The Centers for Disease Control and Prevention (CDC)

One of the most vibrant agencies within the Department of Health and Human Services (HHS) is CDC, headquartered in Atlanta, Georgia. Since 1946, CDC has served as a public health leader in the U.S. and around the world. It has experts assigned to all 50 states and more than 50 countries. Its budget request for Fiscal Year (FY) 2015 approximates $6.6 billion. In 1996, Rodney Hammond became the first Director of the CDC Division of Violence Prevention, emphasizing a public health approach to child abuse and family violence, as well as stressing that the best way to address these critical issues is to prevent them before they occur. Rodney actively promoted the notion that the wide spread expansion of evidence-based parenting and early intervention programs throughout the public health systems would, in the long run, make a significant difference. Over time, this resulted in an institutional appreciation for the potential contributions that psychology and the behavioral sciences could make to the agency’s overall mission, with its emphasis upon data-driven decision making.

The CDC Director: “As we continue to expand and strengthen our collection and use of data, we gain greater knowledge and insight about the extent of our biggest health problems, which populations are most affected by them, and what we need to do to solve them. Information is power—and this power makes it possible for us to implement programs that fulfill our promise to keep America healthy and our nation strong.” Reflecting upon his decade-plus involvement, Rodney notes, “Psychologists currently occupy prominent roles throughout CDC signaling the critical importance of behavioral health to the prevention of disease, injury, and disabilities across the population. For example, Ileana Arias, who I recruited, is a psychologist and serves as the CDC Principal Deputy Director. It is encouraging to see these ideas now taking hold.”

Gwendolyn Keita, Executive Director of the APA Public Interest Directorate, and her colleague Steve Sauter: “It seems hard to believe, but the forthcoming 11^th International Conference on Work, Stress and Health will mark the 25^th anniversary of the inaugural conference in this series. It also represents the 25^th anniversary of the 1990 issue of the American Psychologist containing a cluster of articles that envisioned the new field of Occupational Health Psychology (OHP). From these beginnings, OHP has spread throughout the occupational safety and health field, with graduate training programs in OHP worldwide, a new Society for Occupational Health Psychology, a new Journal of Occupational Health Psychology….” The critical catalyst was the visionary Director of CDC’s National Institute for Occupational Safety and Health (NIOSH), Dr. Don Millar.

The CDC FY 2015 budget notes that chronic diseases are among the most prevalent, costly, and deadly of all health problems—and the most preventable. Chronic diseases are the leading causes of death and disability in the U.S. and account for 70% of all deaths annually (almost 1.7 million). They also cause major limitations in the daily living for approximately one out of every ten people. Core CDC activities in this area include: Preventing and controlling the leading causes of disease, death, and disability, including tobacco use, obesity, heart disease, and stroke, diabetes, and cancer; promoting community health, oral health, safe motherhood, infant health, and healthy behaviors such as physical activity and nutrition; and maintaining surveillance systems to track and monitor behavioral risk factors. Tobacco use is the leading preventable cause of disease, disability, and death, with one of five adults and one of four U.S. high school students currently smoking.

In the area of obesity – one out of every six children (17%) and over one-third of adults (36%) are obese, and thus at increased risk for hypertension, high cholesterol, type 2 diabetes, heart disease, and certain cancers. Obese individuals have an annual per capita medical spending that is $1,429 greater than spending for non-obese people. CDC leads the national agenda on physical activity promotion. Walking is the most popular form of physical activity, with six in ten adults reporting walking, yet many people engage in NO leisure time activity. CDC initiatives include engagement in: *Pedestrian-friendly street design. *Physical education requirements in schools and child care centers. *Community agreements permitting after-hours use of school and mall facilities. And, *Infrastructure support for persons on bicycles and in wheelchairs.

CDC is working closely with the Surgeon General’s Office on a “Call to Action on Walking,” in order to provide critical guidance on factors that support and facilitate physical activity and improve health across the lifespan. Those involved in training our next generation of clinicians should be actively engaged in CDC’s efforts to educate more health professionals on population health and make public health education more practical. Specifically, CDC plans on working with “academic partners to integrate population health concepts into the curricula of medical and nursing schools.” Why not psychology’s?

CDC is the nation’s leading authority on violence and injury prevention. Its objective is to keep Americans safe by researching the best ways to prevent violence and injuries, using science to create real-world solutions to keeping people safe, healthy, and productive—thereby fulfilling President Obama’s “Now is the Time” initiative. The Intentional Injury Prevention program works to prevent youth violence and bullying, child maltreatment, teen dating violence, sexual violence, intimate partner violence, suicide, and firearm-related injuries and deaths. In 2010, over 16,000 individuals died as a result of a homicide and over 38,000 individuals committed suicide. Youth violence was especially prevalent, with over 4,600 homicides and over 585,000 non-fatal physical assaults of individuals between the ages of 15 and 24 being treated in emergency departments that year. Violence affects lives throughout the lifespan.

In 2010, approximately 50 children per hour were victims of child maltreatment and more than 1,500 children died as a result of child maltreatment nationally. Children who are maltreated are at higher risk for serious health problems as adults; including obesity, heart disease, and chronic obstructive pulmonary disease. In addition, they are more likely to smoke and engage in high-risk sexual behaviors later in life. Overall, violence-related injuries and deaths, including interpersonal and self-directed, cost approximately $107 billion a year in medical and other costs. Teen dating violence is an area of particularly growing concern in violence prevention. Teen victims of dating violence are more likely to be depressed and do poorly in school. Current science demonstrates it is more effective to begin working with teens at a younger age to stop dating violence before it starts.

