Viewpoint: Public Health Research: The Time is Now

Imagine a world where all infants benefit from gold-standard prenatal care. All children arrive at school safe, healthy, and ready to learn. All adolescents and adults have the knowledge, support, and self-esteem necessary to make healthy choices. All people are protected in communities prepared for infectious, environmental, and terrorist threats. Seniors live independently and achieve their expected lifespan.

by Julie Louise Gerberding M.D., M.P.H. Director, Centers for Disease Control and Prevention

Then consider the reality of the health issues facing us as we enter the 21st century. Emerging threats like anthrax, SARS, monkeypox, West Nile virus and mad cow disease are problems demanding immediate attention. Expanding epidemics of HIV and other sexually transmitted diseases have yet to be conquered. Health disparities and rising healthcare costs continue to affect the delivery of care across the spectrum. The increasing prevalence of chronic conditions like cardiovascular disease, obesity, and diabetes strike all segments of the population.

As a lead agency within the Department of Health and Human Services for protecting the health of Americans, the Centers for Disease Control and Prevention (CDC) must provide the leadership necessary to close the gap between the safe and healthy 21st century world we envision and the world in which many people currently live.

Beginning in June 2003, the CDC embarked on a comprehensive strategic reinvention process called the Futures Initiative, an "outside-in" approach to creating the future of CDC for the 21st century. Several important themes emerged from the hundreds of interviews and meetings conducted with partners, stakeholders, employees and consumers across America. Most important among them is the recognition that CDC is a credible leader in public health because of the quality and integrity of its scientific foundation, but that the agency must advance a stronger and more diversified intramural and extramural public health research portfolio. Accordingly, the overall CDC public health research enterprise is evolving to develop the knowledge and tools necessary to achieve specific health goals for the American public. These health goals are encompassed in two overarching themes: 1) health promotion and prevention of disease, injury, and disability so that all people can achieve their expected lifespan with the best possible quality of health in every life stage; and 2) all-hazards preparedness, so that people in all communities will be protected from emerging infectious, environmental, and terrorist threats.

One obstacle to accomplishment of the CDC's health protection goals is the lack of evidence supporting specific interventions, practices, and policies that affect health decisions and improve health status. CDC is developing a health protection research initiative as a key component of its public health research agenda to address this critical knowledge gap. The new health protection research initiative is aligned with the agency's goals and will help develop the knowledge that can be applied by individuals, public health professionals, health care providers, policy makers, businesses, private sector organizations and others to protect and measurably improve the health of Americans.

Health protection and innovation go hand-in-hand. Innovation in public health research is inextricably linked to those engaged in that research-the internal and external research workforce. Few data exist to assess the quantity, quality, and performance of the public health research workforce. For example, of the estimated 448,254 public health workers in the United States, 44.6% are categorized as professional workers. The Health Planner / Researcher / Analyst occupation, a subunit of this category, is estimated at 3,573 workers (2,074 from federal agencies and 1,499 from state and territorial agencies). Except for this category, no other information explicitly enumerates those involved in public health research. However, multiple reports herald the impending workforce crisis in science/technology, public health and the health professions.

Achieving a strong public health research workforce will be accelerated by motivating creative investigators to engage in this domain of research. Expanded funding opportunities, academic rewards, and professional recognition are essential. Academic medicine must play an important role in this process. Future physicians and other professionals should not only be armed with the skills to translate public health research findings into effective health protection, but also be encouraged to pursue research careers that address public health priorities.

The partnership between CDC and the AAMC has already achieved remarkable success in curriculum development, practice-based internships, and discipline-specific research. This year, CDC's extra- mural research portfolio will expand to include public health research fellowship programs and support for career development in academic medical centers. Through leveraging our collaborative success, together we can indeed develop the knowledge necessary to create a safer and healthier 21st century for all.

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