensure thatthe National Disaster Medical System (NDMS), 12 theMedical Reserve Corps (MRC), 13 and the EmergencySystem for Advanced Registration of Volunteer HealthProfessionals (ESAR-VHP) 14 are properly coordinated tomaximize and streamline the response to public healthemergencies.Enhancing response personnel capacity. This processbegins with establishing and maintaining a MedicalReserve Corps to provide for an adequate supply ofvolunteers in the case of a Federal, State, local, or tribalpublic health emergency. HHS is also developing corehealth and medical response curriculums and trainingto improve responses to public health emergencies.Enhancing preparedness through leadership andsupport. HHS efforts enhance State and local publichealth and medical preparedness—primarily healthdepartments and hospitals, providing expert medical,scientific, and public health leadership and advice.HHS also leads international programs, initiatives,and policies that deal with public health and medicalemergency preparedness and response related tonaturally occurring threats such as infectious diseasesand deliberate threats from biologic, chemical, nuclear,and radiation sources. In addition, the Departmentawards contracts, grants, and cooperative agreements,or enters into other transactions, such as prizepayments, to promote innovation in technologies thatmay assist countermeasures and produce advanced12 The NDMS is a federally coordinated system that augmentsthe Nation’s medical response capability. The overall purposeis to establish a single integrated national medical responsecapability for assisting State and local authorities in dealing withthe medical impacts of major peacetime disasters and to providesupport to the military and the VA medical systems in caring forcasualties evacuated back to the United States from overseas armedconventional conflicts.13 The MRC establishes teams of local volunteer medical andpublic health professionals who can contribute their skills andexpertise throughout the year and during times of community need.14 ESAR-VHP works to establish standardized volunteerregistration systems within each State and in the territories that willinclude readily available, verifiable, and up-to-date information ofthe volunteer’s identity, licensing, credentialing, accreditation, andprivileging in hospitals or other medical facilities that might needvolunteers. Establishment of these nationally accepted guidelinesto build their State systems would afford each State the ability toquickly identify, and better utilize, health professional volunteers inemergencies and disasters.86 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency Preparednessresearch and development; conducts research onand develops research tools and other devices andtechnologies; and supports research to promotestrategic initiatives (within the purview of BARDA).HHS also awards competitive grants or cooperativeagreements to support the improvement of surgecapacity and enhancement of community and hospitalpreparedness for public health emergencies.Protecting vulnerable populations. HHS ensures thatState and local emergency plans include attention topersons with disabilities in all emergency managementplans and responses.Providing support in emergencies. HHS rapidlyprovides public health and medical support to Federal,State, local, and tribal incidents of national significanceor public health and medical emergencies.Establishing the Public Health Emergency MedicalCountermeasures Enterprise. HHS has developeda strategy for the Public Health Emergency MedicalCountermeasures Enterprise. The ultimate goal is toestablish the foundational elements that will supportmedical countermeasure availability and utilization forthe highest priority chemical, biological, radiological,and nuclear threats facing the Nation.Establishing a nationwide situational awareness.HHS is working to develop and implement a near-realtimeelectronic nationwide public health situationalawareness capability through an interoperable network ofsystems to enhance early detection of, rapid response to,and management of potentially catastrophic infectiousdisease outbreaks and other public health emergencies.HHS Strategic Plan FY 2007-201287

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessGlobal Health InitiativesHHS’s MandateThe mandate of the U.S. Department of Healthand Human Services is to protect the health of theAmerican people. Events in recent years, however, havemade it clear that our efforts to protect Americans’health cannot end at our borders.Pathogens and other threats to human health are asmobile as we are, and have become more and moredangerous through growing drug resistance andnatural mutations. As the world’s population becomesincreasingly mobile, and as diseases change, our ownhealth becomes more and more intertwined with theworld’s health.The health of other nations is also closely tied to economicproductivity, social stability, and good governance. Sucheconomic, social, and political realities clearly intersectwith our national interest, and further compel us toaddress a variety of global health concerns.Health-related programming can also hold a specialplace as a foreign-policy tool for the U.S. Government.Our work to improve global health demonstratesthe generosity of the American people. Given theuniversal value populations place on good health,evidence-based, public-health interventions can help totranscend political boundaries.Meeting its MandateHHS works to improve global health through directassistance, technical and program support, trainingand capacity building, and through research.Within HHS, CDC works to detect, verify, and quicklyrespond to outbreaks of infectious diseases aroundthe globe and to control other health threats attheir origin to prevent international spread. Tomaintain the safety of the American people, FDAregulates millions of products produced abroad. NIHaddresses global health challenges through innovative,collaborative research and training programs, andthrough international partnerships. SAMHSAworks with postconflict and postdisaster countriesto enable stakeholders to work together to addressthe mental health needs of their peoples. It alsohelps to administer programs to train and supportmental health professionals from developing nations.Building on its leadership of the domestic Ryan WhiteHIV/AIDS Program, HRSA provides training andquality improvement interventions in the President’sEmergency Plan for AIDS Relief (PEPFAR).HHS has a significant international presence. HHSstaff—both civil servants and USPHS officers—servearound the globe. These dedicated professionals workto improve the health of the world—through theirwork on PEPFAR, the President’s Malaria Initiative(PMI), the Global Polio Eradication Initiative (GPEI),or through work to encourage innovative, cooperativebiomedical research with researchers from othercountries. HHS also regularly sends its staff to work ashealth attachés in U.S. Embassies and Missions abroad.These health attachés represent the U.S. Government tohost-country ministries of health and to internationalorganizations such as WHO.AchievementsThrough its work in international health, HHS boasts anumber of significant accomplishments. In the first 3years of PEPFAR, in 15 focus countries in Africa, Asia,and the Caribbean, HHS, through the efforts of CDC,FDA, and HRSA, has played a significant role in theU.S. Government’s support of antiretroviral treatmentfor 820,000 people living with HIV/AIDS. In its rolein PEPFAR, HHS has also joined the U.S. effort insupporting care for almost 4½ million people, including2 million orphans and vulnerable children, as well ascounseling and testing for 18.6 million people.88 HHS Strategic Plan FY 2007-2012

CHAPTER 3: Public Health Promotion and Protection, Disease Prevention,and Emergency PreparednessIn the first year of PMI, which HHS and the UnitedStates Agency for International Development(USAID) implement jointly, PMI delivered life-savinginterventions to prevent and control malaria in the firstthree countries (Angola, Tanzania, and Uganda). Nearly1 million long-lasting insecticide-treated bed nets(ITNs) were distributed; approximately half a millionITNs that were not long lasting were re-treated; morethan 2 million people were protected from malariaafter the interiors of their homes were sprayed withinsecticides; and approximately 1.2 million treatmentsof artemisinin-based combination therapy wereprocured and distributed.Through CDC’s participation in the GPEI, HHS hasplayed a significant role in spearheading the globalfight to eradicate polio. At the launch of the GPEI in1988, polio was endemic in more than 125 countries,and paralyzed 350,000 children each year. In 2006,only 1,985 people were paralyzed by polio, and now,only 4 endemic countries remain. CDC continues toprovide significant technical expertise and support togovernments and international organizations in thefight to eradicate polio.HHS, through the work of CDC, is a core partner inthe global Measles Initiative, which also includes theAmerican Red Cross, United Nations Foundation,United Nations Children’s Fund, and WHO. The workof this initiative has had a significant effect on measlesdeaths globally. Such deaths have fallen by 60 percentworldwide, from an estimated 873,000 deaths in 1999,to 345,000 in 2005. In Africa, measles deaths fell by 75percent, from an estimated 506,000 to 126,000 in thatsame period. A concerted initiative in the Americassince 2002 has eliminated endemic measles from theWestern Hemisphere.Interagency EffortsWe also know that we cannot achieve our global healthgoals alone. In our work, HHS partners with manyother Departments, including the U.S. Departmentsof State, Defense, Agriculture, Homeland Security, andCommerce. HHS also collaborates closely with USAIDand with EPA. HHS also enjoys excellent bilateralpartnerships with other governments, as well as goodworking relationships with multilateral organizations,nongovernmental and faith-based organizations, andwith the private sector.HHS is also committed to working to achieve several ofthe Millennium Development Goals (MDGs) developedby the United Nations. Eight MDGs were developedin September 2000 at the United Nations MillenniumSummit to help provide a framework for leaders toimprove the health and well-being of men, women,and children around the world. The intent is to makesignificant improvement in these areas by 2015. Of theMDGs developed, HHS is particularly focused on MDG4 (reduce child mortality), MDG 5 (improve maternalhealth), and MDG 6 (combat HIV/AIDS, malaria, andother diseases).Important as international health may be today,addressing its challenges will be crucial in the future.If the U.S. Government is to continue its leadership inglobal affairs, it must continue to foster these hightech,public health instruments for engaging the world,both to mitigate global health risks and to strengthenU.S. public diplomacy abroad.HHS Strategic Plan FY 2007-201289

Chapter 4Strategic Goal 3:Human ServicesPromote the economic and social well-beingof individuals, families, and communities.

CHAPTER 4: human servicesWelfare reform stands as a flagship achievement insocial policy reform in the mid-1990s. Through welfarereform, many Americans were helped in breakingthe cycle of dependency and encouraged to pursueself-sufficiency. Since the reforms were passed in1996, the employment rates of current and formerwelfare recipients have risen and caseloads havedeclined dramatically. Earnings for current welfarerecipients have increased, as have earnings for femaleheadedhouseholds in general. In addition, childpoverty rates have declined substantially since thestart of the Temporary Assistance for Needy Families(TANF) program. States are using their flexibilityto focus a growing portion of welfare dollars onhelping individuals retain jobs and advance in theiremployment.STRATEGIC GOAL 3:HUMAN SERVICESStrategic Objective 3.1:Promote the economic independence and socialwell-being of individuals and families across thelifespan.Strategic Objective 3.2:Protect the safety and foster the well-being ofchildren and youth.Strategic Objective 3.3:Encourage the development of strong, healthy,and supportive communities.Strategic Objective 3.4:Address the needs, strengths, and abilities ofvulnerable populations.HHS Strategic Plan FY 2007-201291

CHAPTER 4: human servicesDespite these achievements, self-sufficiency remainselusive for many. Only a third of adults in the TANFcaseload are fully meeting work requirements. TheDeficit Reduction Act (DRA) of 2005 (Public Law 109-171), which includes language reauthorizing TANFthrough 2011, challenges and encourages States toengage the remaining adult TANF recipients in workrelatedactivities to move them up the economic ladder.Addressing the needs of vulnerable children continuesto be a priority of HHS. The most recent annual HHSChild Maltreatment Report (covering 2005) indicatedthat each year an estimated 899,000 children in theUnited States are victims of abuse or neglect. At theend of FY 2005, there were 513,000 children in fostercare; 114,000 of these children were waiting to beadopted. Nearly 2 million children have a parent ina Federal or State correctional facility, a number thatmore than doubled over the 1990s.Since 1996, the percentage of children born outof wedlock to teens has dropped but still remainsunacceptably high. In addition, more adults arechoosing to have children outside the protective bondsof marriage. Research suggests that, all other thingsbeing equal, children who grow up in healthy married,two-parent families do better on a host of outcomes;for instance, they are less likely to engage in criminalactivity or abuse drugs and alcohol than those who donot. HHS’s multicomponent Healthy Marriage Initiativeworks to help couples who have chosen marriage togain access to services where they can acquire the skillsand knowledge necessary to form and sustain healthymarriages. Making marriage education accessible andappropriate for families is a major component.Children are not alone in their need for support. As theAmerican population ages, enhanced efforts are neededto help the growing number of older persons remainactive and healthy. An aging society means that thenumber of persons requiring long-term care serviceswill increase. The availability of these services in thehome and other community-based settings will beincreasingly important if people are to maintain theirindependence and quality of life.People with disabilities, refugees and other migrants,and other vulnerable populations also need assistanceand protection to achieve and sustain economicindependence and self-sufficiency, as well as socialwell-being.Strategic Goal 3, Human Services, seeks to protect life,family, and human dignity by promoting the economicand social well-being of individuals, families, andcommunities; enhancing the safety and well-being ofchildren, youth, and other vulnerable populations;and strengthening communities. The Administrationfor Children and Families (ACF), Administration onAging (AoA), Center for Faith-Based and CommunityInitiatives (CFBCI), Office on Disability (OD), andSubstance Abuse and Mental Health ServicesAdministration (SAMHSA) are among the operatingand staff divisions primarily responsible for achievingthis strategic goal. In addition, HHS’s Centers forDisease Control and Prevention (CDC), HealthResources and Services Administration (HRSA), andOffice for Civil Rights (OCR) play important roles.There are four broad objectives under Human Services:• Promote the economic independence and socialwell-being of individuals and families across thelifespan;• Protect the safety and foster the well-being ofchildren and youth;• Encourage the development of strong, healthy,and supportive communities; and• Address the needs, strengths, and abilities of vulnerablepopulations.Below is a description of each strategic objective,followed by a description of the key programs, services,and initiatives the Department is undertaking toaccomplish those objectives. Key partners andcollaborative efforts are included under each relevantobjective. The performance indicators selected for thisstrategic goal are also presented with baselines andtargets. These measures are organized by objective.Finally, this chapter discusses the major externalfactors that will influence HHS’s ability to achieve theseobjectives, and how the Department is working toaddress those factors.92 HHS Strategic Plan FY 2007-2012

CHAPTER 4: human servicesStrategic Objective 3.1Promote the economic independence andsocial well-being of individuals and familiesacross the lifespan.HHS is committed to helping individuals and familiesachieve economic independence and social well-being,through individual efforts of ACF, AoA, OCR, OD, andSAMHSA, and in concert with the U.S. Departments ofJustice and Labor, States, territories, tribes, and otherinterested stakeholders.The focus is twofold. First, HHS will collaborate withStates in moving disadvantaged families to work andeconomic self-sufficiency, using indicators to measurethe movement of individuals from welfare to work, aswell as increases in child support collection. Second,HHS supports interventions that help individualsand families who are disadvantaged improve theireconomic and social well-being across the lifespan;an indicator at the end of the chapter measures thesuccess of services to individuals with developmentaldisabilities. The narrative below describes the efforts,initiatives, programs, and collaborations that theDepartment will implement in the next 5 years toaddress this strategic objective. Many of these arecontinuations and expansions of existing programs.Work and Economic Self-SufficiencyTemporary Assistance for Needy Families.Temporary Assistance for Needy Families (TANF), ablock grant administered by ACF’s Office of FamilyAssistance, provides temporary assistance and workopportunities to needy families by granting Statesthe Federal funds and wide flexibility to developand implement their own welfare programs. TANFprovides funding annually to States, territories, andeligible tribes for the design of creative programs tohelp families transition from welfare to self-sufficiency.States have tremendous flexibility in determining howto use their TANF dollars to achieve program goals.Reauthorization of TANF in 2006 requires that Statesimplement more meaningful work participation raterequirements in the coming years.HHS Strategic Plan FY 2007-201293

CHAPTER 4: human servicesChild Care. To support working families, ACF providesStates, territories, and tribes with direct child careassistance payments to low-income families when theparents work or participate in education or training. Incollaboration with the U.S. Department of Education,ACF’s Office of Head Start, and HRSA, ACF’s ChildCare Bureau promotes State flexibility in developingchild care programs and policies that meet the needsof children and parents within each State; supportsresearch and evaluation of innovative child care subsidypolicies and Web-based access to reports, data, andother research-related information; and helps familiesto achieve and maintain self-sufficiency by improvingaccess to affordable, high-quality child care.Assets for Independence. The Assets for Independence(AFI) program uses asset-building strategies toassist low-income families in achieving economicindependence. The program helps participantssave earned income in special-purpose, matchedsavings accounts called Individual DevelopmentAccounts (IDAs). Every dollar in savings depositedby participants into an IDA is matched by the AFIprogram. The IDA mechanism promotes savings andenables participants to acquire a lasting asset aftersaving for a few years. AFI program families use theirIDA savings, including the matching funds, to acquirea first home, capitalize a small business, or enroll inpostsecondary education or training. In additionto helping participants with their IDA savings, allAFI programs provide basic training and supportiveservices related to family financial management.AFI continues to develop new partnerships to assistfamilies. SCORE, a U.S. Small Business resourcepartner, helps AFI grantees saving for small businessstartups. Moreover, the 360 IDAs Initiative nowhelps increase the availability of IDAs to people withdisabilities and their families.Programs of the Administration for Native Americans.The Administration for Native Americans (ANA) inACF promotes the goal of self-sufficiency by providingsocial and economic development opportunities.ANA programs offer training, as well as financial andtechnical assistance, and support a range of projectsfor eligible tribes and Native American organizations.ANA supports the creation of new jobs, developmentor expansion of business enterprises and social serviceinitiatives, and formulation of environmental ordinancesand training in the use and control of natural resources.Future grants will continue to support social andeconomic development strategies and healthy marriagesto improve the well-being of children.Child Support Enforcement. The Child SupportEnforcement (CSE) program is a joint Federal, State,and local partnership that seeks to ensure financial andemotional support for children from both parents bylocating noncustodial parents, establishing paternity, andestablishing and enforcing child support orders. Childsupport services, as mandated in Title IV-D of the SocialSecurity Act of 1935 (Public Law 74-271), as amended,are available for all families with a noncustodial parent,regardless of welfare status. Child support collectionsplay an important role for families transitioning fromwelfare to self-sufficiency, particularly in light oftime limits on receipt of cash assistance. By securingsupport from noncustodial parents on a consistent andcontinuing basis, families may avoid the need for publicassistance, thus reducing government spending.The CSE program continues to make strong gains inchild support order and paternity establishment, aswell as in collections of current and back support. TheDeficit Reduction Act (DRA) of 2005 (Public Law 109-171) includes a series of provisions to strengthen andimprove the program. Overall, DRA provisions willboth strengthen existing collection and enforcementtools and allow States the option to provide additionalsupport to families who need it most. These provisionsinclude State options to direct more child supportcollections to children and families that ever receivedTANF; new efforts to increase collections such asexpanding passport denial, mandatory review andadjustment of support orders, and improving medicalsupport by requiring States to consider both parents’access to health insurance coverage when establishingchild support orders; and an annual user fee for childsupport cases when enforcement efforts are successfulfor families who have never received TANF assistance.94 HHS Strategic Plan FY 2007-2012

CHAPTER 4: human servicesWell-Being Across the LifespanHealthy Marriage and Responsible Fatherhood. TheDRA provides funding for research and demonstrationsthat support healthy marriage. Approximately 125 Federalgrants were awarded to States and communities to testnew ways to promote and support healthy married-parentfamilies. Grant funds will be used to test promisingapproaches to encourage healthy marriages and providemarriage education, marriage skills training, publicadvertising campaigns, high school education on the valueof marriage, and marriage mentoring programs.HHS supports several other healthy marriage activitiesand research, including Building Strong Families,Supporting Healthy Marriages, and the CommunityHealthy Marriage Initiative. The purpose of the BuildingStrong Families project is to evaluate healthy marriageservices for romantically involved low-income, unwedparents around the time of the birth of a child. Thepurpose of Supporting Healthy Marriages is to informprogram operators and policymakers of the mosteffective ways to help married parents to strengthenand maintain their marriages. The Community HealthyMarriage Initiative evaluates broad-based communitylevelcoalitions that help couples who choose marriagefor themselves to develop the skills and knowledge toform and sustain healthy marriages. In collaborationwith the U.S. Department of State, HHS also promotesprograms and policies at international organizations tostrengthen families and marriages and to promote thepreservation of human life and dignity.The Promoting Responsible Fatherhood Initiativepromotes responsible fatherhood by funding programsthat support healthy marriage activities, enhanceresponsible parenting, and foster economic stability.The initiative will enable fathers to improve theirrelationships and reconnect with their children. Itwill help fathers overcome obstacles and barriers thatoften prevent them from being the most effective andnurturing parent possible. Although the primary goal ofthe initiative is to promote fatherhood in all of its variousforms, an essential point is to encourage fatherhoodwithin the context of marriage. Grant funds will beallocated to promote involved, committed, responsiblefatherhood through counseling, mentoring, marriageeducation, enhancing relationship skills, parenting, andactivities to foster economic stability.HHS Strategic Plan FY 2007-201295

CHAPTER 4: human servicesFamily Violence. ACF’s Family Violence Prevention andServices Program, administered by the Family and YouthServices Bureau (FYSB), provides grants to States andtribes to prevent incidents of family violence, provideimmediate shelter and related assistance for victimsof family violence, and support prevention servicesfor perpetrators. FYSB also supports programs thatoffer safe havens and access to services for victims ofdomestic violence, a national toll-free hotline to provideinformation and assistance to victims of domesticviolence, maternity group home services, and runawayand homeless youth shelters.Several collaborative efforts both within HHS and inpartnership with other departments and stakeholderssupport this effort to prevent family violence. TheNational Advisory Committee on Violence AgainstWomen is an advisory body cochaired by the AttorneyGeneral and the Secretary of HHS. National AdvisoryCommittee members meet periodically to sharetheir thoughts, ideas, and expertise and to submitrecommendations on a variety of priority issues as theFederal Government develops its policies to addressthe crimes of domestic violence, sexual assault, datingviolence, and stalking. The Greenbook initiative, a jointproject of HHS and the U.S. Department of Justice,supported six demonstration projects, helping childwelfare and domestic violence agencies and familycourts work together more effectively to help familiesexperiencing violence. Now that the funding cyclehas been completed, HHS will partner with the U.S.Department of Justice and with the National Council ofJuvenile and Family Court Judges to provide technicalassistance and support to communities interested inimplementing the Greenbook’s recommendations.Support for Older Adults in Home and CommunitySettings. AoA’s Home and Community-Based SupportiveServices program provides an array of services to olderadults and their caregivers, including access services suchas transportation, case management, and information andreferral; in-home services such as personal care, chore,and homemaker assistance; and community services suchas adult day care, respite care, and disease prevention,health promotion, and physical fitness programs.Together, these services strive to help older adultsmaintain their independence and enable them to stayin their homes and communities for as long as possible,delaying the need for costly institutional care.New Freedom Initiative and Olmstead DecisionResponse. The HHS Office on Disability (OD) was createdin 2002 as an outcome of President Bush’s New FreedomInitiative. The New Freedom Initiative commits the UnitedStates to a policy of community integration for individualswith disabilities. OD and OCR are involved in a varietyof efforts to enhance the independence and quality of lifeof persons with disabilities, including those with longtermneeds. OD, through the New Freedom Initiative,ensures a coordinated interagency and intergovernmentalapproach in support of community integration to teardown barriers on behalf of individuals with disabilities.In Olmstead v. L.C. (1999), the U.S. Supreme Court heldthat States unjustifiably segregating qualified personswith disabilities in institutions is a form of discriminationprohibited by Title II of the Americans with DisabilitiesAct of 1990 (Public Law 101-336). OCR has the authorityto enforce the Olmstead decision, and has done sothrough hundreds of complaint investigations, voluntarycompliance efforts, outreach initiatives, and technicalassistance projects. Through these efforts, OCR ensuresthat, when appropriate, States provide individuals withdisabilities access to services in the community. OCRwill continue its Olmstead-related efforts, ensuring thatindividuals with disabilities return to or remain in theircommunities with adequate supports.Low Income Home Energy Assistance Program. ACF’sLow Income Home Energy Assistance Program (LIHEAP)will continue to provide home energy assistancethrough grants to States, tribes, and territories. Of thehouseholds receiving heating assistance, about one-thirdinclude a member 60 years or older; about half have atleast one person with a disability; and about one-fifthinclude at least one child 5 years old or younger. xxxiiFor the past several years, almost 5 million householdsper year received LIHEAP assistance to help themthrough the winter months. The program also providescooling assistance to about 400,000 households andweatherization assistance to about 90,000 more.96 HHS Strategic Plan FY 2007-2012

