Foreword

Thomas R. Frieden, MD, MPH

Director, CDC

Corresponding author: Thomas R. Frieden, Director, CDC. Telephone: 404-639-7000; E-mail: TFrieden@cdc.gov.

This MMWR Supplement presents data related to disease patterns across the United States and describes recent national trends in health status. Indicators of health status (i.e., measures of observed or calculated data on the status of a health condition) were chosen to reflect the range of health issues relevant to CDC's programs that are used across the agency to monitor health. In response to the status of these health issues, CDC works with state and local health systems across the United States on these diseases and others to save lives and protect persons.

Although the United States has made overall progress in improving public health and increasing life expectancy, progress has been slow, and in some aspects of health, change has not occurred or trends are not favorable. Too many adults and adolescents still use tobacco, and each day, approximately 1,000 young persons become daily cigarette smokers (1). An estimated 40% of U.S. households do not have easy access to large grocery stores and supermarkets, and fruit and vegetable consumption remains lower than recommended levels (2). Obesity rates have leveled but have not declined, and one in three adults and one in six children is obese (3). Each year, one in six U.S. residents becomes sick from foodborne illness, resulting in approximately 3,000 deaths (4), and approximately one in 25 hospitalized patients develops a health-care–associated infection, resulting in approximately 75,000 deaths (5). Breastfeeding and vaccine rates remain too low and teen birth rates remain too high, putting the health of future generations at risk.

This report provides data on the 10 leading causes of death in the United States and discusses associated risk and protective factors. Information is derived from 17 CDC and three non-CDC data systems. CDC's robust data systems monitor:

• the health and wellness of the U.S. population,
• progress in preventing or controlling various conditions, and
• individual engagement in selected risk or protective behaviors.

With each of these indicators, public health agencies have an opportunity to make further improvements through dedicated focus, determination, and perseverance in implementing evidence-based strategies to improve health. This report reflects areas of CDC programmatic support in the field through integrated prevention efforts, guideline development and dissemination, training, and improved detection and reporting of health threats.

Many activities and programs are focused on addressing the health indicators discussed in this report. CDC has established two complementary initiatives to prevent and minimize the risk from these leading causes of death: the Million Hearts initiative and CDC's Winnable Battles initiative.

The Million Hearts initiative, which has set a goal of preventing 1 million heart attacks and strokes by 2017, focuses on the "ABCS" of heart disease and stroke prevention: appropriate aspirin therapy, blood pressure control, cholesterol management, and smoking cessation (6). Million Hearts strategies are focused on both the clinical and community settings. The three keys to improve clinical care are:

• focus: turning clinician attention to the most important indicators that are crucial to improve outcomes;
• optimal use of health information technology: giving clinicians access to information they can use and act on to improve performance; and
• clinical innovations: particularly through the utilization of team-based care to improve the performance of health-care systems to address key risk factors.

Communitywide strategies should focus on three objectives: 1) decreasing tobacco use, 2) reducing sodium intake, and 3) eliminating consumption of trans fats. Implementing these strategies in the clinic and the community can help achieve the Million Hearts initiative's ambitious goal of preventing 1 million heart attacks and strokes by 2017.

CDC also is taking steps to measure progress in achieving selected Winnable Battles by implementing evidence-based strategies to address specific public health challenges that have a substantial impact on health (7). Every Winnable Battle has established indicators and targets for measuring progress. The topic areas of CDC's Winnable Battles initiative include:

• tobacco;
• nutrition, physical activity, and obesity;
• food safety;
• health-care–associated infection;
• motor-vehicle safety;
• teen pregnancy; and
• human immunodeficiency virus.

Success of both federal initiatives relies on strong engagement of partners. To that end, the Million Hearts and Winnable Battles initiatives focus on bringing together communities, health systems, nonprofit organizations, federal agencies, and private-sector partners from across the country to develop and implement evidence-based strategies that can have a demonstrable impact in reducing the burden of these significant public health challenges.

The improvements in health status described in this report are attributable to multiple factors:

• policies and environmental supports (e.g., a sidewalk or an accessible farmer's market) to promote and enable healthy decision making,
• organizational infrastructure to institutionalize good health promotion practices,
• community programs to offer critical health support services or promote effective interventions,
• an informed and passionate constituency to demand access to healthy alternatives and make healthy choices, and
• systems to monitor progress continually so that problems are identified quickly and efforts are refined to increase efficacy and target those most in need.

No single entity can improve all of these health indicators alone. Before a person can make the informed choice to eat a healthier diet, she or he first needs access to healthy and affordable options. Health outcomes improve when the entire health system is working together to promote good health, including when clinicians have the support of a multidisciplinary team and integrated electronic health records that utilize built-in reminder systems and prompts for current guidelines. Youths are poised for a lifetime of better health when they receive the benefits of breastfeeding as infants and recommended vaccinations, when they are protected from exposure to secondhand smoke or lead, and when they have access to safe areas in which to walk and play. By tracking progress, public health officials, program managers, and decision makers can better identify areas for improvement and institute policies and programs to improve health and the quality of life.

References

1. US Department of Health and Human Services, Office of the Surgeon General. Preventing tobacco use among youth and young adults: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2012.
2. US Department of Agriculture. Access to affordable and nutritious food: measuring and understanding food deserts and their consequences. Washington DC: US Department of Agriculture Economic Research Service; 2009. Available at http://www.ers.usda.gov/media/242675/ap036_1_.pdf.
3. CDC. Overweight and obesity: facts. Atlanta, GA: US Department of Health and Human Services, CDC. Available at http://www.cdc.gov/obesity/data/facts.html.
4. CDC. CDC estimates of foodborne illness in the United States. Atlanta, GA: US Department of Health and Human Services, CDC; 2011. Available at http://www.cdc.gov/foodborneburden/2011-foodborne-estimates.html.
5. CDC. Healthcare-associated infections (HAIs): the burden. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. Available at http://www.cdc.gov/HAI/surveillance/index.html.
6. US Department of Health and Human Services. Million Hearts initiative. Washington, DC: US Department of Health and Human Services; 2014. Available at http://millionhearts.hhs.gov/index.html.
7. CDC. Winnable Battles. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. Available at http://www.cdc.gov/winnablebattles.