At the Uniformed Services University of the Health Sciences (USUHS), the issues being addressed by CDC are of considerable interest. Nate Galbreath, Senior Executive Advisor to the DoD Sexual Assault Prevention and Response Office, noted that in FY 2013, DoD received 5,061 reports of sexual assault that included at least one service member victim or perpetrator. In FY 2012, a DoD survey found that about 26,000 active duty members indicated experiencing some form of unwanted sexual contact, ranging from rape to unwanted sexual touching. Underreporting is a significant problem, due to fear, stigma, or shame, complicating victim care and holding offenders accountable. A number of those reporting had been victimized prior to joining the military, with 30% of the women and 6% of the men reporting unwanted sexual contact incidents. Alcohol was commonly the only “weapon” involved, with non-stranger offenders often not believing their behavior was criminal. The DoD experience clearly reflects the underlying CDC concerns and that the Services are but a microcosm of society.

Given APA’s long history of advocacy in addressing our nation’s unfortunate health disparities, psychology should be particularly interested in the efforts of the CDC Office of Minority Health and Health Equity. This Office includes the Office of Women’s Health and the Diversity Management Program. It provides leadership for CDC-wide policies, strategies, planning, and evaluation to eliminate health disparities. The Office monitors and reports on the health status of vulnerable populations and the effectiveness of health protection programs; provides decision support to CDC executives in allocating resources to programs of surveillance, research, intervention, and evaluation; coordinates CDC’s response to White House Executive Orders and HHS health disparity initiatives; initiates strategic partnerships with governmental, non-governmental, national, and regional organizations; and provides guidance and oversight to the agency-wide implementation of the CDC Diversity Plan.

Visionary Reflections

“My Presidential Future of Psychology Practice Initiative identified many areas for the growth of professional psychology. Working in integrated health care systems and expanding our focus to include population-based, public health perspectives are two of these important areas for expansion. CDC is the federal agency charged with many of these initiatives and has been moving towards areas in which psychologists are experts, such as violence and trauma prevention, fetal alcohol syndrome prevention, and many others. Yet most psychologists are trained in, and therefore limited to think only about, individuals rather than intervening for the population as a whole. It is time for psychology to step up to these societal challenges and apply our research and clinical expertise to address the ‘big picture’ issues that require us moving out of the individual psychotherapy rooms and into the public health care system. If we don’t step up now, other professions will and we will continue to see our incomes and opportunities drop” (James Bray, former APA President).

“Recently, I heard Early Career Psychologist-extraordinaire Le Ondra Clark Harvey talk about the importance of including policy in the graduate training of all psychologists. I couldn’t agree more. In 1998, I was fortunate to be the first APA representative to the HHS Primary Care Policy Fellowship. For a year in 1998, I worked with a stimulating group of health professional leaders (from Deans and Chairs to Medical Directors and Nurse Leaders) to learn about healthcare policy. We each developed a policy project, + I made a video with 16 different disciplines making fun of their own discipline’s stereotype. This was a lot of fun and very revealing about the stereotypes we each held about each other. We came to see how we could fit together as a team. Through all this I learned the importance of strengthening alliances with other health professional organizations; it benefits us as psychologists when we are pushing legislation, and it benefits the public when we can collectively collaborate on their behalf” (Susan McDaniel, 2007 APF-Cummings Psyche Award recipient).

Giving Back (Sandra Haber): “‘You have a bone marrow cancer. There are medications that can manage it but the only cure is a stem cell transplant.’ This was the gut wrenching news as presented to me in 2012. For the past 20 years, I had worked with many cancer patients in my practice, but this was my diagnosis and it was a doozy. I was fortunate in that I had plenty of support from family and friends. ‘How can I help?’ became the question I was most frequently asked. Fast forward to 2014 – one year post-transplant. Enter a new stage of my life. I feel great, I am back at work and now it is time to ‘give back.’ It is time to give psychology away.

“I have a vision. I want to write a booklet called ‘Giving meaning to ‘How Can I Help? What To Do When Someone You Know Has Cancer.” I want this booklet to be published by a national organization (maybe APA, maybe not). It should be heavily advertised and given away for free. It would be the first ‘gift’ you get from your oncologist along with the cancer diagnosis.

“Let me walk you through an example. Jane Smith has breast cancer and will need chemotherapy and surgery. As the news spreads, Jane gets calls from family and friends. ‘How can I help?’ they ask. Jane feels cared for but none of these calls have really helped her worries. Now imagine that Jane had a booklet of suggestions. Her friend says ‘How can I help?’ and Jane, who has read her booklet, says—‘Well, I know you walk your dog every morning. Are you able to walk my dog at the same time? How often can you do this? For how long?’ Or, Jane says ‘Suzy and Johnny, my kids, need a 9:00 a.m. school drop off. But that is the same time as my chemotherapy. Do you think you could drop the kids at school next week?’ Or, ‘You have such a flair with fashion. I know I should go wig shopping but don’t want to go by myself. Will you come with me?’

“The booklet I envision has checklists where friends and family can assess what they are comfortable doing and how often they are available. Ideally, a best friend or spouse could coordinate all of the potential participation from the well-wishers. What happens is that specifics and structure can now shape the question ‘How can I help?’ and the patient has a valuable ‘buddy system’ to help with the details of managing life while undergoing cancer treatment and recovery. Any feedback or ideas about this are welcome [DrSandraHaber@gmail.com].”

Aloha.

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Pat DeLeon, Ph.D.