CHAPTER 4: human servicesStrategic Objective 3.2Protect the safety and foster the well-being ofchildren and youth.HHS is committed to protecting the safety andfostering the well-being of children and youth, throughthe combined efforts of ACF, SAMHSA, HRSA, and OD,and in partnership with other Federal departments,such as the U.S. Departments of Education and Justice,the Corporation for National and Community Service(CNCS), and other interested stakeholders.Several of the Department’s efforts relate to childmaltreatment and safe and permanent livingsituations for children and youth, as represented by theperformance measure at the end of this chapter, whichfocuses on the adoption rate for children involvedwith the child welfare system. Other programs andcollaborations focus on child care and fostering schoolreadiness, as measured by the percentage of Head Startprograms that have a positive impact on verbal andmathematical abilities. Additional initiatives, includingmentoring, abstinence education, youth development,and suicide prevention, foster positive behavior, asrepresented in the indicator focusing on the lack ofinteraction with law enforcement. Although many ofthese programs are not new, they will continue andwill be strengthened during the period covered by thisStrategic Plan.Child MaltreatmentThe Child Abuse State Grant Program plays a keyrole in the prevention of child abuse and neglect byfunding postinvestigative services such as individualcounseling, case management, and parent education.The Child Welfare Services program helps State childwelfare agencies improve their services with the goal ofkeeping families together. Grants also are provided todevelop and improve education and training programsand resources for child welfare professionals throughthe Child Welfare Training program and to prevent theabandonment of infants and young children exposedto HIV/AIDS and drugs through the Abandoned InfantsAssistance Program. Over the next several years, fundsfor new regional partnership grants will assist Stateand local agencies in building cooperative effortsaddressing the range of issues presented by familieswhose substance abuse impairs parenting and placestheir children at risk. The Independent Living Educationand Training Vouchers program provides up to $5,000for costs associated with college or vocational trainingfor youth ages 16 to 21 in foster care.Two interagency workgroups focus on the issue of childabuse and neglect and provide settings within whichFederal agencies coordinate and collaborate. The first,the Federal Interagency Work Group on Child Abuse andNeglect, led by the Office on Child Abuse and Neglectof ACF/Children’s Bureau, engages ACF, CDC, HRSA,IHS, NIH, and SAMHSA, as well as the U.S. Departmentsof Agriculture, Defense, Interior, Justice, and Labor,State staff, and other partners, in its discussions onchild abuse prevention, child welfare, and independentliving support services. The group shares information,plans and implements joint activities, makes policyand programmatic recommendations, and worksHHS Strategic Plan FY 2007-201297

CHAPTER 4: human servicestoward establishing complementary agendas in theareas of training, research, legislation, informationdissemination, and delivery of services as they relateto the prevention, intervention, and treatment of childabuse and neglect. The second, NIH Neglect Consortium,develops and supports research on child neglect,with support from ACF and the U.S. Department ofEducation. ACF/Children’s Bureau is working with ODin supporting necessary research to understand theimpact of child maltreatment on children and youthwith disabilities residing in long-term care facilities andwith families (including foster care).Safety and PermanencyThe Adoption and Safe Families Act of 1997 (Public Law105-89) established that a child’s health and safety mustbe of paramount concern in any efforts made by a Stateto preserve or reunify a child’s family. ACF’s Foster Care,Adoption Assistance, and Independent Living programshave demonstrated success in improving safety,permanency of living arrangements, and well-beingof children. Working with the States, these programsminimize disruptions to the continuity of familyand other relationships for children in foster care bydecreasing the number of placement settings per yearfor a child in care. The programs also met goals toprovide children in foster care with permanency andstability in their living situations by improving thetimeliness of reunification, if possible, and promotingguardianship or adoption when reunification is notpossible. In recent years, the Children’s Bureau withinACF has pioneered a results-focused approach tomonitoring Federal child welfare programs. The secondround of these Child and Family Service Reviews beganin 2007 and will hold States accountable for the safety,permanency, and well-being of children involved withchild welfare authorities.Additionally, the Promoting Safe and Stable Families(PSSF) program, a capped entitlement programauthorized through the Promoting Safe and StableFamilies Act of 1997 (Public Law 105-89), assistsStates in coordinating services related to child abuseprevention and family preservation. These services98 HHS Strategic Plan FY 2007-2012

CHAPTER 4: human servicesinclude community-based family support, familypreservation, time-limited reunification services, andadoption promotion and support services. Inspiredby research showing that regular caseworker visitsare related to the achievement of important childand family outcomes for children in foster care, newfunding within the PSSF program provides resourcesto States to help them ensure that caseworkers visitchildren monthly.Through the Adoption Incentives program, States willbe able to earn bonus payments by increasing thenumber of adoptions of children in foster care overprevious years. The Adoption Opportunities programsupports grants that facilitate the elimination ofbarriers to adoption, and the adoption awarenessprograms support adoption efforts, including adoptionof children with special needs, through training anda public awareness campaign. Adoption incentivesadded in the 2003 reauthorization of the AdoptionIncentive Payments Program focus on adoptions ofchildren age 9 and older who face particularly longwaits for adoptive homes.Early Care and EducationACF’s Head Start and Early Head Start programs arecomprehensive child development programs thatserve children from birth to age 5, pregnant women,and their families. Head Start is designed to fosterhealthy development and school readiness in lowincomechildren. Head Start programs help ensure thatchildren are ready to succeed at school by supportingsocial and cognitive development. Head Start programsprovide comprehensive child development services,including educational, health, nutritional, and socialservices, primarily to low-income families. They alsoengage parents in their child’s preschool experienceby helping them achieve their own educationaland literacy goals as well as employment goals,supporting parents’ role in their children’s learning,and emphasizing the direct involvement of parents inthe administration of local Head Start programs. EarlyHead Start has a triple mission. It promotes healthyprenatal outcomes, enhances the development ofinfants and toddlers, and promotes healthy familyfunctioning. HHS will continue to explore how tomaximize the use of technology to disseminateinformation and research in ways that will improveprograms and performance. HHS will investigateways that Head Start and child care can collaboratewith other State and local partners, such as Stateprekindergarten programs, to ensure that childrenenter school ready to succeed.Several collaborative efforts between HHS and the U.S.Department of Education support early childhoodprograms and research. The Good Start, Grow Smartinteragency workgroup, with HHS representatives fromACF/Office of Head Start, ACF/Child Care Bureau,NIH, and ASPE, focuses on enhancing early childhoodprograms and fosters better collaboration amongagencies serving young children at risk. The InteragencySchool Readiness Initiative engages the same operatingand staff divisions from HHS and the U.S. Departmentof Education to focus on enhancing early childhoodresearch. Another interagency collaboration, the EarlyChildhood Workgroup on English Language Learners,involves ACF and ASPE in developing strategies forcoordination of early childhood programs aimed atEnglish Language Learners.MentoringResearch indicates that children with parents whoare incarcerated are seven times more likely than thegeneral population to become incarcerated themselvesand are more likely to display a variety of behavioral,emotional, health, and educational problems. ThroughACF’s Family and Youth Services Bureau (FYSB), HHSsupports the Mentoring Children of Prisoners program,through which public and private organizationsestablish or expand projects that provide one-on-onementoring for children of parents who are incarceratedand those recently released from prison.OD promotes physical fitness for children and youthwith disabilities in conjunction with the President’sHealthierUS Initiative and the President’s Council onPhysical Fitness and Sports awards system, through its“I Can Do It, You Can Do It” mentoring program. ThisHHS Strategic Plan FY 2007-201299

CHAPTER 4: human servicesprogram features one-on-one mentoring for childrenand youth with disabilities across the Nation toenhance their physical fitness, with the goal of serving 6million children with disabilities.HHS also participates on the recently formed FederalMentoring Council, an offshoot of the CoordinatingCouncil on Juvenile Justice and Delinquency Prevention(see the section, Collaborative Efforts to Support Youth,for more information on this Council). Convened andstaffed by the CNCS, the Council seeks to improvecoordination and better leverage resources amongall the mentoring programs that exist in the FederalGovernment. The Council includes representativesfrom the U.S. Departments of Defense, Education,Interior, Justice, Labor, and many others. The Councilworks to identify key ways in which the FederalGovernment can advance the goal of involving 3 millionnew mentors by 2010, and then act on those findings.Abstinence EducationACF administers two abstinence education programs—the Community-Based Abstinence Education programand the State Abstinence Education program. ACF’sabstinence education programs provide grants tocommunity-based organizations, including faith-basedorganizations, as well as to States, to develop andimplement abstinence programs. The Community-Based Abstinence Education program focuses onadolescents, ages 12 through 18, and targets theprevention of teenage pregnancy and premarital sexualactivity. The Community-Based Abstinence Educationprogram also supports a national public awarenesscampaign designed to help parents communicate withtheir children about health risks of early sexual activity.The State Abstinence Education program enables Statesto create or augment existing abstinence educationprograms and, where appropriate, provide mentoring,counseling, and adult supervision to promoteabstinence from sexual activity, with a focus on thosegroups most likely to bear children out of wedlock.ACF expects that all grantees will present medicallyaccurate information. ACF is requiring CommunityBased Abstinence Education grantees to certify thatcurricula are medically accurate and is conductingreviews for medical accuracy as part of the grant awardprocess.Within OPHS, the Adolescent Family Life Program (AFL)also supports abstinence education activities. ThroughTitle XX of the Public Health Service Act (42 U.S.C., 300zet seq.), AFL authorizes two types of demonstrationprojects: (1) care projects to develop, implement, andevaluate innovative, comprehensive, and integratedapproaches to the delivery of health care, education,and social services for pregnant and parentingadolescents and their families; and (2) preventionprojects to develop, implement, and evaluate programinterventions to promote abstinence from sexualactivity among preadolescents and adolescents.AFL also places a strong emphasis on ensuring thateducational materials are medically accurate.OPHS, through an interagency agreement withACF, has launched an initiative that focuses on theimportance of parental communication. The ParentsSpeak Up National Campaign (PSUNC) is an educationalcampaign aimed at encouraging parents to talk withtheir children early and often about abstinence. Thisinteractive campaign will include radio, print, andtelevision advertisements to raise awareness. AllPSUNC products direct parents to the 4Parents.govWeb site for further information and skills on talkingearly and often with their children about sex andabstinence. 4Parents.gov provides concise, helpfulhealth information regarding the importance of parentteencommunication. The Web site also providesspecific information on sexually transmitted diseasesand teen pregnancy, benefits of abstinence from sexualinvolvement, drugs and alcohol, development ofhealthy teen relationships, and preparation for futuremarriage and family.100 HHS Strategic Plan FY 2007-2012

CHAPTER 4: human servicesCollaborative Efforts for YouthPositive Youth Development is an approach toyouth programming based on the understandingthat all young people need support, guidance, andopportunities during adolescence, a time of rapidgrowth and change. FYSB’s Positive Youth DevelopmentState and Local Collaboration Demonstration grantswill continue to develop and support innovative youthdevelopment strategies.Together with nine other Federal agencies, HHS alsosupports the First Lady’s Helping America’s Youth initiative,which focuses on the importance of connecting caringadults with youth in order to help youth make betterchoices that lead to healthier, more successful lives.The Community Guide to Helping America’s Youth helpscommunities build partnerships and assess their needsand resources. It also offers information about evidencebasedyouth program designs that could be replicated intheir community. In the coming years, the CommunityGuide will continue to be enhanced so that it serves theneeds of local youth-focused partnerships.Representatives from several operating and staffdivisions within HHS also participate with nine otherFederal agencies and eight practitioner members on theCoordinating Council on Juvenile Justice and DelinquencyPrevention. The Council’s primary functions are tocoordinate Federal juvenile delinquency preventionprograms, Federal programs and activities that detain orcare for unaccompanied juveniles, and Federal programsrelating to missing and exploited children. The Councilworks to implement several of the recommendationsfrom the 2003 report of the White House Task Force onDisadvantaged Youth. In the coming years, the Councilwill conduct an inventory of comprehensive communityinitiatives and will investigate how to support collaborationamong Federal, State, and local partners, to determine howbest to invest Federal resources to serve youth.HHS will continue to participate in the FederalGovernment delegations that attend the meetings ofthe Executive Board of the United Nations Children’sFund. The Department also will promote programs andpolicies at international organizations to protect theinterests and well-being of children and their families.HHS Strategic Plan FY 2007-2012101

CHAPTER 4: human servicesStrategic Objective 3.3Encourage the development of strong, healthy,and supportive communities.HHS is committed to encouraging the developmentof strong, healthy, and supportive communities. ACF,CDC, OD, OPHS, and SAMHSA fund comprehensivecommunity initiatives to help distressed communitiesaddress the most intractable problems. The Center forFaith-Based and Community Initiatives (CFBCI) worksto develop the capacity of faith-based and communitybasedorganizations to respond to community needs.In the performance indicator section at the end of thischapter, the Strategic Plan uses family cohesiveness as aproxy for the strength of communities.Below is a sampling of the Department’s efforts relatedto faith-based and community initiatives, capacitybuilding, and comprehensive community initiatives.Faith-Based and Community InitiativesHHS has made great strides in improving currentfaith-based and community partnerships, providingopportunities for new partnerships with faithbasedand community organizations, and removingexisting barriers to the inclusion of these groups inHHS programs. Through the HHS CFBCI, technicalassistance has been provided throughout the countryto increase the capacity of faith-based and communityorganizations working with vulnerable and needypopulations. HHS has reached out and collaboratedwith religious and neighborhood organizations thatfor decades have been bringing solutions to bear onsome of the Nation’s most intractable problems. CFBCIworks with operating and staff divisions across theDepartment to eliminate barriers to the participationof faith-based and other community organizations;these barriers include regulations, policies, andprocedures. CFBCI also works with operating and staffdivisions to propose the development of innovativepilot and demonstration programs. Finally, HHS staffhave received training to understand how to reach outand partner with these organizations more effectively.102 HHS Strategic Plan FY 2007-2012

CHAPTER 4: human servicesCapacity-Building EffortsThe Compassion Capital Fund advances the effortsof community and charitable organizations,including faith-based organizations, to increase theireffectiveness and enhance their ability to provide socialservices where needed. Grants support intermediaryorganizations that provide training and technicalassistance to grassroots organizations in accessingfunding sources, administering programs, expandingservices, and replicating promising approaches. Inaddition, targeted capacity-building minigrants helpgrassroots organizations more effectively deliverservices to the most vulnerable populations includingyouth at risk, persons experiencing homelessness,families transitioning from welfare to work, andprisoners reentering the community.Comprehensive Community InitiativesSAMHSA funds several comprehensive communitymental health services grants for children and youthwith serious emotional disturbances and theirfamilies. Grants are used to implement a “systems ofcare” approach to services, based on the recognitionthat the needs of children with serious mental healthchallenges can best be met within their home, school,and community, and that families and youth shouldbe the driving force in the transformation of their owncare. The grants will be used to provide a full array ofmental health and support services organized on anindividualized basis into a coordinated network inorder to meet the unique clinical and functional needsof each child and family.OD is coordinating an interagency andinterdepartmental 2-year seamless program, the YoungAdult Program. This program promotes integratedsupport systems spanning education, health, assistivetechnology, employment, transportation, and housingfor young adults 14 to 30 years with disabilities in sixdemonstration States through the National GovernorsAssociation and is documenting outcomes through aprocess and impact evaluation.HHS Strategic Plan FY 2007-2012103

CHAPTER 4: human servicesStrategic Objective 3.4Address the needs, strengths, and abilities ofvulnerable populations.HHS is committed to addressing the needs, strengths,and abilities of vulnerable populations, includingpeople with disabilities, American Indians and AlaskaNatives, refugees and other entrants, victims of humantrafficking, persons experiencing homelessness, andpeople affected by natural or manmade disasters. ACF,AoA, CDC, OCR, OD, and SAMHSA have developedprograms and initiatives tailored for these particularlyvulnerable populations. The two selected performanceindicators at the end of this chapter that focus on thisissue look at services provided to homebound olderpeople and newly arrived refugees. Below are a few ofthe Department’s efforts.People With DisabilitiesA number of interagency collaborations have developedto support the economic independence and socialwell-being of people with physical, sensory, behavioral,cognitive, and developmental disabilities. One is thejoint planning effort between AoA, CMS, HRSA, IHS,NIH, OCR, OD, SAMHSA, and non-Federal organizations,including State developmental disability agencies, longtermcare providers, tribal governments, State and localagencies on aging, and State and local Medicaid agencies.These agencies and organizations work to increasethe independence and quality of life of persons withdisabilities, including those with long-term care needs.Another collaboration, the Committee for Employeeswith Disabilities, with representation from 14 HHSoperating and staff divisions, represents the issuesand needs of the Department’s employees withdisabilities; provides proactive advice, guidance,and recommendations to the Secretary in planning,implementing, monitoring, and evaluating theDepartment’s affirmative action program onemployment of individuals with disabilities; and servesas a focal point for the concerns of employees withdisabilities on matters affecting their employment tohelp resolve Departmentwide problems in this area.104 HHS Strategic Plan FY 2007-2012

CHAPTER 4: human servicesAmerican Indians and Alaska NativesThe Administration for Native Americans (ANA) promoteseconomic and social self-sufficiency for American Indians,Alaska Natives, Native Hawaiians, and other Native PacificIslanders by providing funding for community-based shorttermprojects through three competitive discretionarygrant programs to eligible tribes and nonprofit NativeAmerican organizations. The three program areas areSocial and Economic Development Strategies for NativeAmericans; Native Language Preservation and Maintenance;and Environmental Regulatory Enhancement, which focuseson building the capacity to identify, plan, and developenvironmental programs consistent with Native culture.Coordination with HHS is fostered by the IntradepartmentalCouncil on Native American Affairs, cochaired by theDirector of IHS and the Commissioner for the ANA. Thepurposes of the Council are to develop and promotepolicies to provide greater access and quality services forAmerican Indians and Alaska Natives; identify and developlegislative, administrative, and regulatory proposals thatpromote effective policy; develop a comprehensive strategythat promotes self-sufficiency and self-determination;promote the tribal/Federal Government-to-governmentrelationships on a Departmentwide basis; and ensure thatthe HHS policy on tribal consultation is implemented byall HHS divisions and offices. Within HHS, all operatingdivisions and many staff divisions are engaged in thisimportant collaborative effort.People Affected by DisastersFor victims of natural disasters, immediate priorities areaccess to water, food, shelter, medical care, and security. Asindividuals attempt to recover and rebuild their lives, theymust also contend with stressors on their mental health,which can linger for weeks or months. Almost everyonewho lives through disastrous events experiences feelingsof sadness and depression. Depending on the individual,these feelings can vary in intensity and duration. This is truenot only for the residents of the cities and towns devastatedby natural disasters, but also for the thousands of rescueworkers, emergency medical personnel, and disasterrecovery experts engaged in search-and-rescue operations.SAMHSA is focused on providing resources to aid inthe recovery process, to assist both the people in areasdamaged by natural disasters and the workers whoare taking care of them. SAMHSA’s Disaster TechnicalAssistance Center helps ensure that our Nation isprepared and able to respond rapidly when eventsincrease the need for trauma-related mental health andsubstance abuse services.AoA offers a comprehensive set of technical assistancematerials to help prepare and plan for the managementof major emergencies or disaster events. AoA hasdeveloped a technical assistance guide, which includesmany tools to assist those with the responsibility forthe safety and continued independence of the Nation’solder population. The guide helps State agencies andlocal providers work through the intricate planning andcollaborative efforts needed in an emergency. Usingthis guide, emergency teams will be ready to begin workimmediately should a disaster or emergency occur.The Office on Disability, in conjunction with ASPR andACF’s Administration on Developmental Disabilities,has implemented and monitored the use of a disabilitybasedtoolkit, shelter assessment tool, and public healthstaff training modules. Together with the HIPAA Privacydecision tool for emergency preparedness planning, createdby OCR, these resources ensure that the needs of personswith disabilities are understood by first responders andother emergency response providers at the Federal, State,and local levels during all emergency situations.Interruptions in child care services during an influenzapandemic may cause conflicts for working parentsthat could result in high absenteeism in workplaces.Some of that absenteeism could be expected to affectpersonnel and workplaces that are critical to theemergency response system. A checklist created byCDC will help child care and preschool programsprepare for the effects of a flu pandemic and will helpthem protect the health of their staff and the childrenand families they serve. Many of these steps can alsohelp in other types of emergencies.For more information on this topic, see In the Spotlight:Emergency Preparedness, Prevention, and Response.HHS Strategic Plan FY 2007-2012105

CHAPTER 4: human servicesRefugees and Other EntrantsThe Office of Refugee Resettlement (ORR) in ACF offersa variety of services to support refugees, migrants, andother entrants, including victims of human trafficking.Assistance to refugees includes transitional cashassistance, health benefits, and a wide variety of socialservices, provided through ORR grants. The primaryfocus is employment services such as skills training,job development, orientation to the workplace, and jobcounseling. The priority is to find employment earlyafter arrival, because it not only leads to early economicself-sufficiency for the family, but also adds greatly to theintegrity of families who seek to establish themselves in anew country and provide for their own needs.In addition to economic assistance to adults, ORRsupports the Unaccompanied Refugee Minors program,which delivers child welfare services in a culturallysensitive manner. Specifically, the program assistsrefugee and entrant youth younger than 18 who arewithout a responsible adult in developing appropriateskills to enter adulthood and to achieve economicand social self-sufficiency. The Unaccompanied AlienChildren program provides a safe and appropriateenvironment for minors during the interim periodbetween the minor’s transfer into a shelter care facilityand the minor’s release from custody by ORR orremoval from the United States.Victims of Human TraffickingThe Trafficking Victims Protection Act of 2000 (PublicLaw 106-386), as amended, designates HHS as theFederal Agency responsible for helping victims ofhuman trafficking become eligible to receive benefitsand services so that they may rebuild their lives safelyin this country. As part of this effort, HHS has initiatedthe Rescue & Restore Victims of Human Traffickingcampaign to help identify and assist victims of humantrafficking in the United States. The intent of thecampaign is to increase the number of identifiedtrafficking victims and to help those victims receive thebenefits and services needed to live safely in the UnitedStates. By initially educating health care providers,social service organizations, and the law enforcement106 HHS Strategic Plan FY 2007-2012

CHAPTER 4: human servicescommunity about the issue of human trafficking, HHSwill encourage these intermediaries to look beneaththe surface by recognizing clues and asking the rightquestions because they might be the only outsiderswith the chance to reach out and help victims. Acritical component of the campaign is the creation ofthe Trafficking Information and Referral Hotline, whichconnects victims of trafficking to nongovernmentalorganizations that can help victims in their local areas.The hotline helps intermediaries determine whetherthey have encountered a victim of human trafficking,helps connect victims to resources, and coordinateswith local social service organizations to protect andserve victims of trafficking.People Experiencing HomelessnessThe delivery of treatment and services to personsexperiencing homelessness is included in the activitiesof the Department, both in 5 programs specificallytargeted to such individuals and in 12 nontargeted, ormainstream, service delivery programs. To improvethe response of HHS programs to homelessness, acrosscutting Departmental workgroup, the Secretary’sWork Group on Ending Chronic Homelessness,meets quarterly to develop, lead, and coordinate acomprehensive Departmental approach to addressinghomelessness. The group also supports the Secretaryin his role as a statutory member of the UnitedStates Interagency Council on Homelessness (USICH).The USICH coordinates the Federal response tohomelessness across 20 Federal departments andagencies and provides leadership for activities designedto assist families and individuals who are experiencinghomelessness with the goal of preventing and ending itin the Nation. The Secretary chairs the USICH in 2007.HHS coordinates extensively with its Federal partnersin developing research and program initiatives that willimprove access to housing and treatment resourcesand contribute to ending homelessness.SAMHSA’s Projects for Assistance in Transition fromHomelessness (PATH) program is a formula grantprogram that funds the 50 States, District of Columbia,Puerto Rico, and 4 territories to support servicedelivery to individuals with serious mental illnesses,as well as individuals with co-occurring substanceuse disorders or other disabilities, who are homelessor at risk of becoming homeless. SAMHSA providestechnical assistance to States and local providersfunded by the PATH program, including onsiteconsultation, collection of annual reporting data,development of an annual report to the U.S. Congress,holding of biannual meetings of PATH programcontacts, and identification and dissemination of bestpractices from the program.HRSA’s program, Health Care for the Homeless centers,provides individuals and families experiencinghomelessness with access to comprehensive preventiveand primary care services, including oral health, mentalhealth, and substance abuse services. These servicesare provided in a variety of settings that promoteaccess, including homeless shelters and mobile clinics.The program currently serves as the source of care forapproximately 600,000 people per year.HHS Strategic Plan FY 2007-2012107

CHAPTER 4: human servicesPerformance IndicatorsFY 2012Most Recent ResultTargetStrategic Objective 3.1Promote the economic independence and social well-being of individuals and families across the lifespan.Increase the percentage of adult TANF recipients who become 34.3% 39%3.1.1newly employed.3.1.2Increase the percentage of individuals with developmentaldisabilities reached by State Councils on DevelopmentalDisabilities who are independent, self-sufficient, and integratedinto the community.11.27% 11.34%3.1.3 Increase the child support collection rate for current support orders. 60% 63%Strategic Objective 3.2Protect the safety and foster the well-being of children and youth.Increase the adoption rate for children involved in the Child3.2.1Welfare System.Increase the percentage of Head Start programs that achieveaverage fall to spring gains of10.06% 10.40%3.2.2a) At least 12 months in word knowledge (Peabody PictureVocabulary Test); anda) 52%; and a) 66%;andb) At least four counting items. b) 84.6%. b) 86%.3.2.3Increase the percentage of children receiving Children’s MentalHealth Services who have no interaction with law enforcement inthe 6 months after they begin receiving services.69.3% 70%Strategic Objective 3.3Encourage the development of strong, healthy, and supportive communities.Increase the number of children living in married couple households3.3.1as a percentage of all children living in households.Strategic Objective 3.4Address the needs, strengths, and abilities of vulnerable populations.Increase the number of older persons with severe disabilities who3.4.1receive home-delivered meals.69% 72%313,362 500,0003.4.2Increase the percentage of refugees entering employment throughrefugee employment services funded by ACF.53.49% 60%Note: Additional information about performance indicators is included in Appendix B.108 HHS Strategic Plan FY 2007-2012

