CDC Receives Mixed Reviews on Structural Changes

Julie Gerberding, M.D. CDC Director

Although the announced reorganization at the Centers for Disease Control and Prevention (CDC) was intended to streamline the agency's daily operations and promote new goals, several healthcare observers expressed doubt that thechanges will be wholly beneficial.

Many public health officials worry that consolidating the CDC's subordinate agencies into four categories as part of the agency's "Futures Initiative" will reduce financial support for those entities, as well as dilute the autonomy they have. The impact the change will have on congressional budget priorities remains unclear.

If the CDC implements all the changes, four coordinating centers, Infectious Disease, Environmental and Occupational Health and Injury Prev-ention, Health Promotion and Public Health and Information Services, will house the 11 entities that currently operate independently. This move would reduce the number of sub-agency directors reporting directly to CDC Director Julie Gerberding, M.D., MPH, by almost half.

The CDC officially announced its reorganization in May, highlighting the construction of two new missions: preparedness and health promotion for every stage of life. The plan goes into effect on Oct. 1, 2004. In designing the organizational shift, CDC officials conducted interviews with more than 500 public health partners and state and local health officials to determine how these partners view the agency and if they had recommendations on ways the agency could improve performance.

Ben Klein, manager of federal government relations at the American Cancer Society, said he is pleased with the CDC's efforts and noted that the underlying reason behind the reorganization is admirable, but he added it is possible the changes could limit the amount of funding some valuable programs receive.

"It's unclear from the Futures Initiative whether there will be a shift in budget priorities at the CDC," Klein said. "There's a long way to go to accomplish the CDC's goal of investing in prevention."

Klein said he has heard many concerns about how future funding will be allocated. Many subordinate agencies worry that Congress could shortchange valuable initiatives in the name of reorganization or consolidation moves.

Tom Skinner, a CDC spokesman, said the changes were in line with the CDC's desire to better serve the public, making the consolidated agencies better prepared to share resources and work toward common goals.

"We recognize the need for reaching out to our customers with information and services," he said. "We're making a tremendous effort to educate the American people and emphasize the life choices that protect health."

Georges Benjamin, M.D., executive director of the American Public Health Association, agreed. Combining the efforts of several agencies not only reduces the number of officials reporting directly to Dr. Gerberding but also broadens the CDC's impact on public health. But he also cautioned that each subordinate agency must maintain its own unique characteristics.

"The synergy of centers is needed for the type of work the CDC does, such as combating infectious diseases," Dr. Benjamin said. "But you don't want to diminish the centers. Make sure they don't lose their individual capabilities."

Maintaining Autonomy

Other groups seconded Dr. Benjamin's concern about autonomy. According to Susan Randolph, MSN, president of the American Association of Occupational Health Nurses, Inc., centers such as the National Institute for Occupational Safety and Health (NIOSH) could lose much of their current independence. The Occupational Safety and Health Act originally created NIOSH as a separate entity.

"This reorganization puts NIOSH down a level so other public health groups won't see it as a separate group, and they might limit their partnerships with the agency," Randolph said. "This reorganization significantly weakens and diminishes the importance of occupational safety and health. It should not be watered down under an environmental sub-group."

If the reorganization proceeds, NIOSH will fall under the authority of the Coordinating Center for Environmental and Oc- cupational Health and Injury Prevention along with two other agencies.

The proposed changes created some friction within the agency as well. According to a former high- level CDC employee who requested anonymity, several agency employees are uncomfortable with the proposed changes and wary of the possible organizational shifts.

Occupational safety advocates are not the only group raising a red flag about the reorganization. One former health official said he feared the consolidation would squelch smoking management programs within the federal government.

"No matter how CDC and the administration present [the reorganization], it will ultimately mean one thing: there will be no central leadership anywhere in government to effectively deal with smoking and health policy issues," Donald R. Shopland, former coordinator for smoking and tobacco control programs at the National Cancer Institute, said in an open letter in April. "Major program elements will either die or be rendered meaningless."

Skinner said that the centers serving the CDC will continue to function as individual units.

"The centers will certainly remain intact," he said. "There's a greater emphasis on a greater effort to work more synergistically to accomplish the CDC's overarching goals."

-Whitney L.J. Howell

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