CHAPTER 4: human servicesMeeting External ChallengesWithin the human service goal, changes in economicconditions, specifically downturns, have been shown tobe the most influential external factor influencing howsuccessful HHS’s strategies are in accomplishing itsstated objectives.Historically, when negative economic conditions occur,welfare recipients, low-income people, and personswith disabilities are more vulnerable to unemployment;and fewer local resources and safety nets exist for thesepopulations. Decreases in State and local revenue couldresult in a reduction in funding for home and communitybasedplacements for individuals with disabilities. Familystress is greater as economic situations deteriorate,leading to increased potential for violence and familybreakup. Noncustodial parents may lose jobs or incomeresulting in fluctuations in income support ability.To mitigate these effects, HHS works at the State levelto enhance States’ capacity to coordinate a broad rangeof services, conducts research, provides technicalassistance, and identifies best practices that focus onelimination of barriers for the hard-to-employ and costeffectiveservice delivery. Additionally, HHS can assistcommunity action agencies, community developmentcorporations, and other community groups inleveraging Federal, State, local, and philanthropicresources to strengthen neighborhoods; build socialcapital by developing community leadership andstrengthening community-based organizations; andsupport asset development projects for residents ofdistressed communities. On the individual level, HHSprovides information and support for consumers andtheir caregivers and ensures individuals and familiesare connected to safety net programs for which theyare eligible through outreach and referral. HHS alsoprovides support for child care services, working toconnect families with the most appropriate childcare setting (also called parental choice) and helpingfamilies moving into work to remain connected toother safety net programs for which they are eligible.Child support enforcement activities can also becoordinated with opportunities for job training andsupported work activities.HHS Strategic Plan FY 2007-2012109

CHAPTER 4: human servicesDemographic Changes and TheirImpact on Health and Well-BeingEfforts to improve the health and well-being ofAmericans over the next 5 years will be shaped byimportant changes in demographics. Our Nationis growing older and becoming more racially andethnically diverse.Aging PopulationMore Americans are living longer, and the proportionof the Nation’s population that is age 65 or older isgrowing rapidly. A baby born in 2006 can expectto live to age 78. This age expectancy representsa gain of more than 10 years since 1965, when theOlder Americans Act of 1965 (Public Law 89-73) firstauthorized Medicare and Medicaid. From 1950 to2006, the total resident population of the United Statesdoubled from 150 million to more than 300 million.During this same period, the population 65 years of ageand over grew twice as rapidly, increasing from 12 to 36million. According to projections from the U.S. CensusBureau, after the first Baby Boomers turn 65 in 2011,the number of older people will substantially increase.In 2030, the older population is anticipated to be twiceas large as in 2000, and will represent nearly 20 percentof the total U.S. population. xxxiiiThe aging of the population has importantimplications for health care, public health, andhuman service systems. As the older fraction of thepopulation increases, more services will be requiredfor the treatment and management of chronic andacute health conditions and disabilities. The average75 year old has three chronic conditions and usesfive different prescription drugs. xxxiv Today’s healthcare workforce lacks much of the training required toprovide appropriate care to today’s older adults andis thus unprepared for the projected increase in thenumber of older Americans over the next 20 years.Equally important, the health care workforce is olderthan in the past.Across the country, long-term care providers arefacing a shortage of qualified and committed directcare workers—those certified nursing assistants,home health aides, and personal care workers whoprovide hands-on care to millions of older adults andindividuals with disabilities. Over the next 10 years,the country will need an estimated 874,000 additionaldirect care workers to meet growing demand. At thesame time, the supply of workers traditionally reliedupon to fill these positions—middle-aged women— willfall by about half by 2030. xxxvOlder Americans also have behavioral health andhuman service needs. Some older adults experiencelate onset of mental and addictive illnesses; othershave experienced them throughout their lives. Olderadults may experience depression and anxiety as theyface physical decline, death of family members andother loved ones, and increased limitations in normaldaily activities. In lieu of seeking treatment, someolder adults—as with other populations—may “selfmedicate”with alcohol. Further, older adults maymisuse prescription or over-the-counter medications,often inadvertently.The science of aging indicates that chronic diseaseand disability are not inevitable. As a result, healthpromotion and disease prevention activities andprograms are an increasing priority for older adults,their families, and the health care system.110 HHS Strategic Plan FY 2007-2012

CHAPTER 4: human servicesRacial/Ethnic DiversityDiversity has long been a characteristic of the Nation’spopulation, but the racial and ethnic composition haschanged over time. In recent decades, the percentof the population that is of Hispanic or Asian originhas more than doubled. In 2000, 19 percent of thepopulation identified themselves as Black or African-American, Asian, American Indian or Alaska Native,Native Hawaiian or Other Pacific Islander, or of morethan one race; 12.6 percent of the total U.S. populationidentified themselves as of Hispanic origin. The U.S.Census Bureau projects that by 2010, 20.7 percent of thetotal U.S. population will identify themselves as Blackor African-American, Asian, American Indian or AlaskaNative, Native Hawaiian or Other Pacific Islander, orof more than one race; and 15.5 percent will identifythemselves as of Hispanic origin. xxxviThe U.S. Census Bureau also reports that nearly onein five people, or 47 million U.S. residents age 5 andolder, spoke a language other than English at homein 2000—an increase of 15 million people since 1990.According to the report, Spanish speakers increasedfrom 17.3 million in 1990 to 28.1 million in 2000, a 62percent rise. Only 55 percent of the people who speak alanguage other than English at home report they speakEnglish “very well.” xxxviiThese changes in the racial and ethnic compositionof the population have important consequences forthe Nation’s health because many of the measures ofdisease and disability differ significantly by race andethnicity. These shifts in the racial and ethnic makeupof the United States require health professionals andorganizations to achieve cultural competence andto ensure that they utilize appropriate and tailoredapproaches in working with these population groups.HHS Strategic Plan FY 2007-2012111

Chapter 5Strategic Goal 4:Scientific Research and DevelopmentAdvance scientific and biomedicalresearch and development relatedto health and human services.

CHAPTER 5: Scientific Research and DevelopmentDisease and injury are constantthreats to humankind and are neverstatic. Diseases, such as HIV/AIDS,SARS, pandemic influenza, obesity,and many other conditions canemerge at any time. Twenty yearsago, the impact of Alzheimer’sdisease was not fully appreciated,and its causes were not known.Bioterrorism did not figure prominentlyin the scientific research anddevelopment agenda in 2001, butis now a top priority for numerousHHS divisions, including FDA, NIH,and CDC.STRATEGIC GOAL 4:SCIENTIFIC RESEARCH AND DEVELOPMENTStrategic Objective 4.1:Strengthen the pool of qualified health andbehavioral science researchers.Strategic Objective 4.2:Increase basic scientific knowledge to improvehuman health and human development.Strategic Objective 4.3:Conduct and oversee applied research toimprove health and well-being.Strategic Objective 4.4:Communicate and transfer research resultsinto clinical, public health, and human servicepractice.HHS Strategic Plan FY 2007-2012113

CHAPTER 5: Scientific Research and DevelopmentAs a result of success in preventing and treating acuteand short- term conditions such as heart attacks,stroke, cancer, and many infectious diseases, peopleare living longer. The increasingly older populationfaces the new challenge of multiple chronic conditionsthat now consume about 75 percent of health careexpenditures. The Nation is in a continuous raceagainst the overwhelming health and economicconsequences of disease and human suffering.Therefore, we must utilize research and development toits maximum capacity to transform health care, publichealth, and human service practice efforts.The 21st century is an era of great scientific opportunity.Advances in the understanding of basic human biologyallowed NIH to sequence the human genome by 2003, 2years ahead of schedule, and to complete the haplotypemap, showing the variation between individualhumans, in October 2005. New advances enable newtreatments that could lead to the transformation ofmedical treatment in this century. The hope is tousher in an era in which medicine will begin to bepredictive, personalized, and preemptive. Personalizedmedicine has the potential to transform health carethrough earlier diagnosis, more effective prevention andtreatment of disease, and avoidance of drug side effects.Basic science is the foundation for improved health andhuman services. However, once a basic discovery ismade, the findings must be applied and translated intopractice for health and human service improvement toresult. This continuum from basic and applied researchto practice is a significant emphasis of HHS’s scientificresearch and development enterprise.Strategic Goal 4, Scientific Research and Development,seeks to connect this path from basic research topractice through four broad objectives:• Strengthen the pool of qualified health andbehavioral science researchers;• Increase basic scientific knowledge to improvehuman health and development;• Conduct and oversee applied research to improvehealth and well-being; and• Communicate and transfer research resultsinto clinical, public health, and human servicepractice.A number of HHS operating and staff divisions,including the Agency for Healthcare Research andQuality (AHRQ), Centers for Disease Control andPrevention (CDC), Food and Drug Administration(FDA) and, most significantly, the National Institutesof Health (NIH), sustain and contribute to a fullspectrum of scientific research and developmentactivities.NIH supports and conducts investigations acrossthe full range of the health research continuum,including basic research, which may be diseaseoriented or related to the development andapplication of breakthrough technologies;observational and population-based research;behavioral research; prevention research; healthservices research; translational research 15 ; andclinical research, 16 as well as research on newtreatments or prevention strategies.FDA supports the research and development goal asa scientific regulatory agency. It is responsible forprotecting the public health by assuring the safety,efficacy, and security of human and veterinary drugs,biological products, medical devices, and the Nation’sfood supply. FDA also ensures the safety of cosmeticsand products that emit radiation. FDA advances thepublic health agenda by helping to speed innovationsto market that make medicines more effective and toprovide the public accurate, science-based informationneeded regarding medicines and foods to improve itshealth. FDA plays a significant role in addressing theNation’s counterterrorism capability and in ensuringthe security of the food supply. FDA conducts appliedand translational research that enables it to developregulatory standards and risk assessment criteria toreach sound, science-based public health decisionson regulated products. All of these activities areconducted in collaboration with numerous publicand private partners, including academic researchinstitutions; nonprofit foundations; and vaccine,pharmaceutical, and medical device industries.15 Translational research involves the application of laboratoryfindings to clinical interventions.16 Clinical research includes research to understand both normalhealth and disease states.114 HHS Strategic Plan FY 2007-2012

CHAPTER 5: Scientific Research and DevelopmentCDC focuses primarily on epidemiological and publichealth practice research. AHRQ has establisheda broad base of scientific research and promotesevidence-based improvements in clinical practiceand in the organization, financing, and delivery ofhealth care services.Below is a description of each strategic objective,followed by a description of the key programs,services, and initiatives the Department isundertaking to accomplish those objectives.Although HHS supports a wide array of research anddevelopment activities, these represent the majorareas of the emphasis for the Department over thenext 5 years. Key partners and collaborative effortsare included under each relevant objective. Theperformance indicators selected for this strategicgoal are also presented with baselines and targets.These measures are organized by objective. Finally,this chapter discusses the major external factorsthat will influence HHS’s ability to achieve theseobjectives, and how the Department is working tomitigate those factors.HHS Strategic Plan FY 2007-2012115

CHAPTER 5: Scientific Research and DevelopmentStrategic Objective 4.1Strengthen the pool of qualified health andbehavioral science researchers.The average age of first-time (new) principalinvestigators of research funded by NIH has risen to42 years for Ph.D. degree holders and 44 years for M.D.and M.D./Ph.D. holders. This trend must be curtailedin order to capture the creativity and innovation of newindependent investigators in their early career stages toaddress the Nation’s health-related research needs.The National Research Council of the NationalAcademies of Science issued two reports in 2005 aboutresearch training and career development with calls forimmediate action. NIH will continue to respond to thisneed to assist and mentor creative young researchersthrough existing programs. NIH is also developing newinitiatives to complement existing efforts to strengthenthe pool of qualified health and behavioral scienceresearchers.NIH will continue to support the Ruth L. KrischsteinNational Research Service Award Research TrainingGrants and Fellowships Program. This programprovides grant and fellowship funding for individualinvestigators with or working on a research-relatedor health-profession doctorate degree. Individualawards promote diversity in health-related researchfields across NIH. HHS will use the retention rate ofthese trainees and fellows as an indicator of its successin improving the pool of qualified researchers. NIHwill also support the Pathway to Independence AwardProgram. This program is an innovative and newopportunity for promising postdoctoral scientiststo receive both mentored and independent researchsupport from the same award. NIH will also continueto work with IHS to support the Native AmericanResearch Centers for Health to increase the number ofAI/AN researchers.116 HHS Strategic Plan FY 2007-2012

CHAPTER 5: Scientific Research and DevelopmentBrain ResearchStrategic Objective 4.2Increase basic scientific knowledgeto improve human health and humandevelopment.Basic research contributes significantlyto personalized health careand to increasing understandingof human makeup and biologicalprocesses. Current and future basicresearch projects in HHS focuson those areas with the greatestpotential for reduction in excessmorbidity and mortality, includingbrain function, human development,asthma and other respiratorydiseases, cancers, dementia,influenza strain mapping, andantimicrobial resistance. The performanceindicators for this strategicobjective highlight researchefforts related to major diseases,including cardiovascular diseaseand Alzheimer’s, and imaging toolsfor the early detection of diseases,including cancer.The rising public health impact of disorders of thenervous system makes neuroscience one of the mostimportant scientific frontiers for biomedical andbehavioral research in this century. Discoveries inthe areas of pain, alcoholism, drug abuse, autism,schizophrenia, depression, and other mental disordersare increasing dramatically. NIH will build onthese discoveries by continuing to support researchto better understand the processes of the brain,including improving imaging technologies to be ableto visualize brain processes as they happen. Theincreased understanding of the nerve circuits willpave the way for improved diagnosis and treatmentof common diseases such as depression, stroke, andepilepsy and reduced burden on the Nation in termsof both suffering and health care costs. NIH will alsosupport the Autism Phenome Project, which will identifyvarious clinical characteristics and subtypes of autismto facilitate research on genetic and other potentialcauses of autism and to guide applied research relatedto treatment approaches.Alzheimer’s DiseaseAlzheimer’s disease, the most common cause ofdementia among people older than 65, is one ofthe most serious threats to the Nation’s healthand economic well-being. Currently, 4.5 millionAmericans are affected by the disease; that numberis expected to almost triple by 2050. Those sufferingfrom Alzheimer’s disease advance inexorably, fromearly, mild forgetfulness to a severe loss of mentalfunction and inability for self-care. Existing researchsuggests that Alzheimer’s disease pathology beginsto develop in the brain long before clinical symptomsyield a diagnosis. The ability to make an accurate earlydiagnosis of Alzheimer’s disease would allow targetedintervention before cognitive loss becomes significant.NIH is searching for valid, easily attainable biologicalmarkers that could help identify biological markers forearly disease. For example, NIH will support researchto examine one promising approach that involves usingcoated gold nanoparticles as bioprobes to measureHHS Strategic Plan FY 2007-2012117

CHAPTER 5: Scientific Research and Developmentthe concentrations of substances that correlate withAlzheimer’s disease. NIH will also continue to supportthe Alzheimer’s Disease Neuroimaging Initiative.The 5-year, 50-site project represents the mostcomprehensive effort to date to develop neuroimagingand other biomarkers for the changes associated withmild cognitive impairments and Alzheimer’s disease.The ongoing Genetics Initiative will also support thedevelopment of resources necessary for identifyinglate-onset risk factor genes, associated environmentalfactors such as physical activity and diet, and theirinteractions.Human DevelopmentNIH is committed to funding a diverse portfolio of basicand translational research that addresses the physical,psychological, psychobiological, language, behavioral,social-emotional, and educational development ofchildren. For example, the National Institute of ChildHealth and Human Development (NICHD) at NIHhas taken a leadership role in advancing scientificknowledge regarding the acquisition of reading andmathematics skills, related learning disabilities,and language development and second languageacquisition, as well as child maltreatment, childhoodobesity, and the attainment of school readinessskills. Additionally, understanding normative braindevelopment and its relationship to cognitive, socialemotional,and behavioral development is importantin finding the causes of myriad childhood disordersrelated to mental retardation, mental illness, drugabuse, and pediatric neurological diseases, whichcan continue into adulthood. To define the healthyranges in brain growth and development patternsin children as they mature, NIH-funded researchersare creating the Nation’s first database of MagneticResonance Imaging measurement of normal braindevelopment over time in children and adolescents inthe United States. NIH is bringing together a diversearray of researchers to design and support a largescalelongitudinal study that uses state-of-the-artbrain-imaging technologies and that collects clinicaland behavioral data, which will be used to developanalytical software tools. A special effort will be made118 HHS Strategic Plan FY 2007-2012

CHAPTER 5: Scientific Research and Developmentto disseminate these data, and as a result, the scientificcommunity will have access to a Web-based, userfriendlyresource that integrates neuroanatomical andclinical/behavioral data to examine brain-behaviorrelationships and relationships between physicalmaturation and brain development.Cancer ResearchNIH investment in cancer research is helping tomake a real difference. In the United States, deathrates from all cancers combined dropped 1.1 percentper year from 1991 to 2001. xxxviii Yet cancer remainsa major public health problem with more than 1million Americans per year diagnosed with some formof cancer. Despite significant progress, the cancerchallenge remains formidable, and NIH investmentin basic cancer research remains critical. NIH willcontinue to support a broad range of basic researchto expand the understanding of cancer. Throughthe Cancer Genome Atlas Project, NIH will expandthe capacity of the cancer community to utilizeinformation on cancer genes. NIH also will focus on agrowing area of interest—understanding the reactionof the body’s immune system to a developing tumor—because chronic inflammatory immune responses areknown to exacerbate certain cancers.AsthmaNIH supports a comprehensive asthma programto develop new approaches to prevent, treat, andcontrol asthma. Asthma exacerbations cause manyof the negative effects of asthma, and management ofasthma exacerbations accounts for a large proportionof the estimated annual cost to the Nation’s economy.In contrast to the understanding of the origins ofasthma, little is known about the processes that occurduring an acute episode; how worsening attacksare resolved; the effect of attacks on future severityand frequency; and the long-term effects on lungphysiology, function, and disease progression. Inorder to develop new interventions to prevent andhelp resolve acute or worsening asthma episodes,NIH initiated a set of basic, clinical, and translationalstudies to determine the molecular, cellular, andgenetic causes of asthma exacerbations. The longtermgoal is to identify and characterize two molecularpathways of potential clinical significance that mayserve as a basis for discovering new medications forpreventing and treating the progression of this disease.The studies will address diverse areas including therole of environmental triggers in enhancing airwayhyperresponsiveness; the relationship of environmentalfactors to frequency and severity of asthma attacks;specific effects of initiating events on lung physiologyand inflammation; genetic approaches to individualsusceptibility for worsening attacks; and the rolespecific immune and lung cells play in asthma diseaseclassification, chemistry, and physiology.Pandemic InfluenzaHHS is working intensely against influenza. The centerof this work is the development of multiple vaccinesagainst influenza virus. At the level of basic science,however, NIH is collaborating with numerous publicand private partners on an influenza sequencingproject. This project will determine the complete geneticsequences of thousands of influenza virus strains,providing the scientific community with data vital todevelopment of new vaccines, therapies, and diagnostics.Antimicrobial ResistanceMicrobes once easily controlled by antimicrobialdrugs are causing infections that no longer respondto treatment with these drugs. In addition, new,serious, and unforeseen infectious disease threatshave emerged, including those posed by agentsof bioterrorism. Because the existing repertoireof antimicrobial medications may not provide aneffective defense against newly emerging and resistantorganisms and bioterrorism agents in the future,there is a need to develop new treatments that may beeffective against a range of pathogens. NIH is workingto develop a universal antibiotic, a drug effective againsta wide spectrum of infectious diseases, to help addressthese challenges. NIH also is expanding its capacityfor medicinal and combinatorial chemistry, library anddatabase resources, and screening assays for use inidentifying novel antimicrobial drugs.HHS Strategic Plan FY 2007-2012119

CHAPTER 5: Scientific Research and DevelopmentStrategic Objective 4.3Conduct and oversee applied research toimprove health and well-being.The application of basic scientific findings in the healthand human service areas marks the next step along thecontinuum from basic research to practice. Numerousdivisions within HHS conduct and provide oversight ofapplied research. These activities range from clinicaltrials for promising new pharmaceuticals and vaccinesto behavioral research to identify effective approachesfor reducing risky behaviors associated with infectiousand chronic diseases. The performance indicatorshighlight clinical trials focused on improving treatmentto those with both cardiovascular disease and diabetesand/or chronic kidney disease.Birth Defects/Developmental DisabilitiesCDC conducts a variety of applied research studies toadvance the understanding of factors associated withbirth defects and developmental disabilities in bothchildren and adults. Over the next 5 years, CDC willidentify and evaluate the role of new factors for birthdefects and developmental disabilities. CDC also willinitiate new and continue existing studies of candidaterisk and protective factors associated with birth defectsand developmental disabilities to identify potentialintervention strategies.Substance Abuse TreatmentAlthough research has demonstrated that substanceabuse treatment can be effective in reducing substanceuse and addiction, few science-based interventionshave been developed and tested widely within thehealth care field. The reasons for this are, in part,related to cultural and institutional barriers. Inan effort to narrow the substance abuse treatmentgap, recent substance abuse treatment studies havefocused on deploying interventions in communities.NIH has adapted and is testing three substanceabuse treatment approaches in an effort to bringresearch-based treatments to communities morerapidly. These substance abuse treatment protocols,120 HHS Strategic Plan FY 2007-2012

CHAPTER 5: Scientific Research and DevelopmentBrief Strategic Family Therapy, Seeking Safety, andMotivational Enhancement Treatment, are designedto reach specialized populations that are frequentlyunderrepresented in drug and alcohol abuse researchand are often underserved in drug and alcohol abusetreatment centers. The populations served includeadolescents at high risk for substance addiction andtheir families and abused women, as well as membersof minority groups.Lung CancerLung cancer is one of the leading causes of death inthe United States, with an estimated 160,000 deathsoccurring annually and an estimated incidence of173,000 newly diagnosed cases each year. xxxix Onlyone-third of newly diagnosed cases are identified at astage early enough to allow for effective therapeuticintervention, while more advanced stages of the diseaseare characterized by a median survival rate of lessthan 1 year. The development of new drug treatmentsfor lung cancer has been slowed by difficulty in bothearly detection and measurement of early therapeuticdrug response. NIH is supporting research to evaluate,validate, and compare varying functional imagingmethods that could serve as more sensitive approachesto the measurement of early drug response thanstandard or conventional anatomic imaging techniquesthat are based on significant tumor shrinkage. NIHis striving to validate and to compare three imagingmethods that could offer increased sensitivity overcomputed tomography as a means of assessing lungcancer response to therapy.ObesityObesity is associated with numerous serious diseases,including type 2 diabetes, heart disease, stroke,osteoarthritis, gallstones, breathing problems, andcertain cancers. Type 2 diabetes, formerly viewed as adisease of older adults, has been increasingly reportedamong children.NIH is exploring lifestyle-based approaches to obesityprevention, including behavioral or environmentalinterventions, in settings such as schools, communities,and homes. NIH will support at least two studies thatwill evaluate the effects on weight control of worksiteinterventions that include environmental components,and at least three studies will evaluate the effects ofinterventions delivered in primary care settings totreat and/or prevent obesity in children. Becausemaintenance of weight loss is a critical yet particularlydifficult element of obesity treatment and prevention,NIH also will investigate novel ways to help individualswho have intentionally lost weight to keep the weightoff for at least 2 years. Complementing these areasof investigation relevant to lifestyle interventions isresearch to evaluate the efficacy of different types ofdiets and physical activities.HHS Strategic Plan FY 2007-2012121

CHAPTER 5: Scientific Research and DevelopmentCardiovascular DiseaseTo improve the treatment of cardiovascular disease,NIH is working to develop and clinically apply onenew imaging technique that will enable tracking themobility of stem cells within cardiovascular tissues.Scientists are now devoting considerable effort tounderstanding the role of cytokine 17 production bystem cells rather than focusing solely on assessing theirdifferentiation state and location in vivo. Despite thenew focus on cytokine production, the importanceof understanding stem cell differentiation remains abasic, important problem in regenerative medicine. Apromising new approach for assessing differentiationhas recently been reported in the literature. Scientistshave inserted a reporter of calcium transients intostem cells, allowing scientists to determine whetherstem cells are coupled productively to the normalheart during the regeneration process. Control ofdifferentiation will be critical for the eventual successof cardiovascular cell-based therapy. Imaging methodsto detect and monitor the differentiation process arenow the focus of efforts in numerous laboratories.NIH is undertaking a multimodality imaging effort todevelop tools to track cardiovascular stem cells in vivo,and ultimately in patients.Public Health ProtectionCDC’s applied research portfolio targets fourinterrelated areas: healthy people in every stage oflife, healthy people in healthy places, people preparedfor emerging health threats (infectious, occupational,environmental, and terrorist threats), and healthypeople in a healthy world. In support of the goalsdirectedresearch strategy, CDC has developed theAdvancing the Nation’s Health: A Guide to Public HealthResearch Needs, 2006-2015. This Research Guide is acomprehensive resource of critical national and globalpublic health research priorities that will advancescience and practice toward greater health impact.17 Cytokine is a protein secreted by cells of the lymph systemthat affects the activity of other cells and is important in controllinginflammatory responses.122 HHS Strategic Plan FY 2007-2012

CHAPTER 5: Scientific Research and DevelopmentThe array of public health research priorities includesinfectious diseases, public health preparedness, chronicdiseases and disabilities, safety of environments, globalpublic health, health information and communication,crosscutting research, and health disparities. Over thenext 5 years, CDC will progress toward achievementof the health protection goals and will address theresearch themes in the Research Guide.Within the infectious disease area, research will focuson antimicrobial resistance; bioterrorism-relatedenvironmental microbiology, and zoonotic andvectorborne diseases; vaccines and immunizationprograms, including vaccine supply issues; andspecial populations. Within the preparedness area,research will focus on vulnerable populations,including predictive strategies for risk and recoveryafter an extreme event, infrastructure and workforcepreparedness, and detection and diagnosis of hazardsand their medical consequences.The chronic disease applied research portfolio willfocus on pregnancy planning and preconceptioncare; optimal child and adolescent development;identification of effective health promotion strategies;and reduction of the burden of, disparities in, andrisk factors for, chronic disease among older adults.In order to create safe places to live, work, andplay, CDC will conduct research on environmentalrisk factors such as lead exposure and health, safeworkplace design, effective strategies to preventinjuries and violence, and risk and protective factors forinterpersonal violence and suicidal behavior.Food, Drug, and Device SafetyUnder its Critical Path Initiative, FDA will stimulate andfacilitate a national effort to modernize the scientificprocess through which a potential human drug,biological product, or medical device is transformedfrom a discovery or “proof of concept” into a medicalproduct. FDA will continue to conduct research onresistance of foodborne pathogens to antimicrobialdrugs and to provide for the safe use of antimicrobialsin food animals, while ensuring that the usefulness ofcritical human drugs is not compromised or lost.FDA’s National Center for Toxicological Research(NCTR) will undertake applied research studies thatsupport and anticipate current and future regulatoryneeds, including integrated toxicological research andsupport for the Critical Path Initiative.HHS Strategic Plan FY 2007-2012123

CHAPTER 5: Scientific Research and DevelopmentStrategic Objective 4.4Communicate and transfer research results intoclinical, public health, and human service practice.The implementation of researchresults in the health care Americansreceive every day is the last stepof productive research. The performanceindicators at the end ofthis chapter highlight three ongoingefforts to improve preventionefforts among older adults, reduceinfant mortality among minorities,and implement evidence-basedpractices in clinical care.Community Preventive ServicesThe Guide to Community Preventive Services servesas a filter for scientific literature on specific healthproblems that can be large, inconsistent, uneven inquality, and even inaccessible. This Community Guidesummarizes what is known about the effectiveness,economic efficiency, and feasibility of interventionsto promote community health and prevent disease.The Task Force on Community Preventive Services,convened by HHS, makes recommendations for theuse of various interventions based on the evidencegathered in the rigorous, systematic scientific reviewsof published studies conducted by the review teams ofthe Community Guide. The findings from the reviewsare published in peer-reviewed journals and madeavailable on this Internet Web site. HHS will continueto support the Community Guide and will disseminateits systematic review findings via its Web site.124 HHS Strategic Plan FY 2007-2012

CHAPTER 5: Scientific Research and DevelopmentClinical Preventive ServicesThe Guide to Clinical Preventive Services providesrecommendations on screening, counseling, andpreventive medication topics and includes clinicalconsiderations for each topic. This new pocketguide provides general practitioners, internists,family practitioners, pediatricians, nurses, andnurse practitioners with an authoritative source formaking decisions about preventive services. HHS willcontinue to support the Guide to Clinical PreventiveServices and disseminate its systematic reviewfindings via its Web site.HHS also supports a joint Clinical Decision Supportprogram/project planning and coordination effort.This project will provide recommendations and anaction plan designed to advance the development,widespread adoption, and value of clinical decisionsupport in improving health and the quality and safetyof health care delivery. AHRQ, CMS, IHS, and ONC arecollaborators within HHS. The project also includesnon-Federal partners, including the CertificationCommission for Healthcare Information Technology,Thomas Macromedia, Brigham and Women’s Hospital,Partners HealthCare, American Medical InformaticsAssociation, and Oregon Health & Science University.Dissemination of FindingsAHRQ plays an important role in translational researchand dissemination of research findings. AHRQ conductsand supports research on value-based purchasing tohelp meet these information needs, including articlesfor the field on how to design, implement, and evaluatevalue-based purchasing programs. AHRQ’s studiesand reports will expedite the cycle of research sothat purchasers have quicker access to findings onvalue-based purchasing and will provide guidance ondecisionmaking related to value-based purchasing.AHRQ’s Accelerating Change and Transformation inOrganization and Networks program will promoteinnovation in health care delivery accelerating thedevelopment, implementation, dissemination, anduptake of demand-driven and evidence-based products,tools, strategies, and findings.AHRQ’s Innovations Clearinghouse, an online searchabledatabase and repository of innovations in health servicedelivery, will capture effective methods of disseminatingand sustaining improvements in the delivery of healthcare. In addition, the Innovations Clearinghouse willserve as a forum for learning about innovation andchange. It will provide a national-level, publicly accessiblemechanism for obtaining objective, detailed informationon health care innovations and tools and will promotetheir dissemination, replication, adaptation, and use.Dissemination of InformationHHS also develops and disseminates informationand guidelines based on applied research results. Forexample, NIH continues to develop and disseminateguidance related to Sudden Infant Death Syndrome(SIDS). SIDS, a syndrome of unknown cause, is definedas the sudden death of an infant younger than 1 year ofage, which remains unexplained even after a thoroughcase investigation, autopsy, and review of the clinicalhistory. SIDS is the leading cause of postneonatalmortality in the United States. Led by NIH incollaboration with various sponsors, the NationalBack to Sleep public health education campaign waslaunched in 1994 after the American Academy ofPediatrics recommended back sleeping as the safestsleep position for infants younger than 1 year of age.Since the launch of the campaign, the SIDS rate hasdropped by 50 percent.However, despite the overall success of the campaign,African-American infants are placed to sleep on theirstomachs more often than are White or Caucasianinfants. The SIDS rate for African-American infantsis two times greater than that of White or Caucasianinfants. In collaboration with African-Americanorganizations, NIH has developed comprehensivestrategies to reduce SIDS in African-Americancommunities. First, NIH launched a multiyearproject to disseminate the American Academy ofPediatrics safe sleep guidelines in Mississippi. Theproject has multiple components, including trainingpublic health workers to convey SIDS risk reductionmessages, developing partnerships with State andHHS Strategic Plan FY 2007-2012125

CHAPTER 5: Scientific Research and Developmentlocal stakeholders, and providing minigrants tocommunity and faith-based organizations to assistwith their outreach efforts. Second, a continuingeducation curriculum has been developed for nurseson safe sleep guidelines and effective ways to conveythe risk reduction message. This curriculum will beimplemented at regional and national conferences.Evidence-Based PracticesSeveral HHS operating divisions support grantprograms that facilitate the utilization of evidencebasedapproaches. SAMHSA’s Strategic PreventionFramework State Incentive Grants, e.g., require Stategrantees and their subrecipients to identify theirsubstance use-related problems and to develop andimplement evidence-based programs, policies, andpractices that have been proven effective in addressingthese issues. AoA funds a grant program and public/private partnership to increase older people’s accessto programs that have proven to be effective inreducing their risk of disease, disability, and injury.The partnership involves a variety of Federal agenciesand private foundations that are coordinating theirefforts to support the implementation of evidencebaseddisease prevention programs at the State andcommunity levels.In addition, the President’s Budget for FY 2008 requests$10 million in new funding under the Child AbusePrevention and Treatment Act to fund competitive grants.These grants will support the development of a statewideinfrastructure to implement, monitor, and sustain highquality,evidence-based nurse home visitation programs.Funds will be used to support and enhance collaborationand coordination across multiple State and private agenciesthat already receive Federal or State funding to implementvarious home visitation models. This new funding willbe used for investments in cross-agency collaboration,program development, quality-assurance systems, training,technical assistance, workforce recruitment and retention,evaluation, and other administrative mechanisms neededto successfully implement and sustain high-quality,evidence-based home visitation programs that have strongfidelity to proven effective models.126 HHS Strategic Plan FY 2007-2012

CHAPTER 5: Scientific Research and DevelopmentThese programs demonstrate how the results of researchfrom HHS divisions, including NIH, CDC, and AHRQ, canbe effectively translated into practice at the communitylevel through service providers. HHS will continue itscommitment to infuse evidence into practice throughsuch discretionary programs.National RegistrySAMHSA supports the National Registry of EvidencebasedPrograms and Practices, a Web-based systemdesigned to disseminate timely and reliableinformation about interventions that prevent and/ortreat mental and substance use disorders. Programsin the Registry have undergone a rigorous review.The Registry provides detailed descriptions of eachintervention as well as outcome data.HHS Strategic Plan FY 2007-2012127

CHAPTER 5: Scientific Research and DevelopmentPerformance IndicatorsMost Recent ResultFY 2012 TargetStrategic Objective 4.1Strengthen the pool of qualified health and behavioral science researchers.4.1.1Through the National ResearchService Award program,increase the probabilitythat scientists continueparticipation in NIH-fundedresearch within the followingten years:a) Post-doctoral fellows; andb) Pre-doctoral trainees andfellows.Strategic Objective 4.2a) 13 percentage points; andb) 13 percentage points.a) 12+ percentage points; andb) 12+ percentage points.Increase basic scientific knowledge to improve human health and human development.4.2.1Develop and apply clinicallyone new imaging technique toenable tracking the mobility ofstem cells within cardiovasculartissues.Researchers in the NIHintramural program havedeveloped probes that arecompatible with opticalmicroscopy techniquesdeveloped by intramuralscientists.Develop one new imagingtechnique that is able to beclinically applied.4.2.2Identify at least one clinicalintervention that will delaythe progression or onset ofAlzheimer’s disease (AD), orprevent it.Nearly 1,000 new late-onset ADfamilies have been identifiedand recruited to the ADGenetics Initiative.Identify the next generation ofcompounds for testing in pilotclinical trials.4.2.3Develop a novel advancedpattern recognition algorithmto analyze data obtained fromimaging technologies to aidclinicians in diagnosing theearliest stage of disease, e.g.,brain cancer.The prototype patternrecognition algorithm hasbeen designed and trained torecognize anomalies in thepilot study of brain MagneticResonance SpectroscopicImaging (MRS) scans.Apply, in conjunction witha Cooperative Research andDevelopment Agreement(CRADA) partner, a patternrecognition algorithm toidentify early biomarkersof brain disease to otherdisease endpoints in clinicalapplications such as thoseused to identify breast cancermarkers.128 HHS Strategic Plan FY 2007-2012

CHAPTER 5: Scientific Research and DevelopmentMost Recent ResultFY 2012 TargetStrategic Objective 4.3Conduct and oversee applied research to improve health and well-being.4.3.1Conduct clinical trials to assessthe efficacy of at least three newtreatment strategies to reducecardiovascular morbidity/mortality in patients with type 2diabetes and/or chronic kidneydisease.Initial findings made public atthe annual American DiabetesAssociation meeting in June2006.Complete clinical trials andmake results available.Strategic Objective 4.4Communicate and transfer research results into clinical, public health, and human service practice.4.4.1Increase the number of AoAsupportedcommunity-basedsites that use evidencebaseddisease and disabilityprevention programs.27 sites 136 sites4.4.2Reduce the disparity betweenAfrican-Americans infants andWhite infants in back sleepingby 50% to reduce the risk ofSudden Infant Death Syndrome(SIDS).The SIDS rate for African-American infants is two timesgreater than that of Whiteinfants.Reduce disparity by 50%4.4.3Reduce the financialcost (or burden) of uppergastrointestinal (GI) hospitaladmissions by implementingknown research findings.$93.46 per U.S. resident ages 65to 85.10% reductionNote: Additional information about performance indicators is included in Appendix B.HHS Strategic Plan FY 2007-2012129

CHAPTER 5: Scientific Research and DevelopmentMeeting External ChallengesNumerous external factors influencethe Department’s ability toadvance its scientific researchand development enterprise. Thepace and uncertainty of progressin basic and applied researchmake it difficult to predict howand from where the next importantadvances will emerge. Additionally,applied research dependson advances in basic biomedicaland behavioral research as a preconditionof new work, the timeoften needed for a basic researchfinding to develop into a publichealth result, and drug testing timeneeded to develop animal modelsand move through the phases ofclinical trials successfully.Pace and Success of ResearchIn recent years, rapid advances in the biomedicalsciences have raised expectations of similar progressin the development of products for the prevention andtreatment of serious illnesses. Despite huge strides todecipher the intricacies of human biology, medicinetoday remains, to an unfortunate degree, an attempt tobalance the risks of treatments against their uncertainpotential to cure. Physicians earnestly attempting toprovide the best treatments, along with their patients—who may be suffering from any of a host of debilitating,even fatal, diseases—are too often left waiting fortreatments that are expensive and, ultimately, maynot work for them. Compounding these problems130 HHS Strategic Plan FY 2007-2012

CHAPTER 5: Scientific Research and Developmentis the fact that the number of new drugs and othertreatments approved each year for use in the UnitedStates is steadily dropping, in no small part becausescientists test new discoveries using outdated andinefficient tools and techniques. The result is a slow,expensive process. It produces fewer and fewertreatments that can be approved as safe and effective,and it leaves consumers on their own to grapple withthe question marks of treatment and a short list ofprevention options.One of HHS’s primary strategies for reversing this trendis through the FDA Critical Path Initiative (CPI). TheCPI identifies and prioritizes the most pressing medicalproduct development problems and the greatestopportunities for rapid improvement in public healthbenefits. The goal is to stimulate the development ofpowerful new scientific and technical tools—such asproven biomarkers, innovative clinical trial designs,simulation models of physiology and disease processes,and manufacturing quality assessment methods—capable of rapidly predicting the safety, effectiveness,and quality of new medical products. Developmentof these tools will be based on an understanding ofthe most successful practices as well as the failures,roadblocks, bottlenecks, and missed opportunitiesalong the way.Business InterestsWithin the research and development sector, businessdecisions, such as technical capabilities, competingopportunities, interest in the field to develop basicfindings into next steps or the next generationof science, economic motivations, public healthmotivations, and other considerations, significantlyinfluence research and development progress. Forexample, during the last half-century, pharmaceuticalcompanies have been gradually abandoning thedevelopment and manufacture of vaccines. Today,fewer companies are making vaccines because of anumber of factors, including the expense involved inbringing vaccines to market and the small size of thevaccine market compared to the larger drug market.There does not appear to be a single reason to explainthe decline in the number of vaccine manufacturers.High-risk research that is critical to biomedicaladvances must often be initiated by public agencies;because of the high risk of failures, private for-profitgroups may be less likely to pursue this type of research.A larger trend in pharmaceutical company mergers andacquisitions, which has seen vaccine-only companiesacquired by larger manufacturers, has also contributedto the decreases in the total number of companiesmaking vaccines. In the 1990s, these mergers andacquisitions were largely driven by the need to cut costs.Companies are merging and acquiring other companiesin order to secure enough capital and expertise totake advantage of these innovations and, at the sametime, cut costs and create efficiencies. The concernremains, however, that leaving the manufacture of allvaccines in the hands of so few producers leaves thesupply vulnerable to disruptions and shortages as hasbeen observed in recent years regardless of the totalcapacity to produce vaccines. HHS is working withmanufacturers to identify incentives to promote marketreentry and capacity expansion.Intellectual PropertyIntellectual property issues also influence theadvancement of science. HHS is working to devisecreative incentives to promote the sharing ofknowledge among researchers. HHS is also workingas a member of the global community to promoteknowledge sharing across countries through formaland informal channels.Recruiting and Retaining ExpertiseThe scientific labor market is highly competitive. Ahighly competitive labor market may impact HHS’sability to recruit and retain scientific experts toconduct and oversee research activities and to reviewapplications for medical products. HHS will workto address this challenge by developing training andfellowship programs, as well as partnerships withacademia, to enhance the pool of qualified scientists.HHS Strategic Plan FY 2007-2012131

Chapter 6Responsible Stewardshipand Effective Management

CHAPTER 6: Responsible Stewardship and Effective ManagementResponsible Stewardship and Effective ManagementEffective Human Capital ManagementEffective Information Technology ManagementEffective Resource ManagementEffective Planning, Oversight, and Strategic CommunicationsThis section of the Strategic Plan highlights themeans and strategies employed by HHS’s operatingand staff divisions to support the achievement of theDepartment’s goals. Many of these functions andactivities are not seen by the citizens we serve; however,they are critical to our stakeholders and the HHSemployees who implement our programs.As the goals of this Strategic Plan make clear, HHS’score mission is to protect the health of all Americansand provide essential human services, especially forthose who are least able to help themselves. Signs ofthe positive results of this mission come to light everyday, as HHS employees develop cures for devastatingdiseases; research critical trends in public health; assistchildren, families, and older adults in living betterlives; and perform countless other services for theNation and the world. Less visible is the frameworkof planning, administration, and management thatfacilitates all of these accomplishments. The successof HHS’s scientists, researchers, caregivers, inspectors,and technicians depends on the solid foundationprovided by managers, contracting officers, analysts,accountants, human resource specialists, attorneys,and all the other support staff across the Department.A robust and reliable system of administrative supportprovides the necessary groundwork for the Departmentto remain dedicated to, focused on, and unhindered inits programmatic work.A critical factor in the Department’s achievement of itsmission and goals is its ability to formulate, implement,execute, and manage effective administrative support forits programs—from exercising responsible stewardshipof taxpayer dollars to managing employees effectively.Our underlying approach will be an interactive, ongoingeffort to formulate policy and strategies, monitorprogress and results, reward excellence, correctmistakes, and adjust to changing circumstances.HHS Strategic Plan FY 2007-2012133

CHAPTER 6: Responsible Stewardship and Effective ManagementHHS continuously reviews and refines managementpractices as needed to ensure that the Departmenthas the resources to provide first-rate administrativesupport. Through aligning its strategic plans, budgets,and performance plans and establishing measures thatassess our progress and results, HHS clearly definesits intended outcomes, and effectively projects andmanages resources required to implement programs.This section of the Strategic Plan outlines themanagement means and strategies that HHS willemploy to facilitate program success. In carrying outthese strategies, the Department places the utmostimportance on fostering a culture of leadership andaccountability. All employees are expected to assumeleadership roles in their areas of responsibility byexhibiting a willingness to develop and coach others,a commitment to teamwork and collaboration, and adrive to meet challenges with innovation and urgency.Effective Human Capital ManagementRecruit, develop, retain, and strategically manage aworld-class HHS workforce.Implement rigorous recruiting strategies to ensurethe hiring of top talent. Approximately a quarter ofall HHS nonsupervisory employees, and about half ofall HHS managers, will be eligible for retirement withinthe 5 years covered under this Strategic Plan. To ensurethat future workforce needs are met, HHS has identifiedits mission-critical and core competencies and willcontinue highly targeted recruitment efforts. Amongthe strategies the Department will use are CooperativeEducation Programs, the Direct-Hire Program, theFederal Career Intern Program, the HHS EmergingLeaders Program, the Presidential Management FellowsProgram, and the Retired Annuitants hiring process.HHS will aggressively identify robust technologysystems that will enable the Department to competewith private industry for top talent. In addition, HHSwill continually examine recruitment processes toensure that it improves the quality of the candidatesrecruited and is able to hire them in the quickesttimeframe possible.134 HHS Strategic Plan FY 2007-2012

CHAPTER 6: Responsible Stewardship and Effective ManagementStrengthen the workforce by developing staff skills,improving competencies, and retaining talent. HHSwill develop an effective learning and developmentstrategy that leverages current capabilities at HHSUniversity and also takes advantage of trainingopportunities in the operating divisions. Emphasiswill be placed on achieving better results throughmore effective utilization of the Department’s trainingrelatedfinancial resources. To ensure that resourcesare allocated to produce maximum effectiveness inan optimal timeframe, HHS will support this activitythrough traditional classroom training, online selfstudy,development programs, and career counseling.In addition, the HHS Web-based, DepartmentwideLearning Management System supports closingcompetency gaps (core and technical) in missioncriticaloccupations.Ensure that the HHS workforce reflects the diversityof the Nation it serves. A diverse workforce capitalizeson the contributions of persons of distinct ethnicities,races, cultures, and backgrounds. Leveraging thesedifferences enhances the social and business workplaceenvironment, helps to eradicate discrimination, andincreases organizational efficiency and productivity.Through personal leadership and involvement, all HHSemployees will proactively support and promote theDepartment’s Equal Employment Opportunity (EEO)and Diversity Management programs to achieve amore diverse workforce and promote a workplace freeof discrimination. Through program accountability,training, outreach, recruitment, and use of flexiblehiring techniques, HHS will ensure that representationof minorities and persons with disabilities at HHSreflects the Nation as a whole.HHS has some specific initiatives to recruitunderrepresented populations. HHS, through itspartnership with the U.S. Department of DefenseComputer/Electronic Accommodations Program andthe U.S. Department of Labor Workforce RecruitmentProgram, plans to leverage these resources to increasehiring of people with disabilities. In addition, HHSminority outreach initiatives include participationin a number of student intern programs, such as theAsian Pacific American Institute for CongressionalStudies, Bilingual/Bicultural Program, Federal CareerIntern Program, HHS Emerging Leaders Program,Hispanic Association of Colleges and UniversitiesNational Internship Program, International LeadershipFoundation, and the Organization of Chinese AmericansGovernment Internship Programs. In the area oftraining, HHS has developed the EEO and DiversityAcademy, which offers courses designed to instill inhiring managers, as well as all in HHS employees,recognition of the intrinsic value a diverse Federalworkforce brings to a Department with a diversecustomer base.Ensure the highest level of efficiency and effectivenessof HHS organizations, through regular competitionwith the private sector. In accordance with OMBCircular A-76, XL HHS will continue to ensure thatthe most efficient organization carries out theDepartment’s commercial functions. HHS will utilize acombination of standard studies, streamlined studies,and restructuring efforts to implement competitivesourcing. The savings generated from competitivesourcing studies will continue to provide benefits toHHS programs and the American taxpayer.Ensure that all HHS employees are accountablefor results. Guided by the Department’s HumanCapital Accountability System Policy, HHS willcontinue to monitor, manage, and evaluate itsformal Departmentwide, integrated human capitalaccountability system to ensure mission-aligned humancapital goals are achieved effectively, efficiently, andwithin merit system principles and related regulations.All HHS employees will have an approved performanceplan in place within 30 days of hire and will receive atleast one midyear progress review annually. The SeniorExecutive Service and Organizational PerformanceManagement System and the Performance ManagementAppraisal Program will connect expectations tomission and link performance ratings with measurableoutcomes. Performance plans for all HHS employeesare designed to cascade from the goals and objectivesoutlined in the Strategic Plan and operating divisionstrategic plans, to ensure that performance expectationsHHS Strategic Plan FY 2007-2012135

CHAPTER 6: Responsible Stewardship and Effective Managementthroughout the entire agency are aligned with the HHSmission and oriented toward achieving results. 18Effective Information Technology ManagementProvide a well-managed and secure enterpriseinformation technology environment. 19Development of a comprehensive plan that optimizesthe use of resources in support of all strategic andmanagement goals and objectives. The Clinger-CohenAct of 1996 (Public Law 104-106) requires that everyFederal agency develop an Enterprise Architecture (EA).EA ensures that the business and technical architecturesfor the Department support the HHS mission andoutcome objectives by establishing relationships betweenand among business operations and the informationsystems and resources that enable those operations. EAtakes a comprehensive view of the enterprise, includingstrategic planning, organizational development,relationship management, business processimprovement, information and knowledge management,and operations. EA will enable the Department toachieve more effective planning and control overinvestments for information technology by enhancingflexibility and interoperability across informationsystems; reducing redundancies; and improving access toaccurate, timely, and consistent information.Maintain a secure environment in which allaspects of security, privacy, and confidentialityare addressed. HHS is an attractive high-profiletarget for hackers and those with malicious intentseeking sensitive medical information, homelandsecurity first responder information, patent andintellectual property worth billions of dollars, andmuch more. In order to address these immediatechallenges and comply with Federal legislation, HHShas developed a proactive, enterprisewide informationtechnology (IT) security program (Secure One HHS)to help protect the HHS IT infrastructure againstpotential threats and vulnerabilities. The Secure OneHHS IT Security Program was designed to increase the18 Appendix C, Performance Plan Linkage, provides additionalinformation on these strategies.19 Additional information about HHS’s information technologystrategies is included in the Information Technology section.baseline IT security posture across all HHS operatingdivisions while reducing reporting burdens forcompliance with Federal mandates. The creation ofthis new security program, which spans the HHS ITcommunity, Headquarters, and the operating divisions,is an important step in protecting HHS’s ability toprovide mission-critical services and maintain thepublic’s trust and confidence in the quality of HHSservices and business operations.Manage information technology projects andinvestment to demonstrate results and consistentlyprovide the value intended. This activity will requirethe successful completion of all aspects of project andinvestment management rigor that are described in theHHS Enterprise Performance Life Cycle (the integrationof management, business, and engineering life-cycleprocesses that span the enterprise to align IT with thebusiness). This success will be measured by the HHSCapital Planning and Investment Control process, whichstructures budget formulation and execution, ensuresthat investments consistently support the strategicgoals of the agency, and includes the evaluation ofeffective earned value management.Effective Resource ManagementUse financial and capital resources appropriately,efficiently, and effectively.Ensure the integrity of HHS financial managementprocesses. Financial management systems thatmeet Joint Financial Management ImprovementPlan certification standards will be in placeDepartmentwide by 2010, with all but Medicare PartsC and D covered by the beginning of FY 2010. HHSalso will address all identified outstanding materialweaknesses and internal control deficiencies.Manage financial resources wisely and appropriatelythrough the reduction of improper payments.According to the Improper Payments InformationAct of 2002 (Public Law 107-300), improper paymentsoccur when funding is provided to the correct recipientin the incorrect amount, when the wrong recipientreceives funds, or when funds are used by the recipientimproperly. HHS will continue its efforts to reducethe rates of improper payment in three of its largest136 HHS Strategic Plan FY 2007-2012

CHAPTER 6: Responsible Stewardship and Effective Managementprograms, Medicare, Head Start, and Foster Care. Atthe same time, the agency will develop improvedinformation on payment error rates for other largeprograms such as Medicaid, State Children’s HealthInsurance Program (SCHIP), and Temporary Assistancefor Needy Families (TANF).Strategically manage the acquisition, leasing,construction, operation, maintenance, and disposalof HHS’s real property assets. HHS will overseeeffective real property acquisition and operations andmaintenance practices, right size the real propertyportfolio, and realize cost savings through increasedefficiency and strategic investments. Efficiency andeffectiveness of real property assets will be maximizedby disposing of excess property and reducingunderutilization and overutilization. HHS will improveboth the condition of HHS’s buildings and facilities andenvironmental management through greater energyconservation, enhanced occupational safety and health,and sustainable development.Create a seamless integration of acquisition policies,procedures, systems, and contract vehicles to betterserve employees, customers, and vendors. Throughthe Acquisition Integration and Modernization initiative,HHS will develop a uniform way of conductingbusiness, minimize duplication and improveefficiency, and provide excellent customer service toHHS stakeholders. In addition, HHS will facilitatemobility among HHS acquisition personnel as well aspersonnel interfacing with the acquisition community,leverage spend opportunities and drive cost savings,capture knowledge and share best practices within theacquisition community, ensure sufficient resources toconduct acquisition activities, and ensure an optimalallocation of these resources as efficiencies are realized.Improve coordination of grant activities acrossthe Department. HHS will implement a grantannouncement planning and review process (linkedto budget plans) that ensures alignment of plannedgrant announcements with Departmentwide priorities,identifies opportunities for collaboration across theDepartment, and gives the public advance informationon grant announcement plans.Effective Planning, Oversight, and StrategicCommunicationsImprove the management of HHS by providingongoing oversight, evaluation, and analysis of policiesand programs and by ensuring effective strategiccommunications.Provide ongoing oversight, evaluation, and analysisof policies and programs. We will monitor ourprograms to ensure that the Department is fulfillingits statutory, regulatory, and fiduciary responsibilitiesand intergovernmental commitments in an ethical andlegal manner. In addition, we will conduct independentand objective audits, evaluations, analysis, andinvestigations to assess the effectiveness and efficiencyof policy and program implementation.Improve communication with the public, employees,and stakeholders about HHS’s mission, goals,and performance, as well as the benefits andservices that the Department provides. We willimprove communications by proactively developing,maintaining, and widely disseminating comprehensiveand accurate information about our plans, activities,and accomplishments in a timely manner to ouremployees, stakeholders, and customers. In addition,we will endeavor to respond promptly to requests forinformation from members of the U.S. Congress, ourother stakeholders and partners, local and nationalmedia, and the public regarding HHS policies andprograms.Effective human capital, information technology,resource management, and management oversightand communications are HHS’s most critical meansto provide support for the Department’s goals andstrategies. HHS will continue to analyze its practicesand procedures to ensure that the managementstrategies defined for the future meet the needs of theDepartment and, most importantly, its customers: theAmerican people.HHS Strategic Plan FY 2007-2012137

APPENDIX AHHS Program Evaluation Efforts

Appendix a: program evaluation effortsHHS Program Evaluation EffortsEvaluations play an integral role in carrying out theHHS mission. Evaluation assesses the efficiency, effectiveness,and responsiveness of the Department’sprograms or strategies through the analysis of data orinformation collected scientifically. It also ensures theeffective use of resulting information in strategic planning,program or policy decisionmaking, and programimprovement.HHS evaluation planning activities are coordinatedwith Departmentwide planning initiatives. HHS evaluationactivities support the Department’s strategicplanning and performance management activitiesin several ways. Completed evaluation studies helpprograms determine the means and strategies they willuse to achieve HHS strategic goals and objectives. Programevaluations also may identify data that programscan use to measure performance. A sample of currentevaluations is listed in Table A-1. Also listed are futureevaluations that will inform strategic planning. HHSdivisions use findings from their evaluations to supportthe Government Performance and Results Act (GPRA)of 1993 (Public Law 103-62) annual performance reportingto the U.S. Congress and program budget justificationsof various HHS programs. Evaluation findingsprovide important sources of information and evidenceabout the success of policies and programs.Typically, HHS evaluation priorities include congressionallymandated program evaluations, evaluations ofSecretarial program or policy initiatives, assessmentsof new programs, evaluations of programs that arecandidates for reauthorization, and reviews of programperformance that support management decisionmakingand accountability.The U.S. Congress requests that HHS coordinate all ofits Research, Demonstration, and Evaluation (RD&E)programs to ensure that the results of these projects addressHHS program goals and objectives. HHS reportsto the Congress annually on RD&E activities. The AssistantSecretary for Planning and Evaluation (ASPE) andthe Assistant Secretary for Resources and Technology(ASRT) work together with HHS divisions to providethe Congress with a special annual research, demonstration,and evaluation budget plan that coincideswith the preparation of the President’s fiscal year budget.The plan outlines HHS RD&E priorities as relatedto the Department’s strategic goals and objectives.Evaluation OversightHHS divisions and ASPE execute annual evaluationplans that involve developing evaluation contractsand disseminating and applying evaluation results. Alldivisions and their subunits (centers, institutes, andbureaus) coordinate with each other on research andevaluation project planning and release of final reportsthat relate to work of other HHS divisions. Althoughthere is some oversight responsibility and executioncapability in the Office of the Director or Administratorfor each division, the various subunits conduct much ofthe day-to-day evaluation activity.The Office of Inspector General (OIG) performs independentevaluations, also called inspections. The OIGmission includes providing HHS, the U.S. Congress, andthe public with evaluations that focus on preventingfraud, waste, or abuse; promoting economy, efficiency,and effectiveness in Departmental programs; andpresenting practical recommendations for improvingprogram operations. XLIQuality Assurance and ImprovementMost evaluation projects are developed at the programor office level. A committee of division- or office-levelpolicy and planning staff members generally conductsthe initial quality review. Before a project is approved, asecond committee reviews it for technical quality withexpertise in evaluation methodology. Technical reviewcommittees follow a set of criteria for quality evaluationpractice established by each division. ASPE, forexample, has a formalized peer review process in whichexperienced evaluators on staff review, discuss, andapprove all proposed research projects before they aresubmitted for funding. Some HHS divisions have externalevaluation review committees composed of evaluationexperts from universities and research centers.HHS uses a variety of program evaluation techniquesto review the effectiveness of programs and to ensurethat programs are on target so that HHS can meet itsstrategic goals. Comprehensive, independent evaluationsare an important component of the HHS strategyto improve overall program effectiveness and to ensurethat the goals identified in the Strategic Plan accuratelyrepresent HHS’s progress in achieving its goals. Theseevaluations are an important component in evaluatingwhether or not programs are effective, well designed,and well managed.HHS Strategic Plan FY 2007-2012139

Appendix a: program evaluation effortsProgram Assessment Rating ToolThe Program Assessment Rating Tool (PART) was createdto improve program performance and inform fundingand management decisions throughout the FederalGovernment. From CYs 2002–2006, HHS reviewednearly all programs using the PART. The review processinvolved with PART helps to identify each program’sstrengths and growth areas through a comprehensiveanalysis of the program’s purpose and design; performancemeasurement, evaluation, and strategic planning;program management; and program results.After a PART review, programs implement a series offollowup actions to improve program effectiveness.PART results may lead programs to develop new performanceindicators, conduct independent evaluationsof program activities, request legislative changes to theprogram structure, or make a series of other programimprovements. The Strategic Plan highlights severalmeasures developed during the PART process.Role of Program Evaluations inStrategic PlanningAs noted above, evaluations play an important role insetting the goals and objectives in strategic planning.Examples follow below.Strategic Goal 1: Health CareBy closely monitoring the implementation of the newMedicare prescription drug benefit and the capacity torespond to Medicare beneficiaries’ questions, HHS wasable to provide the resources needed to improve theability of beneficiaries, and the others who assist them,to obtain the information they needed to enroll in adrug plan. In addition, the demographic and other informationdeveloped to describe Medicaid beneficiariesand the uninsured are helping policymakers determinehow to address these issues.Success in increasing health care service and availabilityrelies, in part, on how effectively we are able toensure the successful translation of research into safeand effective medical products. Evaluation informationsupports our ability to help human drug sponsors improvethe quality of their drug development and relatednew drug applications. The Prescription Drug and UserFee Act of 1992 (Public Law 102-571), as amended (PD-UFA III), effective from FYs 2003–2007, expanded userfee funding to support several initiatives to improveapplication submissions and FDA-sponsored interactionsduring drug development and application review.FY 2005 was the fifth consecutive year in which FDAreceived an increased number of priority original drugapplications, which represent significant new medicaltreatments for American patients. Additionally, FDAfound that new mechanisms for FDA-sponsored interactions,such as meetings and consultations during thedrug development phase, had a positive impact on therate of first-cycle approval of drug applications, whichspeeds the availability of safe and effective new medicaltreatments to patients.Through the Medicaid program, a substantial numberof people receive personal assistance services, whichallow them to function independently in their ownhomes. Consumer-directed services further allow beneficiariesto manage not only their human assistance,but also other covered supportive services. Cash andCounseling is an expanded model of consumer-directedservices. ASPE and the Robert Wood Johnson Foundationcollaborated to fund the Cash and CounselingDemonstration Evaluation (CCDE) to track the experiencesof beneficiaries and providers in three States—Florida, Arkansas, and New Jersey—that participated ina unique Medicaid waiver experiment. Because of theCCDE, 11 other States have been selected to participatein an expansion of Cash and Counseling. Equally important,consumer choice, control, and empowermenthave been inculcated throughout the Medicaid programand are reflected in many of the long-term careinitiatives highlighted in this Strategic Plan, includingthe Money Follows the Person demonstration.Strategic Goal 2: Public HealthPromotion and Protection, DiseasePrevention, and EmergencyPreparednessThe development of food labeling information strategieswas based in part on information from the FDAHealth and Diet Survey – 2004 Supplement. Through thedata gained from this survey, we were able to identifythat most people have a limited understanding of mostdietary fats and their relationship to the risk of coronaryheart disease. In addition, we gained new informationon consumer attitudes toward diet, health, andphysical activity.As a part of a wide-ranging effort to improve patientsafety, in 2004 FDA finalized a rule requiring barcodeson the labels of thousands of human drugs and biologicalproducts. The measure is to protect patients frompreventable medication errors by helping ensure that140 HHS Strategic Plan FY 2007-2012

Appendix a: program evaluation effortshealth professionals give patients the right drugs at theappropriate doses. FDA estimates that the rule willhelp prevent nearly 500,000 adverse events and transfusionerrors while saving $93 billion in health care costsover 20 years.Obesity has reached epidemic levels and is a primaryfocus of many HHS public health interventions. However,little is known about the dynamics of how obesityaffects disability and other health outcomes as peopleage. To help inform policy and programmatic decisionsaround research and interventions aimed at preventingand treating obesity and alleviating its potentialeffects on disability and other health outcomes, ASPEis analyzing data from the Health and Retirement Surveyas well as the Assets and Health Dynamics Among theOldest Old Study. These data will expand our understandingof how obesity affects disability and otherhealth outcomes as people move from late adulthoodto older ages.Strategic Goal 3: Human ServicesThe National Evaluation of Welfare-to-Work Strategiesand the State welfare waiver evaluations foundthat mandatory welfare employment programs thatemployed a work-first approach are effective in increasingthe employment and earnings of welfare recipients,particularly long-term recipients. These findingshelped to influence the provisions of the Deficit ReductionAct of 2005 (Public Law 109-171) that strengthenthe TANF work requirements.Early findings from the Family and Child ExperiencesSurvey (FACES) showed that Head Start children werenot performing well in the area of letter identificationand vocabulary. These findings motivated Head Start’sintensive efforts to strengthen children’s preliteracy.According to more recent FACES data, Head Startchildren are coming closer to national norms for letterrecognition. The percentage of Head Start parentsreading to their children three or more times a weekhas also increased, after intensive efforts to improveearly literacy activities. Head Start anticipates continuedgains as it continues to focus training and technicalassistance resources in this area.ASPE conducted a study to assess the costs of providingsupportive services to individuals and families whoare experiencing homelessness and residing in thehomeless assistance programs through the U.S. Departmentof Housing and Urban Development (HUD). Thefindings identified the actual cost of these services andthe myriad funding streams used. The study findingshelped guide subsequent HHS and Administration policieson supportive services for individuals and familiesexperiencing homelessness, particularly those residingin HUD homeless assistance programs.Strategic Goal 4: Scientific Researchand DevelopmentAHRQ sponsored the Combining Clinical and AdministrativeHospital Data Evaluation project. AHRQ alsoidentified the most efficient set of clinical data elementsthat can be added to administrative data toincrease the reliability and validity of hospital-specificpublic quality reporting. The intent was to developmixed clinical-administrative data models that areclinically sound and defensible. The study focused onadding key clinical data elements to specific measuresfrom the AHRQ Quality Indicators (QIs) to create clinicallyenhanced QIs.Health information technology (health IT) is increasinglyviewed as a tool that can promote quality andcost-effective care in the United States. Althoughmuch progress has been made in the development ofelectronic health records and other infrastructure, thelack of robust evidence on health IT costs and benefitsacross settings has stymied efforts to develop suchcapabilities in the post-acute care (PAC) and long-termcare environment. A deeper, evidence-based understandingof costs and benefits is needed and is essentialto inform providers contemplating purchase of healthIT systems. In addition, such an understanding canprovide useful and reliable information to policymakers,payers, employers, and others who seek to influencehealth IT adoption. ASPE is designing an evaluationto assess the business case for health IT in PACand long-term care settings and to provide additionalsupport for a keystone of the Department’s vision forthe health care delivery system of the future.HHS Strategic Plan FY 2007-2012141

Appendix a: program evaluation effortsTable A-1Selected Current Program Evaluation EffortsDivision Topic DescriptionStrategic Goal 1: Health CareAHRQLong-term careEvaluate outcome measures and hold an expert meeting to improveuse of long-term care tools.AHRQMarket forcesEvaluate research utility on health care cost, productivity,organization, and market forces.AHRQPharmaceutical outcomes Evaluate research goals, impact, and progress reporting and useappreciative inquiry.AHRQ National Resource Center (NRC) Evaluate the NRC program and the NRC Web site.ASPEASPEASPEASPEASPEASPEASPEASPEASPEASPEASPEAccuracy of MedicaidenrollmentAdvance directivesCash and CounselingEmployer health insuranceGraduate Medical Education(GME)Health care qualityImpacts on premiums ofchanges in plan benefit designImplementation of MedicarePart D paymentsMassachusetts universal healthcoverageMedicaid and SCHIP participationMedicare beneficiaries inintegrated hospital systemsEvaluating data from several sources to determine the accuracy ofthe estimate of Medicaid enrollment is correct and the accuracy ofthe estimate of the number of uninsured people.Analyze existing advance care planning efforts, prepare paperson selected topics, and conduct roundtable discussions withleading experts and persons with disabilities in order to developa framework for a report from the Secretary to Congress onpromoting the use of advance directives.Encourage and facilitate the diffusion of the Cash and Counselingmodel of consumer-directed home and community-based servicesto 11 additional States.Measure changes in costs of and access to employer healthinsurance in a standardized and comparable way. The researchwill produce information to support increased access to affordablehealth care coverage.Assess the current state of GME, including sources of funding,characteristics of residency programs, and resident demographics.Evaluated strengths and weaknesses of current system of funding,and analyzed alternative models of funding and support.Completing a project to design evaluations of the Medicare QualityImprovement Organizations and will plan to fund projects toevaluate their performance.Develop models that calculate the impact that changes in planbenefit design have on premiums.Collecting and analyzing data measures associated with theimplementation of the Part D benefit including enrollment,pharmacist inquiries, and helpline call volume.Monitoring the implementation of the Massachusetts initiative toachieve universal health insurance coverage.Evaluate the effectiveness of outreach and retention efforts inimproving participation in Medicaid and SCHIP.Examining utilization patterns of Medicare beneficiaries treated inintegrated hospital systems, including the sites of care after acutehospitalization.142 HHS Strategic Plan FY 2007-2012

Appendix a: program evaluation effortsDivision Topic DescriptionStrategic Goal 1: Health CareASPEASPEASPEASPEASPEASPEASPEASPEASPEASPEASPECDCCDCCDCCDCMedicare Part D paymentsMedicare physician servicesMental health prevention andtreatment educationMental Health WorkforceDevelopment and RetentionNational Medicare EducationProgramOwn Your FuturePalliative end-of-life carePayments in ambulatory sites ofserviceQuality of Long-Term CareRegional patterns in drugutilizationState health care reformprogramsCommunity-based interventionsfor alcohol-impaired drivingCommunity-based interventionsto reduce motor vehicle-relatedinjuriesFall preventionManagement of the learning-todriveprocessEvaluate risk adjustment used to establish Part D payments to planswith regard to low- income and institutionalized beneficiaries.Assess value-based purchasing options for Medicare physicianservices used by other payers to examine elements that could beused in Medicare.Conducting an evaluation of the impact and distribution of theOffice of Women’s Health’s publication, “People’s Piece on MentalHealth.”Identify gaps in the Nation’s mental health workforce and todetermine what efforts need to be implemented to retain a highlyskilled workforce.Designing an evaluation of the National Medicare EducationProgram, a multifaceted educational and social marketingcampaign intended to inform beneficiaries and their caretakersabout health benefits under the Medicare program.Conduct a followup survey of respondents in five States thatparticipated in the long-term care awareness campaign entitled“Own Your Future,” which encourages consumers to plan ahead forlong-term care.Develop a policy and research conceptual framework to help guidefuture Medicare efforts in palliative end-of-life care.Evaluating the differences between payments for the same servicesin different ambulatory sites of service.Examine whether the current approach to Medicare home healthcare quality adequately captures the potential differences in postacutecare and chronically ill patients.Evaluate regional patterns in drug utilization to determine whetherthese patterns should be accounted for in the Part D payment rates.Evaluate State health care reform programs and theirimplementation, and focus on the employer response to theseprograms in particular. This research can be expected to guideStates and Federal proposals to expand access to health insurancecoverage using premium assistance, private insurance marketreform, and employer-sponsored insurance.Evaluate interventions to decrease alcohol-impaired driving incommunity settings and its resulting deaths and injuries.Evaluate community-based interventions with demonstratedeffectiveness for preventing motor vehicle-related injuries.Evaluate the translation of an exercise intervention that rigorousresearch has shown is effective in reducing falls among older adults,into a program.Evaluate the effectiveness of the Checkpoints intervention tomeasure the restrictions that parents place on their teens as theymove from learner’s permit to provisional license to full licensure.HHS Strategic Plan FY 2007-2012143

Appendix a: program evaluation effortsDivision Topic DescriptionStrategic Goal 1: Health CareCDCCDCCDCCDCCDCCDCCMSCMSCMSCMSCMSCMSMultilevel parent trainingNational Breast and CervicalCancer Early Detection ProgramPrevention of childmaltreatmentRisk and protective factors forsexual violence perpetrationand the overlap with bullyingbehaviorTeen driving safetyTraining skills of home visitorsOutpatient therapy utilizationCancer prevention andtreatment demonstrationEvaluate disease managementprograms in MedicareCompetitive bidding forMedicare clinical laboratoryservicesDirect Service CommunityWorkforceEnd stage renal diseasemanagementEvaluate the effectiveness of a multilevel parent training programfor families with children 6 and younger.Evaluate the variation in diagnostic followup rates among differentracial and ethnic groups.Evaluate the strategies and techniques for reducing attrition andenhancing compliance with extant parenting programs for theprevention of child maltreatment.Evaluate the association between bullying experiences and cooccurringand subsequent sexual violence perpetration.Evaluate the effectiveness of enhanced enforcement through teenself-reports on the number of passengers, adherence to nighttimecurfews, seat belt use, and perceptions of police enforcementactivity.Evaluate the impact of home visitor training and factors relatedto the implementation (i.e., competency of visitors providingservices, as well as adequate coverage of content according to aprespecified protocol) of an existing efficacious or effective homevisiting program on family outcomes of child maltreatment and riskbehaviors for youth violence (e.g., poor parent-child relations and/orharsh, lax, or inconsistent discipline).Evaluate the impact of the Balanced Budget Act of 1997 (Public Law105-33) on the delivery and utilization of inpatient and outpatientrehabilitation therapy services to beneficiaries.Evaluate the success in eliminating or reducing disparities incancer screening rates through timely facilitation of diagnostictesting, appropriate treatment modalities, cost-effectiveness of eachdemonstration, quality of services provided, and beneficiary andprovider satisfaction.Evaluate the effectiveness of Capitated Disease ManagementDemonstration for beneficiaries with chronic medical conditionsand another demonstration of disease management focusing onbeneficiaries with advanced stage diabetes and congestive heartfailure.Evaluate a demonstration of testing of competitive bidding forclinical laboratory services under a demonstration project.Develop a site-specific evaluation plan, develop a Web-basedreporting tool, develop an evaluation design for the NationalDemonstration Program, and develop a series of promisingpractices to improve the recruitment and retention of direct serviceworkers, for 10 demonstration projects.Evaluate the end stage renal disease management to determinecase-mix, patient satisfaction, outcomes, quality of care, and costsand payments.144 HHS Strategic Plan FY 2007-2012

Appendix a: program evaluation effortsDivision Topic DescriptionStrategic Goal 1: Health CareCMSCMSCMSCMSCMSCMSCMSCMSCMSCMSCMSCMSCMSCMSHealth insurance flexibilityInformatics, Telemedicine, andEducation DemonstrationLife Masters DemonstrationLong-Term Care HospitalPayment System RefinementMaintaining independence andemploymentMedical Adult Day-Care ServicesDemonstrationAlternative models for deliveryof care to Medicare beneficiariesMedicare Lifestyle ModificationProgram DemonstrationMMA’s changes on dual eligiblebeneficiaries in demonstrationand other managed care andfee-for-service arrangementsMedicare Part DQuality of health careValue-based purchasingProgram of All-Inclusive Carefor the Elderly (PACE) as apermanent programRural Hospice DemonstrationEvaluate the strength of the relationship between the HealthInsurance Flexibility and Accountability initiative and the numberand rate of uninsured for health care.Evaluate the telemedicine diabetes demonstration.Evaluate the combination of the State’s Medicaid pharmacy benefitwith a disease management activity funded by Medicare.Evaluate the Long-Term Care Hospital Payment System Refinementand its effect on overall Medicare payments, and determine thefeasibility of CMS establishing facility- and patient-level criteria forLong-Term Care Hospital payments.Evaluate several demonstrations providing supplemental Medicaidbenefits to persons with HIV/AIDS.Evaluate the Medical Adult Day-Care Services Demonstration todetermine the impact on patient outcomes and costs of furnishingcare.Evaluate the implementation and operational experiences ofparticipating Medicare Advantage Special Needs Plans, MedicareCare Management participating medical practices, MedicarePreferred Provider Organizations, Medicare Coordinated CareDemonstration, Medicare Health Care Quality Demonstration,Medicare Health Support, and Medicare Savings Accounts.Evaluate the health outcomes and cost-effectiveness of the MedicareLifestyle Modification Program Demonstration for Medicarebeneficiaries with coronary artery disease.Evaluate the changes of the Medicare Prescription Drug,Improvement, and Modernization Act (MMA) of 2003 (Public Law108-173) on beneficiaries in dual eligible Medicare AdvantageSpecial Needs Plans demonstrations that also contract forcomprehensive Medicaid benefits.Evaluate the Medicare Part D payment demonstration thatrepresents an alternative payment approach for private plansoffering prescription drug coverage under Part D.Evaluate components of two CMS quality initiatives—Nursing HomeCompare and Home Health Compare.Evaluate the quality of care furnished to Medicare beneficiaries innursing facilities and, in a separate demonstration, physician grouppractice, as part of a value-based purchasing initiative.Evaluate PACE in terms of site attributes, patient characteristics,and utilization data statistically analyzed across sample sites andcompared to the prior demonstration data and other comparablepopulations.Evaluate the impact of the Rural Hospice Demonstration on changesin the access and cost of care and to assess the quality of care forMedicare beneficiaries.HHS Strategic Plan FY 2007-2012145

Appendix a: program evaluation effortsDivision Topic DescriptionStrategic Goal 1: Health CareCMSCMSCMSHRSAHRSAHRSASenior Risk ReductionDemonstrationState pharmacy assistanceprogramsSystem Change GrantsCommunity-based insurancemodelsState Medicaid opportunities forHRSA granteesValue and cost of providingcomprehensive pharmacyservicesEvaluate health promotion and disease prevention using health-riskassessments, as well as ongoing tailored feedback, counseling, andreferrals to local and national resources.Evaluate two State pharmacy programs that have expandedMedicaid pharmacy coverage to low-income residents otherwise notMedicaid eligible.Evaluate the Real Choice Systems Change Grants includingComprehensive Family to Family, Housing, Life Accounts, MentalHealth System Transformation, Portals from EPDST to AdultSupports, Rebalancing, and Quality Assurance and QualityImprovement in Home and Community-Based Services.Evaluate current experience with existing models of communitybasedinsurance products designed to make insurance affordablefor low-income individuals. This evaluation relates to a range ofsafety-net programs that need to maximize reimbursement to coverthe costs of serving the uninsured.Evaluate changes in the national Medicaid program, and the impactof those changes on HRSA grantees in the respective States. Thisstudy is focused on the changes made in Medicaid by the Statesas they develop their systems, the impact on safety-net providerssuch as Health Centers, and opportunities for such providers toparticipate in State systems.Evaluate the value and cost to safety-net providers of providingcomprehensive pharmacy services.IHS White Earth Health Center Evaluate changes in center service and health status of patients.NIHContinuing Medical Education Evaluate NIH Medical Education Program Continuing MedicalEducation to determine whether the program is operating asplanned, is meeting regulatory criteria, and is achieving areas forprogram improvement.SAMHSASAMHSACo-Occurring State IncentiveGrant (COSIG)HIV Services CollaborativeEvaluate to what extent SAMHSA’s goals and objectives for theCOSIG program were met; the strengths and weaknesses of the“State incentive grant” approach to helping States improve theirsystems of services for specific populations; and how SAMHSA canstructure and support similar programs in the future.Evaluate the HIV Services Collaborative, which supports SAMHSA’shealth oversight role, providing data and analyses, as well asdefinitive documentation of the benefits of program efforts to assistclinicians and program administrators in strengthening programs;in tailoring outreach and recruitment efforts; in better documentingthe Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition, diagnoses within treatment populations; and indetermining mental health staffing needs.146 HHS Strategic Plan FY 2007-2012

Appendix a: program evaluation effortsDivision Topic DescriptionStrategic Goal 1: Health CareSAMHSASAMHSASAMHSANational Child Traumatic StressInitiative (NCTSI)Screening, Brief Intervention,and Referral and Treatment(SBIRT) programSubstance Abuse Preventionand Treatment Block GrantEvaluate the program to describe the children and families served bythe NCTSI centers; describe the behavioral and clinical outcomes ofchildren served; describe services utilized; assess the developmentand dissemination of effective products, treatments, and services;assess intranetwork collaboration; and assess the network’s nationalimpact.Evaluate the program in various settings and under somewhatdifferent approaches to determine which models of SBIRT offer thegreatest potential to improve the Nation’s service system.Evaluate to analyze the management, implementation, andoutcomes of the Substance Abuse Prevention and Treatment BlockGrant.HHS Strategic Plan FY 2007-2012147

Appendix a: program evaluation effortsDivision Topic DescriptionStrategic Goal 2: Public Health Promotion and Protection, Disease Prevention, and Emergency PreparednessACFACFACFACFACFAHRQASPEASPEASPECDCCDCCDCCDCCDCCDCAssets for Independence ActCompassion Capital FundDomestic violence emergencysheltersLong-term transitional livingprogramMentoring Children Of Prisoners(MCP) programPreventionDisability and health amongolder adultsFall reductionObesity reduction andpreventionCommunity-based interventionsfor alcohol-impaired drivingpreventionEffective strategies to reducemotor vehicle injuries amongAmerican Indians and AlaskaNativesEmergency communicationstrategic and organizationalplanning and managementFall prevention strategies amongcommunity-dwelling olderadultsInternational influenzanetworks for pandemicinfluenza preparednessNational Breast and CervicalCancer Early Detection ProgramEvaluate the program to determine the effectiveness of IndividualDevelopment Account projects funded by the Assets forIndependence Act of 1998 (Public Law 105-285).Evaluate the Compassion Capital Fund program to assess outcomesand impacts on the organizational capacity of faith-based andcommunity organizations.Evaluate domestic violence emergency shelters in collaborationwith the U.S. Department of Justice/National Institute of Justice.Evaluate the program to track long-term gains or losses in housing,educational, employment, and other outcomes for older youthexperiencing homelessness and in transitional living residentialprograms after they are discharged.Evaluate the program to compare long-term cognitive, academic,behavioral, and other outcomes of children in MCP programs withthose of similar children at risk in concurrent Big Brothers/BigSisters school mentoring programs.Evaluate the Prevention Portfolio to determine the extent to whichthe work of the Portfolio contributes to AHRQ’s mission and toidentify gaps where additional research is needed in preventivehealthcare.Expand our understanding of how obesity affects disability and otherhealth outcomes as people move from late adulthood to older ages.Pursuing Phase II of a multiyear effort to develop and evaluate a fallreduction intervention for community-dwelling older adults.Encouraging and facilitating future discussions on the issueof marketing foods and beverages to youth and examining theindustry’s efforts to modify marketing practices to vulnerablepopulations.Evaluate interventions to decrease alcohol-impaired driving incommunity settings and its resulting deaths and injuries.Evaluate Native American community-based interventions todetermine effectiveness for preventing motor vehicle injuries.Evaluate the verification of maintenance of 24/7 communicationcapability to disseminate information to the public.Evaluate the effectiveness of a comprehensive approach to theprevention of falls among community-dwelling older adults.Evaluate the countries supported by HHS with enhanced influenzasurveillance capabilities and the enhancement of influenza virusdetection and reporting in these countries.Evaluate the National Breast and Cervical Cancer Early DetectionProgram, focusing on economic analysis.148 HHS Strategic Plan FY 2007-2012

Appendix a: program evaluation effortsDivision Topic DescriptionStrategic Goal 2: Public Health Promotion and Protection, Disease Prevention, and Emergency PreparednessCDCCDCCDCCDCCDCCDCFDAFDANIHNIHODSAMHSASAMHSASAMHSAPrevention of intimate partnerviolenceRacial and Ethnic Approaches toCommunity Health programStrategic National Stockpile(SNS) preparednessTerrorism preparedness at U.S.Ports of EntryUsing technology to augmenteffectiveness of parentingprogramsYouth violence preventionthrough community-level changeConsumer medicationinformationSeafood Hazard Analysis CriticalControl Point (HACCP) programKidney measure useParkinson’s diseasePhysical Fitness MentoringProgram for Children and Youthwith DisabilitiesMental Health Services BlockGrantSafe Schools/Healthy StudentsInitiativeStrategic Prevention FrameworkState Incentive Grant ProgramConduct efficacy and effectiveness trials of intervention strategies toprevent intimate partner violence and/or its negative consequences,particularly studies of strategies that have not been well studied.Evaluate the Racial and Ethnic Approaches to Community Healthprogram to determine the program’s effectiveness in reducing healthdisparities.Evaluate, through the Program Preparedness Branch, preparednessplanning to receive, distribute, and dispense the SNS.Evaluate CDC surveillance of and response to reports of infectiousdiseases among globally mobile and migrating populations during,and immediately after, travel.Evaluate the effects of information and communication technology(e.g., cell phones, Internet, video conferencing, and Web cameras)on program outcomes, fidelity, enrollment and attrition rates, andcost-effectiveness in reducing child maltreatment when added to apreviously demonstrated efficacious or effective parenting program.Evaluate community-level interventions to reduce youth violence.Evaluate compliance with Public Law 104-180 requiring that by2006, 95% of consumers receiving a new prescription will receiveuseful written information.Evaluate the status of domestic and international seafood firms inoperating preventive controls under FDA’s HACCP program.Evaluate the extent and conditions under which health careand lab service providers are reporting a measure of kidneyfunction (glomerular filtration rate), to inform development andmanagement of an educational program within the National KidneyDisease Education Program to encourage reporting of this measure.Evaluate the Morris K. Udall Parkinson’s Disease Centers ofExcellence research program to determine whether the centers haveachieved program goals.Evaluate the “I Can Do It, You Can Do It” Physical Fitness MentoringProgram for Children and Youth with Disabilities.Evaluate the Mental Health Services Block Grant Program toexamine system-level activities, outputs, and outcomes associatedwith supporting the development of comprehensive systems ofmental health care within States for adults with serious mentalillness and children with serious emotional disturbance.Evaluate this initiative to identify practices related to positivesystems and student behavior change.Evaluate this program to examine (1) change in State andcommunity systems, particularly improved targeting of, and moreappropriate service delivery through, systematic needs assessment,by using the Strategic Prevention Framework; and (2) change inlevels of substance use and related risk factors, as well as substancerelatedproblems, among program participants and populations atthe State and community levels.HHS Strategic Plan FY 2007-2012149

Appendix a: program evaluation effortsDivision Topic DescriptionStrategic Goal 3: Human ServicesACF and ASPEAoAAoAASPEASPEASPEASPE and ACFNIHODODSAMHSAHard-to-Employ Demonstrationand Evaluation ProjectNutrition services and NativeAmerican nutrition, supportive,and family caregiver servicesprogramsSupportive Services programAbstinence educationDevelopment of supportivecommunitiesCollaborative initiative to helpend chronic homelessnessResponsible fatherhood andmarriage grants for fathers whoare incarcerated and reenteringthe communityCancer Disparities ResearchPartnerships ProgramBiennial international congresson children, youth, and familieswith special needsYoung Adult InitiativeProjects for Assistance inTransition from HomelessnessprogramEvaluate four diverse strategies designed to improve employmentand other outcomes such as child well-being for low-income parentsand others who face serious barriers to employment.Evaluate the programs to document overall results, find ways toimprove the programs, aid the program planning process, show theprograms’ contributions to older adult independence, and assessbest practices including those programs demonstrating the mosteffective cost-benefit outcomes and impacts.Evaluate to determine how, to what extent, and with what resultsthe aging network has implemented the Title III-B SupportiveServices program.Evaluate to assess the implementation and long-term impactsof selected Title V, Section 510 abstinence education programs.Build capacity through the Center for Research and Evaluation inAbstinence Education to conduct sound program evaluations in theabstinence field.Identifying and addressing the existing barriers that prevent faithbasedcommunities from applying for HHS grants.Evaluate the outcomes and effectiveness of comprehensiveintegrated community strategies used to deliver stable housing andservices to persons experiencing chronic homelessness.Evaluate the implementation, outcomes, and impact of marriageand corrections strategies in order to identify effective programstrategies and determine what kinds of marriage educationinterventions lead to stronger families and safer communities.Evaluate the program to determine whether it is operating asplanned and to identify program effects.Evaluate the congress to determine its impact on each participant,as well as the effect of the information from the summit onintegrated systems of care in the participating countries.Evaluate this initiative to assess how six demonstration Statesand tribal representatives are attaining State-level administrativeinfrastructure changes to support transparency across youth andadult services on behalf of young adults (14 to 30 years old) withdisabilities.Evaluate the Projects for Assistance in Transition fromHomelessness program.SAMHSAProtection and Advocacy forIndividuals with Mental IllnessProgramEvaluate program inputs, resources, processes, outputs, andoutcomes that will be collected from a representative cross-sectionof stakeholders through surveys and interviews.150 HHS Strategic Plan FY 2007-2012

Appendix a: program evaluation effortsDivision Topic DescriptionStrategic Goal 4: Scientific Research and DevelopmentAHRQASPEBuilding Research Infrastructureand Capacity Program (BRIC)and Minority ResearchInfrastructure Support Program(M-RISP)Health information technology(health IT)Evaluate the effectiveness of the capacity-building BRIC and M-RISPprograms.Design at least three alternative business case demonstrations andevaluations for the acquisition and use of health IT in long-termcare.ASPE Health IT Explore how health information is exchanged with “unaffiliated”post-acute and long-term care providers and other componentsof the health care delivery continuum (e.g., physician offices,laboratories, pharmacies, and hospitals) that use health IT.CDCAmelioration of effects ofpoverty on childrenEvaluate to identify an effective public health intervention toameliorate the effects of poverty on the health and well-being ofchildren.CDC New factors for birth defects Evaluate the role of at least five new factors for birth defects anddevelopmental disabilities.CDC Occupational safety and health Evaluate progress in reducing agriculture-related workplace illnessand injuries, as judged by independent panels of external customers,stakeholders, and experts (based upon relevance and impact of theprogram).IHSNative American ResearchCenters for HealthEvaluate program administration and progress of grantees.NIH Parkinson’s disease research Evaluate the Morris K. Udall Parkinson’s Disease Centers ofExcellence to determine whether the centers have achieved theprogram’s goals and to examine management of the program.NIH Extramural peer review Evaluate the NIH Extramural Peer Review program to determinewhether the current method of determining workload, andconsequently staffing requirements, is appropriate and adequate tomeet the needs of the NIH Peer Review Program.HHS Strategic Plan FY 2007-2012151

Appendix a: program evaluation effortsTable A-2Selected Future Program Evaluation EffortsDivision Topic DescriptionStrategic Goal 1: Health CareSAMHSASAMHSASAMHSAAddiction Technology TransferCenters (ATTCs)Hepatitis A and B VaccinationProject Performance MonitoringResidential Treatment forPregnant and Post-PartumWomen and their MinorChildrenEvaluate both the process and impact of the ATTCs, specifically theimpact of the ATTCs on increasing and developing the substanceuse disorder treatment workforce.Evaluate basic clinical information to determine the feasibilityand level of success of delivering the combined Hepatitis A and Bvaccination (Twinrix) in nontraditional facilities such as substanceabuse, methadone, and primary care settings to reach clientsinfected with or at risk of becoming infected with hepatitis.Evaluate the Residential Treatment program for Pregnant and Post-Partum Women and their Minor Children.152 HHS Strategic Plan FY 2007-2012

Appendix a: program evaluation effortsDivision Topic DescriptionStrategic Goal 2: Public Health Promotion and Protection, Disease Prevention, and Emergency PreparednessComprehensive Cancer Control Evaluate CCCLI.CDCLeadership Institutes (CCCLI)CDCCDCEvaluation of cooperativeagreementsNational OrganizationalStrategies to Provide Informationand Education (with respect toHematologic Cancers)Evaluate Chronic Disease Prevention and Health PromotionPartnership cooperative agreements that were not previouslyevaluated.Evaluate Hematologic National Organizations.CDC Abusive Head Trauma Prevention Evaluate strategies for the prevention of abusive head trauma.CDCCDCCDCCDCFDASAMHSASAMHSADissemination Research on FallPrevention: “Stepping On” in aU.S. Community SettingFamily and Dyadic FocusedInterventions to PreventIntimate Partner Violence (IPV)Understanding Risk andProtective Factors for SexualViolence Perpetration and theOverlap with Bullying BehaviorMaximizing Protective Factorsfor Youth ViolenceVoluntary Cosmetic RegistrationProgramMental Health TransformationState Incentive Grants (SIGs)Garrett Lee Smith MemorialSuicide Prevention GrantsEvaluate implementation of the program in a communitysetting; and conduct dissemination evaluation researchfocusing on participants’ outcomes, reach, uptake (adoption),feasibility, fidelity, and acceptability.Evaluate to develop, implement, and rigorously test the impactof either a family-based or dyad-based primary preventionstrategy on the outcome of physical IPV perpetration andidentified mediators with populations at risk for IPV.Evaluate to (1) assess the association between bullyingexperiences and co-occurring and subsequent sexualviolence perpetration and (2) test associations betweenthese forms of violence and potentially modifiable risk andprotective factors from multiple levels of social influence (i.e.,individual, family, peer, and community factors) to determinethe shared and unique risk and protective factors for bullyingexperiences and sexual violence perpetration.Evaluate to conduct secondary analyses of existing data (notmeta-analysis of published studies) to identify potentiallymodifiable protective factors for youth violence. Thisresearch will inform the development of youth violenceprevention programs and policies by identifying promisingprotective factors that reduce the likelihood of violence in thelives of young people.Evaluate the Voluntary Cosmetic Registration Programto assess the impact of conversion to the online systemin capturing current information on use of cosmeticingredients. FDA uses this information in setting publichealth priorities as well as allocating resources forregulatory science and enforcement.Evaluate the National Outcome Measures data for theSIG States v. data before the beginning of transformationactivities and/or v. data from non-SIG States; a collectionand analysis of seven GPRA Infrastructure Indicators and aprocess evaluation of the degree to which the transformedsystem is recovery oriented.Evaluate the initiative and its two programs (campus and State/tribal grants) to better understand and improve the initiative.HHS Strategic Plan FY 2007-2012153

Appendix a: program evaluation effortsDivision Topic DescriptionStrategic Goal 3: Human ServicesACFACFAoAAoAASPEODSAMHSASAMHSADevelopmental DisabilitiesPrograms IndependentEvaluationHead Start Family and ChildExperiences Survey (FACES)2009Title III-E, National FamilyCaregiver Support ProgramTitle VII, Long-Term CareOmbudsman ProgramAbstinence educationNeeds of Youth with Co-Occurring DevelopmentalDisabilities and Emotional/Substance Abuse DisordersAccess to Recovery (ATR)programFamily Drug Treatment CourtsProgramEvaluate to determine the effectiveness and outreach ofdevelopmental disabilities programs.Evaluate to provide longitudinal information on a periodic basison the characteristics, experiences, and outcomes for childrenand families served by Head Start; and to observe the relationshipamong family and program characteristics and outcomes.Evaluate to describe program implementation, and documentprogram results, including identification of areas for programimprovement and for provision of program planning guidance.Evaluate to examine program efficiency and efficacy to informprogram monitoring, improvements, and planning.Evaluate to (1) assess the implementation and long-term impactsof abstinence education curriculums delivered in middle schoolsettings and (2) assess the implementation and long-term impactsof comprehensive sex education curriculums delivered in middleschool settings.Evaluate to determine the effectiveness of the interdepartmentalinitiative to integrate early intervention services for youth withco-occurring developmental disabilities and emotional substanceabuse disorders in demonstration States.Evaluate to review and analyze grantee GPRA data, as well asexamine and analyze whether the ATR program is helping Statessupport systems changes to incorporate recovery support servicesas an integral component of their service delivery systems.Evaluate to examine the effectiveness of the Family Drug TreatmentCourts Program in four sites that represent two distinct models: astand-alone family treatment drug court that serves some familieswho abuse substances involved with the child welfare system and asystemwide approach to serving these families.154 HHS Strategic Plan FY 2007-2012

Appendix a: program evaluation effortsDivision Topic DescriptionStrategic Goal 4: Scientific Research and DevelopmentAHRQCDCCDCCDCNIHBuilding Research Infrastructureand Capacity Program (BRIC)and Minority ResearchInfrastructure Support Program(M-RISP)Occupational Safety and Health(Construction)Guide to Community PreventiveServices (Community Guide)Making National Center forHealth Statistics Data PubliclyAvailableInfectious Disease ModelsEvaluate the effectiveness of the capacity-building BRIC and M-RISPprograms.Evaluate progress in reducing construction-related workplaceillness and injuries, as judged by independent panels of externalcustomers, stakeholders, and experts (based upon relevance andimpact of the program).Evaluate the level of awareness and use of the Community Guide byState and local public health officers.Evaluate the timeliness of health and vital statistics data deliveredto the Nation’s health decisionmakers.Evaluate the Models of Infectious Disease Agent Study to determinewhether the program is operating as planned and areas for programimprovement.HHS Strategic Plan FY 2007-2012155

APPENDIX BPerformance Indicators

Appendix b: performance indicatorsPerformance Indicators—Supplemental InformationStrategic Goal 1: Health CareStrategic Objective 1.1Broaden health insurance and long-term care coverage.Most RecentResultFY 2012 20TargetSource1.1.1Implement the Medicare Prescription Drug Benefit– Increase the percentage of Medicare beneficiarieswith Prescription Drug Coverage from Part D orother sources.90%(FY 2007)93% ManagementInformationIntegrity Repository(MIIR) and updatesfrom other externaldata sources1.1.2Reduce the percentage of improper payments madeunder the Medicare FFS program.4.4%(FY 2006)(Available FY2009)CMSComprehensiveError Rate TestingProgramStrategic Objective 1.2Increase health care service availability and accessibility.1.2.1Increase the number of persons (all ages) withaccess to a source of ongoing care.87%(FY 2005)96% National HealthInterview SurveyExpand access to health screenings for AmericanIndians and Alaskan Natives:IHS ClinicalReporting System1.2.2a) Increase the proportion of patients withdiagnosed diabetes who receive an annual retinalexamination; andb) Increase the proportion of eligible patients whohave had appropriate colorectal cancer screening.a) 49%; and a) 75%; andb) 22%.b) 50%.(FY 2006) (FY 2010)1.2.3Increase the number of patients served by HealthCenters.14.1 million(FY 2005)16.4 million Bureau of PrimaryHealth CareUniform DataSystem1.2.4Serve the proportion of racial/ethnic minoritiesin programs funded through the Ryan WhiteHIV/AIDS Program at a rate that exceeds theirrepresentation in national AIDS prevalence data.72%(FY 2005)5 percentagepoints aboveCDC dataon nationalprevalenceRyan White HIV/AIDS ProgramData; CDC HIV/AIDS SurveillanceReport1.2.5Increase the number of client admissions tosubstance abuse treatment programs receivingpublic funding.1,875,026(FY 2004)2,005,220 Treatment EpisodeData Set20 FY 2012 Target, unless otherwise indicated.HHS Strategic Plan FY 2007-2012157

Appendix b: performance indicatorsMost RecentResultFY 2012 20TargetSourceStrategic Goal 1: Health CareStrategic Objective 1.3Improve health care quality, safety, cost, and value.1.3.1Increase physician adoption of electronic healthrecords.10%(FY 2005)40% NationalAmbulatoryMedical CareSurvey1.3.2Decrease the prevalence of restraints in nursinghomes.6.1%(FY 2006)5.8% Minimum DataSet-QualityMeasure1.3.3Increase the number of States that have the abilityto assess improvements in access and qualityof health care through implementation of theMedicaid Quality Strategy.0 States(FY 2007)12 States State Reportsinclude, but arenot limited to:State QualityImprovementstrategies, ExternalQuality ReviewOrganizationReports, andHome- andCommunity-Based ServicesWaiver QualityAssessmentreportsStrategic Objective 1.4Recruit, develop, and retain a competent health care workforce.1.4.1Increase the number of Commissioned Corpsresponse teams formed.10 teams(FY 2006)36 teams OSG/Office ofForce Readinessand Deployment1.4.2Increase the number of Commissioned Corpsofficers.5,906(FY 2006)6,600 Office of PublicHealth andScience, monthlybilling amounts158 HHS Strategic Plan FY 2007-2012

Appendix b: performance indicators2.1.1Most RecentResultFY 2012TargetStrategic Goal 2: Public Health Promotion and Protection, Disease Prevention, and Emergency PreparednessStrategic Objective 2.1Prevent the spread of infectious diseases.Achieve or sustain immunization coverage of atAt least 90%least 90% in children 19 to 35 months of age for:2.1.22.1.32.1.4a) 4 doses of Diphtheria-Tetanus-Pertussis(DtaP) vaccine;b) 3 doses of polio vaccine;c) 1 dose of Measles-Mumps-Rubella (MMR)vaccine;d) 3 doses of hepatitis B vaccine;e) 3 doses of Haemophilus influenzae type b(Hib) vaccine;f) 1 dose of varicella vaccine; andg) 4 doses of pneumococcal conjugate vaccine(PCV7).Increase the proportion of people with HIVdiagnosed before progression to AIDS.Reduce the incidence of infection with keyfoodborne pathogens:a) Campylobacter;b) Escherichia coli O157:H7;c) Listeria monocytogenes; andd) Salmonella species.Increase the rate of influenza vaccination:a) In persons 65 years of age and older; andb) Among noninstitutionalized adults at highrisk, aged 18 to 64.Strategic Objective 2.2Protect the public against injuries and environmental threats.2.2.1a) Reduce nonfatal work-related injuriesamong youth ages 15 to 17; andb) Reduce fatal work-related injuries amongyouth ages 15 to 17.a) DTaP: 86%;b) Polio: 92%;c) MMR: 92%;d) Hepatitis B: 93%;e) Hib: 94%;f) Varicella: 88%; andg) PCV7: 83%.(FY 2005)76.5%(FY 2005)SourceNationalImmunizationSurvey81% HIV/AIDS ReportingSystemCases/100,000: Cases/100,000: FoodNet (TheFoodborne Diseasesa) 12.72;a) 12.30;Active SurveillanceNetwork) Datab) 1.06;b) 1.00;c) 0.30; andc) 0.23; andd) 14.55.d) 6.80.(FY 2005)National Healtha) 59.6%; anda) 90%; andInterview Surveyb) 25.3%.b) 60%.(FY 2005)a) 4.4/100 FTE 21 ;andb) 3.2/100,000 FTE.(FY 2006)a) 4.2/100 FTE;andb) 2.8/100,000FTE.a) NationalElectronic InjurySurveillance System;andb) Census of FatalOccupational Injuriesspecial researchfile provided toNational Institute ofOccupational Safetyand Health by Bureauof Labor Statistics.21 FTE = full-time equivalent employee, and one FTE = 2,000 hours worked (average hours worked by a full-time employee in a year).HHS Strategic Plan FY 2007-2012159

Appendix b: performance indicatorsMost RecentResultFY 2012TargetSourceStrategic Goal 2: Public Health Promotion and Protection, Disease Prevention, and Emergency PreparednessStrategic Objective 2.3Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery.Reduce complications of diabetes among 37%50%IHS ClinicalAmerican Indians and Alaska Natives by (FY 2006)(FY 2010) Reporting System2.3.1 increasing the proportion of patients withdiagnosed diabetes who have achieved bloodpressure control (

Appendix b: performance indicatorsMost RecentResultFY 2012TargetSourceStrategic Goal 3: Human ServicesStrategic Objective 3.1Promote the economic independence and social well-being of individuals and families across the lifespan.3.1.1Increase the percentage of adult TANF 34.3%39% National Directory ofrecipients who become newly employed. (FY 2005)New HiresIncrease the percentage of individuals with 11.27%11.34% Program Performancedevelopmental disabilities reached by State (FY 2005)Reports of State3.1.2 Councils on Developmental DisabilitiesCouncils onwho are independent, self-sufficient, andintegrated into the community.DevelopmentalDisabilities3.1.3Increase the child support collection ratefor current support orders.60%(FY 2005)Strategic Objective 3.2Protect the safety and foster the well-being of children and youth.3.2.1Increase the adoption rate for childreninvolved in the Child Welfare System.10.06%(July 2007)3.2.2Increase the percentage of Head Startprograms that achieve average fall tospring gains of:a) 52%; andb) 84.6%.63% Office of Child SupportEnforcement Form 15710.40% Adoption and FosterCare Analysis ReportingSystem66%; andNational Reporting86%.Systema) At least 12 months in word knowledge a) (FY 2005)(Peabody Picture Vocabulary Test); andb) At least four counting items.b) (FY 2006)Increase the percentage of children69.3%70% Delinquency Surveyreceiving Children’s Mental Health3.2.3 Services who have no interaction with lawenforcement in the 6 months after theybegin receiving services.(FY 2006)Strategic Objective 3.3Encourage the development of strong, healthy, and supportive communities.Increase the number of children living in 69%72% Census Survey Data3.3.1 married couple households as a percentageof all children living in households.(CY 2005)Strategic Objective 3.4Address the needs, strengths, and abilities of vulnerable populations.3.4.13.4.2Increase the number of older persons withsevere disabilities who receive homedeliveredmeals.Increase the percentage of refugeesentering employment through refugeeemployment services funded by ACF.313,362(FY 2005)53.49%(FY 2005)500,000 National Aging ProgramInformation SystemState Program ReportsNational Surveys60% Quarterly PerformanceReport (Form ORR-6)HHS Strategic Plan FY 2007-2012161

Appendix b: performance indicatorsStrategic Goal 4: Scientific Research and DevelopmentMost Recent ResultStrategic Objective 4.1Strengthen the pool of qualified health and behavioral science researchers.FY 2012TargetSource4.1.1Through the National ResearchService Award program,increase the probability thatscientists continue participationin NIH-funded research withinthe following 10 years:a) Postdoctoral fellows; andb) Predoctoral trainees andfellowsa) 13 percentage points; andb) 13 percentage points.(FY 2006)a) 12+ percentagepoints; andb) 12+ percentagepoints.OutcomeEvaluation of NIHNational ResearchService AwardPostdoctoralTraining ProgramStrategic Objective 4.2Increase basic scientific knowledge to improve human health and human development.4.2.1Develop and apply clinicallyone new imaging technique toenable tracking the mobility ofstem cells within cardiovasculartissues.Researchers in the NIHintramural program havedeveloped probes that arecompatible with opticalmicroscopy techniquesdeveloped by intramuralscientists.(FY 2006)Develop one newimaging techniquethat is able to beclinically applied.Study Data4.2.2Identify at least one clinicalintervention that will delaythe progression or onset ofAlzheimer’s disease (AD), orprevent it.Nearly 1,000 new late-onset ADfamilies have been identifiedand recruited to the ADGenetics Initiative.(FY 2006)Identify the nextgeneration ofcompounds fortesting in pilotclinical trials.Study Data4.2.3Develop a novel advancedpattern recognition algorithmto analyze data obtained fromimaging technologies to aidclinicians in diagnosing theearliest stage of disease, e.g.,brain cancer.The prototype patternrecognition algorithm hasbeen designed and trained torecognize anomalies in thepilot study of Brain MRS scans.(Nonpublished results, spring2007)Apply, in conjunctionwith a CRADA partner,a pattern recognitionalgorithm to identifyearly biomarkers ofbrain disease to otherdisease endpoints inclinical applicationssuch as those used toidentify breast cancermarkers.Annual NCTRResearchAccomplishmentsand Plansdocument locatedat: http://www.fda.gov/nctr/science/research_index.htm162 HHS Strategic Plan FY 2007-2012

Appendix b: performance indicatorsStrategic Goal 4: Scientific Research and DevelopmentMost Recent ResultStrategic Objective 4.3Conduct and oversee applied research to improve health and well-being.FY 2012TargetSource4.3.1Conduct clinical trials to assessthe efficacy of at least three newtreatment strategies to reducecardiovascular morbidity/mortality in patients with type 2diabetes and/or chronic kidneydisease.Initial findings were madepublic at the annual AmericanDiabetes Association meetingin June 2006.(FY 2006)Complete clinicaltrials, and makeresults available.Study DataStrategic Objective 4.4Communicate and transfer research results into clinical, public health, and human service practice.4.4.1Increase the number ofAoA-supported communitybasedsites that use evidencebaseddisease and disabilityprevention programs.27 sites(FY 2005)136 sites Evidence-Based DiseasePreventiondiscretionarygrant semiannualreports4.4.2Reduce the disparity betweenAfrican-American infants andWhite infants in back sleepingby 50% to reduce the risk ofSudden Infant Death Syndrome(SIDS).The SIDS rate for African-American infants is two timesgreater than that of Whiteinfants.(FY 2003)Reduce disparity by50%.Study Data4.4.3Reduce the financial cost (orburden) of upper GI hospitaladmissions by implementingknown research findings$93.46 per U.S. resident ages 65to 85.(FY 2006)10% reduction Healthcare Costand UtilizationProjectHHS Strategic Plan FY 2007-2012163

APPENDIX CPerformance Plan Linkage

Appendix c: performance plan linkagePerformance Plan LinkageHHS Strategic Plan, Annual Plan, and AnnualPerformance BudgetsHHS manages hundreds of programs that aim to improvehealth status, increase access to health services,and create opportunities for disadvantaged individualsto work and lead productive lives. HHS programs reachall Americans by providing health and social services,protecting public health, and funding biomedical research.The Strategic Plan defines the goals and objectivesof the Department and is driven by the Department’smission to enhance the health and well-being ofAmericans by providing for effective health and humanservices and by fostering strong, sustained advances inthe sciences underlying medicine, public health, andsocial services. HHS also uses strategic planning, annualperformance planning, and the annual budget processto identify policy and program priorities. The StrategicPlan, along with the Secretary’s 500-Day Plan, theSecretary’s Priorities, 23 and the President’s ManagementAgenda, xlii provide the overarching framework for theDepartment’s operating and staff divisions to use on anannual basis to create an annual performance plan.The HHS Annual Plan is the primary mechanism for implementingthe Strategic Plan. The two planning documentsare intertwined. The Strategic Plan sets broad,long-term objectives for the Department and describesprincipal implementation strategies for achieving thestrategic objectives. The Annual Performance Plan setsspecific annual goals for HHS programs and initiativesand relates these goals to the strategies and long-termobjectives in the Strategic Plan. In so doing, the linkbetween annual program activities and goals and theStrategic Plan is established.To gauge program effectiveness, HHS uses performanceindicators as a basis for comparing program resultswith established program performance goals. Eachyear, HHS tracks the performance indicators fromthis Strategic Plan in the HHS Annual Plan, whichillustrates the Department’s progress in accomplishingits priorities and goals. HHS performance budgetsannually track a broader set of performance indicatorsto measure progress on all Departmental programs andactivities. The HHS performance budgets present theresource needs of HHS programs and identify the re-23 The Introduction/Executive Summary In the Spotlight sectioncontains additional information about the Secretary’s 500-Day Planand priorities.Statutory Requirements:GPRA,OMB Circular No. A-11The Government Performance and Results Act of1993 (GPRA) provides the statutory framework fora recurring cycle of reporting, planning, and execution,requiring agencies to craft5-year strategic plans, updated every 3 years; annualperformance plans, or annual performance budgets;and annual program performance reports.OMB Circular No. A-11, Section 210 (2006), Preparingand Submitting a Strategic Plan indicatesthat agencies should include in their strategicplans a description of the relationship between annualprogram performance goals and the agency’sstrategic goal framework, including a description ofhow the Program Assessment Rating Tool (PART)process contributes to this effort.sults that Americans can expect from their investmentin these programs. The performance budgets stateplanned goals based on funding levels and also reporton past achievements of all HHS programs. xliiiAt the close of each fiscal year, HHS produces a Performanceand Accountability Report (PAR), which incorporatesperformance results with audited financialstatements for the year. The PAR highlights illustrativeprograms to report on HHS performance. Together, theAnnual Plan and the PAR constitute an annual planningand reporting process for HHS programs. The performanceindicators in the Strategic Plan will be reportedon in the PAR so that progress in achieving goals ismeasured on an annual basis.A Culture of Excellence: ComprehensivePerformance Management System for EmployeesOnly by maintaining a strong “culture of excellence”can HHS continue to achieve the exceptional resultsthat the public has come to expect. This approachlinks the work of every employee to the ultimateoutcomes of the Department and stresses eachindividual’s accountability for the results of HHSas a whole. Expectations must be transparent;assessments of performance must be meaningful; andHHS Strategic Plan FY 2007-2012165

Appendix c: performance plan linkageevery employee must understand how his or her ownefforts contribute to accomplishing the HHS mission.HHS has taken major steps toward implementing acomprehensive performance management systemcovering every one of its employees, including updatingthe Senior Executive Service and OrganizationalPerformance Management System and implementingthe Performance Management Appraisal System at alloperating divisions.Senior Executive Service and OrganizationalPerformance Management SystemHHS has an updated Senior Executive Service (SES)Organizational Performance Management System. Thesystem includes the Department’s first detailed descriptionof its organizational assessment process and isdesigned to produce accountability for results for everyone of HHS’s senior executives. The SES system operatesunder a straightforward set of guiding principles:True excellence is rewarded; mediocre performancecarries real consequences; and poor performers areremoved from the SES. Most important, evidence ofmeasurable, citizen-centered outcomes is valued overbureaucratic process and “time served.”As the key elements of SES performance plans arecascaded to the plans of all non-SES employees, thisnew comprehensive performance system will ensurethat expectations throughout the entire agency areconsistently aligned with the HHS mission and focusedon achieving results. Ultimately, the system placesthe greatest emphasis where it belongs: on achievingresults that benefit the American people.Performance Management Appraisal ProgramThe HHS Performance Management Appraisal Program(PMAP) establishes a new performance managementsystem that focuses on the connections betweenan individual’s day-to-day work and the overarchinggoals of the Department. Covering all non-SES HHSemployees, PMAP will provide staff with a clearersense of how their own success contributes to that ofthe Department as a whole. With four performancelevels—exceptional, fully successful, minimally successful,and unsatisfactory—the new system improves thetransparency of the appraisal process and helps ensurethat distinctions between high and low performers willbe meaningful and consistent across the Department.As of December 2006, PMAP covers every non-SESemployee at HHS.166 HHS Strategic Plan FY 2007-2012

Appendix c: performance plan linkageHHS Strategic Plan FY 2007-2012167

APPENDIX DInformation Technology

Appendix d: information technologyThe transformation of how technologicaland data access work is performed inthe Department is due in part to rapidchanges in computer technology. Thetechnology industry has evolved fromword processors to microprocessors,from collecting data to warehousingdata, and from information managementto knowledge management. In orderto leverage these advances, HHS’sbusiness model must be supported byits technical model. Both must becomefully synchronized to realize the strategicgoals and objectives of HHS.Over the past several years, each HHS division hasdeveloped its own means and methods of dealingwith computer technology, resulting in a network ofseparate systems that have limited capacity to interactwith each other in a seamless fashion. HHS has nowimplemented an Enterprise Architecture program thataddresses planning from an enterprise perspectiveto ensure that the allocation of resources is alignedwith the effort to realize the HHS strategic goals andobjectives. Within this enterprise planning activity,information resources and technology are not onlyaligned in support of the HHS strategies, but also focuson the facilitation of interoperability, data sharing,and overall efficiency and effectiveness across theDepartment and with HHS’s external partners.This appendix offers a broad overview of the initiativesthat the Department is currently undertaking, andsome of the innovations and trends that are planned.InitiativesTwo basic pieces of legislation have framed how theFederal Government operates and provides servicesto the public. The first is the E-Government Act of2002 (Public Law 107-347), which seeks to enhancemanagement and promotion of business throughthe Internet, reduce a paper-based environment, andincrease citizen services and access to Governmentinformation. The second piece of legislation is theFederal Information Security Management Act of2002 (Public Law 107-347), which provides for acomprehensive framework to ensure that access toinformation is kept safe and secure.This legislation creates a trend in the Governmentthat requires a higher level of attention to securitythan ever before. The drive for greater efficiency ininformation technology spending, combined with anever-increasing need to share networks, services andsupport, and information, has resulted in both placingmore business transactions online and creating a needfor increased attention on the Department’s security.Secure One HHSOn the basis of the best practices of the GovernmentAccountability Office and the standards and guidanceprovided by the National Institute of Standards andTechnology, HHS has set up an overarching informationtechnology security program called Secure One HHS. Theemphasis of Secure One is to create strong governancewith clearly defined roles, responsibilities, and securityexpertise. Established at the headquarters level, SecureOne seeks to achieve a consistent security baselineacross operating divisions by supporting universalinformation technology security requirements. TheSecure One program is driven by close coordination andcollaboration with each operating division to ensure thatany needs and expectations are identified and addressed.InfrastructureCost-effectiveness in technology representsresponsible stewardship over taxpayer dollars as wellas responsible and effective management of humanresources. Over the years, as divisions developed theirHHS Strategic Plan FY 2007-2012169

Appendix d: information technologyown methods of managing computer technology, thebasic infrastructure for a unified Departmentwidecomputer system was overlooked. To unify thesedisparate systems, reduce duplication of effort, andstabilize the technical environment, the Departmenthas initiated several strategies for improving thetechnological infrastructure.IT Consolidation. This strategy employs the sharing andreuse of common, standards-based materials andprograms that support the business of computertechnology. An example of this strategy is using the samephysical systems (networks, servers, and help desks).Software Standardization. A preliminary inventoryof software packages used across the Departmentrevealed that more than 12,000 unique types ofsoftware had been loaded on computers. A majorinitiative is underway to streamline the amount andtype of software loaded on employee machines. Thestandardization process ensures that security is notcompromised and that all software is up to date.Health Information TechnologyThe Department is committed to the principles,objectives, and strategies of the Office of the NationalCoordinator for Health Information Technology(ONC), in the Office of the Secretary. This majorinitiative is being supported by the Office of the ChiefInformation Officer, and is discussed in depth in Inthe Spotlight: Advancing the Development and Use ofHealth Information Technology. The Office of the ChiefInformation Officer will coordinate consultation forONC in the areas of standards, best practices, reviews,and support.HHS Data CouncilThe HHS Data Council advises the Secretary ondata policy and serves as a forum for coordinationand consideration of those issues. The Councilalso coordinates the Department’s data collectionand analysis activities and ensures effective longrangeplanning for surveys and other investmentsin major data collection. The Council also serves asthe Department’s focal point for data standards andnational health information issues.Confidentiality and Data Access CommitteeThis group provides a forum for staff members of Federalstatistical agencies who work on confidentiality anddata access topics.Web ServicesCitizens, employees, and stakeholders now use theInternet for most of their information needs. The Internethas become the standard for conducting businesstransactions, finding key information, and engagingin knowledge sharing with others of like interests. TheDepartment recognizes the need to have the most upto-datestrategies involving the Internet, from structureto design, and from functionality to accessibility. Severalinitiatives are underway to ensure that the rich repositoryof information and knowledge within HHS is easilyaccessible and effectively displayed, and that the formatof Web pages is usable to the average visitor.Governance. The HHS Department Web site exists toempower citizens, its business and service partners,and its employees by providing information, workprocesses, services, and opportunities to be involved intheir government effectively, efficiently, and in a timelymanner. Therefore, they can improve their lives, solvetheir problems, and accomplish their objectives. To thatend, the Department is developing Web governanceprinciples, strategies, and recommendations so thatHHS’s Web presence will be more consistent andcoherent across divisions. HHS Web governanceprinciples will maximize the creative use of people,policy, and processes to manage short- and long-rangegoals, mitigate ambiguity, and resolve conflicting cross-Department needs and priorities. They will providea framework for establishing clear Web managementresponsibilities, identifying and allocating necessaryresources, promoting Departmentwide standards forbest practices, and providing recognition and support forthe Department’s Web community.Usability. On the basis of sound research, theDepartment has developed a cutting-edge guide toWeb design and usability. Produced by HHS and theGeneral Services Administration, this guide is aninvaluable tool for Web developers, Web designers,170 HHS Strategic Plan FY 2007-2012

Appendix d: information technologyand Web site managers. The guide was created todeliver better and more usable health and humanservice sites for the Department. HHS is mandated toprovide clear information in an efficient and effectivemanner to patients, health professionals, researchers,and the public. Translating the latest Web designresearch into a practical, easy-to-use format isessential to the effective design of the numerousDepartment Web sites. In addition, the Departmenthas set standards and criteria for all Web sites to be infull compliance with Section 508 of the RehabilitationAct of 1973 (29 USC 794d), as amended, whichrequires the Internet to be accessible to individualswith disabilities.Innovations and Future TrendsE-GovernmentE-Government is the President’s goal of utilizingtechnology to improve how the Federal Governmentserves citizens, businesses, and agencies alike. Federalemployees are serving citizens, businesses, and localcommunities via E-Government. E-Governmentuses improved Internet-based technology to make iteasy for citizens and businesses to interact with theGovernment, save taxpayer dollars, and streamlinecitizen-to-government communications. E-Governmentuses technology to its fullest to provide services andinformation that are centered on citizen groups.The Department will continue its investment inE-Government initiatives by using standards-basedWeb services. This means that reliable and consistentmethodologies will be used to create and supportWeb and Internet services. The Department usesInternet Web sites, an Intranet Web site, and aninternal HHS Web portal. These sites have providedtimely and important communications to stakeholdersand the public.In the coming months, HHS will launch a softwareprogram, known as Content Management Solution,which will reduce the time and effort to modify Webpages and update information. This software willmake Internet maintenance more streamlined andconvenient for contributors.Integrated PlanningHHS is adopting a strategy, the Capital Planning andInvestment Control (CPIC) program, in which investmentsin technology will be based on strategic goals andobjectives. For each strategy, the questions will be posed:“How will technology support this? How much is needed,how will it be measured, how will it perform?”In this model, the investments in technology aretreated as a portfolio, with information available onmeasurement, results, and return on investment. Thisapproach will allow senior managers to access upto-dateinformation on program performance from atop-to-bottom view of the Department. Informationtechnology portfolio management is implementedwithin the context of the HHS information technologyCPIC program, which is strongly integrated with theHHS Enterprise Architecture program to ensure thatthe information technology investments proposed forportfolio inclusion are effectively aligned in support ofthe HHS strategic goals and objectives.In addition, the model includes a framework for acentralized information management system. Thiswill mean that the multiple requests for informationthat HHS receives can be handled centrally withoutduplication or redundancy. The model also promotessharing and reusing data across HHS once they arecollected in the centralized database.The CPIC program will fulfill several general requirements.Strategic planning and performance management will beintegrated with other information technology processes.The CPIC program will be able to permeate the entireDepartment, and accommodate new data and legislativerequirements as they arise. Data reusability will solvethe problem of repeated requests for information that isindividually managed in a time- consuming process. TheCPIC program will support the right information collectedat the right time so that it can be formatted and presentedto meet demands.Information technology is sometimes seen as an enablerof the mission and strategic plan, rather than a directcontributor. The CPIC program realizes the need togive insight to how information technology is leadingHHS Strategic Plan FY 2007-2012171

Appendix d: information technologybusiness and mission outcomes, through objectivesand measures. This insight can help foster a culture ofaccountability and increase management’s effectiveness.Knowledge ManagementHHS is a knowledge-intensive organization and facessignificant opportunities and challenges in generatingvalue from its intellectual and knowledge-based assets.Knowledge Management is a way of doing business thatcapitalizes on the knowledge of an organization and itsindividual employees.Knowledge Management provides the processesand structures to create, capture, analyze, and act oninformation. It highlights both the conduits to knowledge,as well as the bottlenecks. The emphasis in KnowledgeManagement is on human know-how and how to enable itto bring maximum return for an organization.Information technology is critical to facilitate knowledgesharing and can be seen as the vehicle for effectiveKnowledge Management. Getting the right knowledgeto the right person for the right task at the right time isthe goal. Whether to improve organizational efficiency,or embrace innovation, Knowledge Management effortsand initiatives add great value to an organization.Knowledge Management:• Facilitates better, more informed decisions;• Contributes to the intellectual capital of anorganization;• Encourages the free flow of ideas that leads toinsight and innovation;• Eliminates redundant processes, streamlinesoperations, and enhances employee retentionrates;• Improves customer service and efficiency; and• Can lead to greater productivity.HHS is charged with communicating information tocitizens, customers, employees, and Federal, State, andlocal governments. The management and sharing ofknowledge within HHS is of paramount importanceto its stakeholders. The collaborative nature ofactivities depends on advancing the understandingof this innovative business model. HHS is committedto implementing this innovative business processthroughout the Department.172 HHS Strategic Plan FY 2007-2012

Appendix d: information technologyHHS Strategic Plan FY 2007-2012173

APPENDIX EHHS Organizational Chart

Appendix e: hhs organizational chartDirector,Intergovernmental Affairs& Secretary’s RegionalRepresentativesSecretaryDeputy SecretaryChief of StaffDeputy Chief of StaffExecutive SecretaryAssistant Secretaryfor HealthAssistant Secretary,Administration forChildren & FamiliesAdministrator,Agency for ToxicSubstance & DiseaseRegistryGeneralCounselAssistant Secretaryfor Administration& ManagementDirector,Program SupportCenterAssistant Secretaryfor Resources &TechnologyAssistant Secretaryfor Planning &EvaluationAssistant Secretaryfor Preparednessand ResponseAssistant Secretaryfor LegislationAssistant Secretaryfor AgingAdministrator,Centers for Medicareand Medicaid ServicesAdministrator,Agency for HealthcareResearch and QualityDirector,Centers for DiseaseControl & PreventionAdministrator,Substance Abuse andMental Health ServicesAdministrationCommisisioner,Food and DrugAdministrationAdministrator,Health Resources &Services AdministrationDirector,Indian Health ServiceDirector,National Institutesof HealthChief AdministrativeLaw Judge, Office ofMedicare Hearingsand AppealsDirector,Office forCivil RightsDirector, Center forFaith-Based andCommunity InitiativesInspectorGeneralChair,DepartmentalAppeals BoardAssistant Secretaryfor Public AffairsDirector,Office ofGlobal HealthAffairsOffice of theNationalCoordinatorfor Health ITHHS Strategic Plan FY 2007-2012 175

APPENDIX FHHS Operating and Staff Divisionsand Their FunctionsHHS works to accomplish its mission through the individual andcollaborative efforts of the operating divisions and staff divisions within theOffice of the Secretary (OS). The primary goal of OS is to provide leadership,direction, and policy and management guidance to the Department.

Appendix f: hhs operating and staff divisions and their functionsOperating Divisions:Administration for Children and Families (ACF)http://www.acf.dhhs.gov/To promote the economic and social well-being of families, children, individuals, andcommunities. ACF grant programs lead the Nation in strengthening economicindependence and productivity and enhancing quality of life for people across the lifespan.Agency for Healthcare Research and Quality (AHRQ)http://www.ahrq.govTo support, conduct, and disseminate research that improves access to care and theoutcomes, quality, cost, and utilization of health care services. Information fromAHRQ’s research on outcomes, quality, costs, use, and access helps people make moreinformed decisions and improves the value of the health care services they receive.Administration on Aging (AoA)http://www.aoa.govTo promote the dignity and independence of older people, and to help society preparefor an aging population. AoA serves as the primary Federal focal point and advocacyagent for older Americans through a network of State and area agencies on aging andgrants to States, tribal organizations, and other community service providers.Agency for Toxic Substances and Disease Registry (ATSDR)http://www.atsdr.cdc.govTo serve the public by using the best science, taking responsive public health actions, andproviding trusted health information to prevent harmful exposures and diseases relatedto toxic substances. ATSDR efforts prevent exposure and adverse human health effectsand diminished quality of life associated with exposure to hazardous substances.Centers for Disease Control and Prevention (CDC)http://www.cdc.govTo promote health and quality of life by preventing and controlling disease, injury, anddisability. CDC strengthens existing public health infrastructure while working withpartners throughout the Nation and the world.Centers for Medicare & Medicaid Services (CMS)http://www.cms.hhs.govTo ensure effective, up-to-date health care coverage and to promote quality care forbeneficiaries. CMS serves as the primary source of health care insurance coveragefor a large population of medically vulnerable individuals and acts as a catalyst forenormous changes in the availability and quality of health care for all Americans.Food and Drug Administration (FDA)http://www.fda.govTo rigorously assure the safety, efficacy, and security of human and veterinary drugs,biological products, and medical devices, and assure the safety and security of theNation’s food supply, cosmetics, and products that emit radiation. FDA advances thepublic health by helping to speed innovations to market that make medicines andfood more effective, safer, and more affordable, and assisting the public in getting theaccurate, science-based information they need to use medicines and foods to improvetheir health.HHS Strategic Plan FY 2007-2012177

Appendix f: hhs operating and staff divisions and their functionsHealth Resources and Services Administration(HRSA)http://www.hrsa.govTo provide the national leadership, program resources,and services needed to improve access to culturallycompetent, quality health care. HRSA focuses onuninsured, underserved, and special needs populationsin its goals and program activities.Indian Health Service (IHS)http://www.ihs.govTo raise the physical, mental, social, and spiritual healthof American Indians and Alaska Natives to the highestlevel. IHS provides comprehensive health services forAI/AN people, with opportunity for maximum tribalinvolvement in developing and managing programs toimprove their health status and overall quality of life.National Institutes of Health (NIH)http://www.nih.govTo employ science in pursuit of fundamental knowledgeabout the nature and behavior of living systems andthe application of that knowledge to extend healthylife and reduce the burdens of illness and disability.NIH, through its 27 institutes and centers, supportsand conducts research, domestically and abroad,into the causes, diagnosis, treatment, control, andprevention of diseases and promotes the acquisitionand dissemination of medical knowledge to healthprofessionals and the public.Substance Abuse and Mental Health ServicesAdministration (SAMHSA)http://www.samhsa.govTo build resilience and facilitate recovery for peoplewith or at risk for substance abuse and mental illness.SAMHSA supports States and communities in buildingresilience and facilitating recovery through grantprograms, policy guidance, information dissemination,data collection and reporting, evaluation, and technicalassistance.Office of the Secretary:Staff Divisions:Assistant Secretary for Administration andManagement (ASAM)http://www.hhs.gov/asamTo help bring about improvements and effectivenessthat can be achieved by structuring HHS as a uniteddepartment, in support of the Secretary’s goals and thePresident’s Management Agenda. ASAM advises theSecretary on all aspects of administration and humanresource management.Assistant Secretary for Health (ASH)http://www.hhs.gov/ashTo provide senior professional leadership across HHSon crosscutting, population-based public health andclinical preventive services. The Office of Public Healthand Science is under the direction of the ASH, whoserves as the Secretary’s primary advisor on mattersinvolving the Nation’s public health and oversees theCommissioned Corps of the United States Public HealthService through the Office of the Surgeon General.Assistant Secretary for Legislation (ASL)http://www.hhs.gov/aslTo advise the Secretary and the Department oncongressional legislation and to facilitate communicationbetween the Department and the U.S. Congress. ASLinforms the Congress of Departmental priorities,actions, grants, and contracts.Assistant Secretary for Planning and Evaluation(ASPE)http://aspe.hhs.gov/To provide advice and support to the Secretary on thedevelopment and analysis of crosscutting, populationbasedhealth and human service policies. ASPE isresponsible for major activities in policy coordination,legislation development, strategic planning, policyresearch, evaluation, and economic analysis.Assistant Secretary for Public Affairs (ASPA)http://www.hhs.gov/newsTo serve as the Secretary’s principal counsel on publicaffairs matters and to provide centralized leadershipand guidance for public affairs activities within HHS.ASPA coordinates media relations and public serviceinformation campaigns throughout HHS and managesthe Freedom of Information process for the Department.178 HHS Strategic Plan FY 2007-2012

Appendix f: hhs operating and staff divisions and their functionsAssistant Secretary for Preparedness andResponse (ASPR)http://www.hhs.gov/aspr/To serve as the Secretary’s principal advisory staff onmatters related to bioterrorism and other public healthemergencies. ASPR directs the Department’s emergencyresponse activities and coordinates interagencyactivities related to emergency preparedness and theprotection of the civilian population.Assistant Secretary for Resources andTechnology (ASRT)http://www.hhs.gov/asrtTo provide advice and guidance to the Secretary on budget,financial management, and information technology and toprovide for the direction and coordination of these activitiesthroughout the Department. ASRT provides oversightof the administrative and financial organizations andactivities of the Department, including production ofthe Department’s financial statements and the annualperformance plan and report under the GovernmentPerformance and Results Act of 1993 (Public Law 103-62).Center for Faith-Based and CommunityInitiatives (CFBCI)http://www.hhs.gov/fbciTo create an environment within HHS that welcomesthe participation of faith-based and community-basedorganizations as valued and essential partners assistingAmericans in need. CFBCI leads the Department’s effortsto better utilize faith-based and community-basedorganizations in providing effective human services.Departmental Appeals Board (DAB)http://www.hhs.gov/dabTo provide the best possible dispute resolution services forthe people who appear before the board, those who rely onthe decisions, and the public. DAB provides prompt, fair,and impartial dispute resolution services to parties inmany different kinds of disputes involving components ofthe Department. DAB encourages the use of mediationand other forms of alternative dispute resolution.Office for Civil Rights (OCR)http://www.hhs.gov/ocrTo ensure that people have equal access to, andopportunity to participate in and receive services from allHHS programs without facing unlawful discrimination,and the protection of the privacy of their identifiablehealth information while ensuring access to care.Through prevention and elimination of unlawfuldiscrimination, OCR helps HHS carry out its overallmission of improving the health and well-being of allpeople, including those affected by its many programs.Office on Disability (OD)http://www.hhs.gov/odTo oversee the coordination, development, andimplementation of programs and special initiativeswithin HHS that impact people with disabilities. ODserves as focus of advocacy activities undertaken onbehalf of persons with disabilities.Office of the General Counsel (OGC)http://www.hhs.gov/ogcTo advance the Department’s goal of protecting the healthof all Americans and providing essential human services,especially for those who are least able to help themselves.OGC is the legal team for the Department, providingquality representation and legal advice on a wide rangeof highly visible national issues. OGC supports thedevelopment and implementation of the Department’sprograms by providing the highest quality legal servicesto the Secretary and the Department’s divisions.Office of Global Health Affairs (OGHA)http://www.hhs.gov/oghaTo promote the health of the world’s population byadvancing HHS global strategies and partnerships, thusserving the health of the people of the United States.OGHA represents HHS to other governments, otherFederal departments and agencies, internationalorganizations, and the private sector on internationaland refugee health issues.Office of Inspector General (OIG)http://oig.hhs.govTo protect the integrity of HHS programs, as well asthe health and welfare of the beneficiaries of thoseprograms. By conducting independent and objectiveaudits, evaluations, and investigations, OIG providestimely, useful, and reliable information and adviceto Department officials, the Administration, the U.S.Congress, and the public.Office of Intergovernmental Affairs (IGA)http://www.hhs.gov/igaTo facilitate communication regarding HHS initiativesas they relate to State, local, and tribal governments.IGA is the Department’s liaison to State, local, andtribal governments, and the national organizationsthat represent them. IGA represents the perspectivesHHS Strategic Plan FY 2007-2012179

Appendix f: hhs operating and staff divisions and their functionsof these HHS partners in the Federal policymakingprocess and helps communicate the Federalperspective to them. IGA’s Office of Tribal Affairsserves as the first point of contact for tribes and tribalorganizations working with HHS and assists tribesin navigating policies and requirements for HHSprograms and services.Office of Medicare Hearings and Appeals(OMHA)http://www.hhs.gov/omhaTo administer the nationwide hearings and appealsfor the Medicare program, and to ensure that theAmerican people have equal access and opportunityto appeal and can exercise their rights for health carequality and access. OMHA, under direct delegationfrom the Secretary, administers nationwide hearingsfor the Medicare program. The Administrative LawJudges within OMHA conduct impartial hearings andissue decisions on behalf of the Secretary on claimsdetermination appeals involving Parts A, B, C, and D ofMedicare, and on Medicare entitlement and eligibilityappeals.Office of the National Coordinator for HealthInformation Technology (ONC)http://www.hhs.gov/healthitTo provide leadership for the development andnationwide implementation of interoperable healthinformation technology to improve the quality andefficiency of health care and the ability of consumers tomanage their care and safety. The National Coordinatorfor Health Information Technology is the Secretary’sprincipal advisor on the development, application, anduse of health information technology in both the publicand private health care sectors that will reduce medicalerrors, improve quality, and produce greater value forhealth care expenditures.Program Support Center (PSC)http://www.psc.govTo provide a full range of support services to HHSand other Federal agencies, allowing them to focus ontheir core mission. PSC, a component of ASAM, isthe Department’s Shared Services Center, providingservices on a fee-for-service basis to customers acrossthe Federal Government in administrative operations,financial management, enterprise support, strategicacquisitions, and occupational health service.180 HHS Strategic Plan FY 2007-2012

Appendix f: hhs operating and staff divisions and their functionsHHS Strategic Plan FY 2007-2012181

APPENDIX GAcronyms

Appendix g: acronymsAcronymsACFAdministration for Children and FamiliesADAlzheimer’s diseaseADDAdministration on Developmental DisabilitiesAERSAdverse Event Reporting SystemAFIAssets for IndependenceAFLAdolescent Family Life ProgramAHICAmerican Health Information CommunityAHRQAgency for Healthcare Research and QualityAI/ANAmerican Indian and Alaska NativeANAAdministration for Native AmericansAoAAdministration on AgingASAMAssistant Secretary for Administration and ManagementASHAssistant Secretary for HealthASLAssistant Secretary for LegislationASPAAssistant Secretary for Public AffairsASPEOffice of the Assistant Secretary for Planning and EvaluationASPROffice of the Assistant Secretary for Preparedness and ResponseASRTOffice of the Assistant Secretary for Resources and TechnologyATRAccess to RecoveryATSDRAgency for Toxic Substances and Disease RegistryATTCAddiction Technology Transfer CenterBARDABiomedical Advanced Research and Development AuthorityBRICBuilding Research Infrastructure and Capacity ProgramCAREComprehensive AIDS Resources EmergencyCCCLIComprehensive Cancer Control Leadership InstitutesCCDECash and Counseling Demonstration EvaluationCCHITCertification Commission for Health Care Information TechnologyCDCCenters for Disease Control and PreventionCFBCICenter for Faith-Based and Community InitiativesCHGME Children’s Hospitals Graduate Medical EducationCISAClinical Immunization Safety AssessmentCMSCenters for Medicare & Medicaid ServicesCNCSCorporation for National and Community ServiceCOSIGCo-Occurring State Incentive GrantCPICritical Path InitiativeCPICCapital Planning and Investment ControlCRADACooperative Research and Development AgreementCSEChild Support EnforcementCYCalendar YearDABDepartmental Appeals BoardDMATDisaster Medical Assistance TeamDRA Deficit Reduction Act of 2005 (Public Law 109-171)DTaPDiphtheria-Tetanus-PertussisEAEnterprise ArchitectureEEOEqual Employment OpportunityEPAU.S. Environmental Protection AgencyESAR-VHP Emergency System for Advanced Registration of Volunteer Health ProfessionalsESFEmergency Support FunctionFACESFamily and Child Experiences SurveyHHS Strategic Plan FY 2007-2012183

Appendix g: acronymsFDAFood and Drug AdministrationFFSFee-For-ServiceFHAFederal Health ArchitectureFPLFederal Poverty LevelFTEFull-time equivalent employeeFYFiscal YearFYSBFamily and Youth Services BureauGDPGross Domestic ProductGIGastrointestinalGMEGraduate Medical EducationGPEIGlobal Polio Eradication InitiativeGPRA Government Performance and Results Act of 1993 (Public Law 103-62)HACCPHazard Analysis Critical Control PointHCVHepatitis C virusHHSU.S. Department of Health and Human ServicesHibHaemophilus influenzae type bHIPAA Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191)HITSPHealth Information Technology Standards PanelHIV/AIDS Human Immunodeficiency Virus/Acquired Immunodeficiency SyndromeH.R.House of Representatives bill (with number)HRSAHealth Resources and Services AdministrationHSAHealth Savings AccountHUDU.S. Department of Housing and Urban DevelopmentIDAIndividual Development AccountIGAOffice of Intergovernmental AffairsIHSIndian Health ServiceIPVIntimate Partner ViolenceITInformation technologyITNInsecticide-treated bed netLEPLimited English ProficiencyLIHEAP Low Income Home Energy Assistance ProgramM-RISPMinority Research Infrastructure Support ProgramMCPMentoring Children of PrisonersMDGMillennium Development GoalMIIRManagement Information Integrity RepositoryMMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173)MMRMeasles-Mumps-RubellaMRCMedical Reserve CorpsMRSMagnetic Resonance Spectroscopic ImagingMSAMedical Savings AccountNCHSNational Center for Health StatisticsNCTRNational Center for Toxicological ResearchNCTSINational Child Traumatic Stress InitiativeNDMSNational Disaster Medical SystemNHSCNational Health Service CorpsNICHDNational Institute of Child Health and Human DevelopmentNIHNational Institutes of HealthNRCNational Resource CenterNRPNational Response PlanOCROffice for Civil RightsODOffice on Disability184 HHS Strategic Plan FY 2007-2012

Appendix g: acronymsOGCOffice of the General CounselOGHAOffice of Global Health AffairsOIGOffice of Inspector GeneralOMBOffice of Management and BudgetOMHOffice of Minority HealthOMHAOffice of Medicare Hearings and AppealsONCOffice of the National Coordinator for Health Information TechnologyOPHSOffice of Public Health and ScienceORROffice of Refugee ResettlementOSOffice of the SecretaryOSGOffice of the Surgeon GeneralPACPost-acute carePACEProgram of All-Inclusive Care for the ElderlyPAHPA Pandemic and All-Hazards Preparedness Act of 2006 (Public Law 109-417)PARPerformance and Accountability ReportPARTProgram Assessment Rating ToolPATHProjects for Assistance in Transition from HomelessnessPCV7Pneumococcal conjugate vaccinePDMPersonal dust monitorPDUFAPrescription Drug and User Fee ActPEPFAR President’s Emergency Plan for AIDS ReliefPHINPublic Health Information NetworkPMAPPerformance Management Appraisal ProgramPMIPresident’s Malaria InitiativePSCProgram Support CenterPSSFPromoting Safe and Stable FamiliesPSUNCParents Speak Up National CampaignQIQuality IndicatorRD&EResearch, Demonstration, and EvaluationSAMHSA Substance Abuse and Mental Health Services AdministrationSARSSevere Acute Respiratory SyndromeSBIRTScreening, Brief Intervention, and Referral and Treatment ProgramSCHIPState Children’s Health Insurance ProgramSESSenior Executive ServiceSIDSSudden Infant Death SyndromeSIGState Incentive GrantSNSStrategic National StockpileSPARCSickness Prevention Achieved through Regional CollaborationSPFStrategic Prevention FrameworkTANFTemporary Assistance for Needy FamiliesUSAIDUnited States Agency for International DevelopmentUSCUnited States CodeUSICHUnited States Interagency Council on HomelessnessUSPHSUnited States Public Health ServiceUSPSTF United States Preventive Services Task ForceVAU.S. Department of Veterans AffairsVAERSVaccine Adverse Event Reporting SystemVFCVaccines for Children ProgramVICPVaccine Injury Compensation ProgramWHOWorld Health OrganizationHHS Strategic Plan FY 2007-2012185

APPENDIX HEndnotes

Appendix h: endnotesEndnotesI.The Secretary’s core principles are available at http://www.hhs.gov/secretaryspage.htmlII.Current budget amounts and numbers of employees are available at http://www.hhs.gov/about/whatwedo.html/III.Office of Management and Budget (OMB). (2006). OMB circular no. A-11- Part6: Preparation and submission of strategic plans, annual performance plans,and annual program performance reports. Available at http://www.usgs.gov/budget/docs/a_11_2006_ch6.pdfIV.Lewin Group. (2005). Health information technology leadership panel finalreport. Available at http://www.hhs.gov/healthit/HITFinalReport.pdfV.Office of the Assistant Secretary for Planning and Evaluation (OASPE). (2005,September). ASPE issue brief: Overview of the uninsured in the United States:An analysis of the 2005 Current Population Survey. Available at http://aspe.hhs.gov/health/reports/05/uninsured-cps/index.htm#VI.Centers for Medicare & Medicaid Services (CMS). (2007, January 30).Medicare Drug Plans Strong and Growing: Beneficiaries Compared Plans andContinued to Sign Up for Prescription Drug Coverage [news release]. Availableat http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=2079VII.Indian Health Service (IHS). (2006). Indian Health Service introduction.Available at http://www.ihs.gov/publicinfo/publicaffairs/welcome%5Finfo/ihsintro.aspVIII.Agency for Healthcare Research and Quality. (Unknown). Strategies to ReduceHealth Disparities, Access to Insurance. Available at http://www.ahrq.gov/news/ulp/dispar/dispar3.htmIX.Agency for Healthcare Research and Quality. (Unknown). Strategies to ReduceHealth Disparities, Access to Insurance. Available at http://www.ahrq.gov/news/ulp/dispar/dispar3.htmX.IHS. (2006). Indian Health Service fact sheet. Available at http://www.ihs.gov/PublicInfo/PublicAffairs/Welcome_Info/ThisFacts.aspXI.U.S. Department of Health and Human Services (HHS). (2006). HHS FY2007 budget in brief. Available at http://www.hhs.gov/budget/07budget/healthres.htmlXII.HHS. (2007). HHS FY 2008 President’s Budget Congressional Justification.XIII.Food and Drug Administration (FDA). (2003). Greater access to genericdrugs: New FDA initiatives to improve drug reviews and reduce legalloopholes. FDA Consumer Magazine, September-October. Available at http://www.fda.gov/fdac/features/2003/503_drug.htmlXIV.HHS. (2006). HHS FY 2007 budget in brief. Available at http://www.hhs.gov/budget/07budget/healthres.htmlHHS Strategic Plan FY 2007-2012187

Appendix h: endnotesXV.Health Resources and Services Administration. (n.d.). Nursing education infive states, 2005. Available at http://bhpr.hrsa.gov/healthworkforce/reports/nurseed/intro.htmXVI.The National Healthcare Disparities Report. Available at http://www.ahrq.govXVII.Glynn, M., & Rhodes, P. (2005, June). Estimated HIV prevalence in theUnited States at the end of 2003. Paper presented at the 2005 National HIVPrevention Conference. Abstract available at http://www.cdc.gov/hiv/topics/surveillance/basic.htm#hivestXVIII.Centers for Disease Control and Prevention (CDC). (2005). Foodborne illness:Technical information. Available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_t.htmXIX.CDC. (2006). Surveillance for waterborne disease and outbreaks associatedwith recreational water — United States, 2003–2004. Morbidity and MortalityWeekly Report, SS55, 1-24. Available at http://www.cdc.gov/mmwr/PDF/ss/ss5512.pdfXX.CDC. (2004). The impact of malaria, a leading cause of death worldwide.Available at http://www.cdc.gov/malaria/impact/index.htmXXI.____. (2006). Challenges in global immunization and the globalimmunization vision and strategy 2006-2015. WHO Weekly EpidemiologicalRecord, 19(81), 190-195.XXII.CDC. (2006). Web-based Injury Statistics Query and Reporting System(WISQARS) [electronic version]. Available at http://www.cdc.gov/ncipc/wisqars http://www.cdc.gov/ncipc/factsheets/Cost_of_Injury-Productivity_Losses.htmXXIII.CDC. (2006). Chronic disease prevention. Available at http://www.cdc.gov/nccdphp/XXIV.National Center for Health Statistics (NCHS). (2006). Deaths: Preliminarydata for 2004. National Vital Statistics Reports, 54(19), 2-52. Available athttp://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_19.pdfXXV.CDC. (2006). National program of cancer registries, 2006-2007. Available athttp://www.cdc.gov/cancer/npcr/npcrpdfs/0607_npcr_fs.pdfXXVI.NCHS. (2006). Prevalence of overweight and obesity among Adults – UnitedStates, 2003-2004. Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_adult_03.htmXXVII.National Institutes of Health (NIH). (2005). National diabetes statistics: Totalprevalence of diabetes in the United States, all ages, 2005. Available at http://diabetes.niddk.nih.gov/dm/pubs/statistics/XXVIII.NIH. (2005). National diabetes statistics: Pre-diabetes: Impaired glucosetolerance and impaired fasting glucose. Available at http://diabetes.niddk.nih.gov/dm/pubs/statistics/XXIX.Substance Abuse and Mental Health Services Administration (SAMHSA).(2006). Results from the 2005 National Survey on Drug Use and Health: Nationalfindings. Rockville, MD.188 HHS Strategic Plan FY 2007-2012

Appendix h: endnotesXXX.CDC. (2005). Annual smoking-attributable mortality, years of potential lifelost, and productivity losses — United States, 1997–2001. Morbidity andMortality Weekly Report, 54(25), 625-628. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5425a1.htmXXXI.HHS. (2006). FY 2007 HHS budget in brief. Available at http://www.hhs.gov/budget/07budget/subabuse.htmlXXXII.HHS. (2006). FY 2007 HHS budget in brief. Available at http://www.hhs.gov/budget/07budget/acf.htmlXXXIII.He, W., Sengupta, M., Velkoff, V.A., & DeBanos, K.A. (2005). 65+ in the UnitedStates: 2005. Current Population Reports — Special Studies. Washington,DC: Government Printing Office. Available at http://www.census.gov/prod/2006pubs/p23-209.pdfXXXIV.FDA. (2006). Medication use and older adults. FDA Consumer Magazine,July-August. Available at http://www.fda.gov/fdac/features/2006/406_olderadults.htmlXXXV.OASPE. (2004, May). Recruitment and retention of direct care workerssymposium: Background materials. Available at http://aspe.hhs.gov/daltcp/reports/04cfpk02.htmXXXVI.U.S. Census Bureau. (2004). U.S. interim projections by age, sex, race andHispanic origin. Available at http://www.census.gov/ipc/www/usinterimproj/XXXVII.U.S. Census Bureau. (2003). Language use and English-speaking ability: 2000.Available at http://www.census.gov/prod/2003pubs/c2kbr-29.pdfXXXVIII.National Cancer Institute (NCI), NIH. (2006). Annual report to the nationon the status of cancer, 1975-2001. Available at http://www.cancer.gov/newscenter/pressreleases/ReportNation2006releaseXXXIX.NCI. (2006). New focus on lung cancer research. NCI Cancer Bulletin, 3(21),1-2. Available at http://www.cancer.gov/ncicancerbulletin/NCI_Cancer_Bulletin_052306/page3XL.OMB. (2003). OMB circular no. A-76 (revised). Available at http://www.whitehouse.gov/omb/circulars/a076/a76_rev2003.pdfXLI.Individual evaluation reports and other OIG reports are available at http://oig.hhs.gov/reports.htmlXLII.OMB. (2002). The President’s Management Agenda. Available at http://www.whitehouse.gov/omb/budget/fy2002/mgmt.pdfXLIII.More detailed information on HHS programs and performance goals can befound at http://www.hhs.gov/budget/HHS Strategic Plan FY 2007-2012189

Department of Health and Human ServicesAssistant Secretary for Planning and Evaluation200 Independence Avenue, S.W.Washington, DC 20201U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES STRATEGIC PLAN FISCAL YEARS 2007-2012The report also available electronically athttp://aspe.hhs.gov/hhsplan/