De diplomática frustrada a una de las agentes espías más importantes

(dollars in millions) Budget Authority $24.876 $26.806 $26.806 $0.000

1FY 2013 levels have been made comparable to FY 2014 Enacted to reflect the permanent realignment of the BSS budget line.

Overview

Arthritis¹¹⁰ is the most common cause of disability in the United States, with approximately 52.5 million adults reporting diagnosed arthritis¹¹¹ and 22.7 million reporting arthritis-attributable activity limitations. Arthritis is widespread among adults with heart disease (49%), diabetes (47%), and obesity (36%), and complicates

managing these co-occurring diseases because of associated activity limitations. CDC’s long-term program goal is to reduce pain and disability, and improve quality of life among people affected by arthritis. CDC-recommended interventions improve the quality of life of people with arthritis by increasing their ability to manage their condition, reduce pain, and increase function. To expand the reach of effective interventions, CDC works with 12 state health departments, national organizations (e.g., Arthritis Foundation, the National Association of Chronic Disease Directors, and Y-USA), and other partners (e.g., cooperative extension service programs and state/local recreation and parks associations) to embed self-management and physical activity interventions within existing systems of service and care.

Epilepsy¹¹² , a chronic neurological condition, affects about 2.3 million adults and over 465,000 children 0-17 years of age resulting in an estimated $15.5 billion in medical costs and lost productivity. CDC’s Epilepsy Program works with the National Epilepsy Foundation (EF) to strengthen professional and public education about seizures and epilepsies to increase awareness, reduce stigma, and enhance care and safety for people with epilepsy. For example, in 2012 the EF reached 16,751 middle and high school students and teachers through the Seizures and Youth: Take Charge programs; trained 1,212 staff in Adult Day Programs to enhance staff’s recognition of seizures in older adults; and trained almost 2,000 childcare personnel who work in child day care centers. CDC supports the Managing Epilepsy Well Network¹¹³, through the CDC-funded Prevention Research Centers, to conduct innovative research for epilepsy self-management. For example, the first evidence-based online epilepsy self-management program (WebEASE)¹¹⁴ is now available at no cost on the EF website. CDC also

conducts studies to better understand who epilepsy impacts. In 2013, CDC published a study¹¹⁵ which found that adults with epilepsy reported co-occurring cardiovascular, respiratory, some inflammatory, and other disorders more frequently than respondents without epilepsy.

Lupus is a rheumatic autoimmune disease that can cause inflammation and tissue damage to virtually any organ system in the body and result in serious disability, pain, and premature death. Lupus affects women far more than men and, unlike other autoimmune diseases, affects African Americans far more than whites. Because lupus is difficult to diagnose, its severity and corresponding burden on society has been extremely difficult to estimate. CDC-funded population-based lupus registries in Georgia and Michigan published results in 2013 that describe for the first time lupus cases from two comparable urban populations.

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Budget Request

CDC’s FY 2015 request of $26,806,000 for Arthritis and Other Chronic Diseases is level with the FY 2014 Enacted level.

In 2015, CDC’s will address the burden of Arthritis and Other Conditions by doing the following:

 Increasing access and availability of evidence-based interventions

 Conducting surveillance to measure burden

 Strengthening the science base of effective strategies

 Increasing awareness and promoting health equity

Table: Public Health activities to support Arthritis and Other Chronic Conditions.

Activities Examples

Access and availability of effective interventions

Arthritis: Fund 12 states and work with national organizations and other partners to expand access to proven arthritis physical activity and self-management interventions.

Epilepsy: Fund Epilepsy Foundation to expand access to effective interventions.

Surveillance and epidemiological studies

Arthritis: Support surveillance and analysis of arthritis and arthritis-attributable activity limitations and its impacts.

Lupus: Fund the completion of population-based registries in CA, NY, and the Indian Health Service to estimate lupus among Hispanics, Asians, and American Indians/Alaska Natives. Fund follow-up studies on treatment, healthcare access, and factors associated with outcomes.

Epilepsy: Support studies to define epilepsy incidence and prevalence in various populations.

Strengthen the science of effective strategies

Arthritis: Support research for new and adapted effective arthritis self-management and physical activity interventions.

Epilepsy: Fund the Managing Epilepsy Well Network to conduct research that promotes self-management and improved quality of life using innovative methods to overcome transportation and stigma barriers.

Awareness and health equity

Epilepsy: Fund Epilepsy Foundation to develop and implement programs to enhance public awareness and promote partnerships, education, and communication at local and national levels, including a focus on underserved populations.

CDC will work closely with grantees to improve and increase self-management attitudes and behaviors among persons with arthritis. CDC’s Arthritis Program awards funds to 12 state health departments to expand access to proven arthritis interventions. Specifically, the competitive five-year cooperative agreements (FY 2012–FY 2016) require grantees to embed arthritis interventions that also benefit other chronic conditions, such as the Chronic Disease Self-Management Program¹¹⁶ and EnhanceFitness¹¹⁷, in health care and community delivery systems. At the end of this project period, CDC expects grantees to reach over 450,000 individuals with arthritis-appropriate, evidenced-based programs and strategies, conduct surveillance and use data to inform priority setting and

116 http://patienteducation.stanford.edu/programs/cdsmp.html

117 http://www.projectenhance.org/enhancefitness.aspx

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decision making, and implement health communications campaigns. CDC will continue to work with national arthritis grantees, such as the Arthritis Foundation and the National Association of Chronic Disease Directors to make physical activity and self-management education interventions more accessible.

Tables: Arthritis State Grant (dollars in millions)

FY 2013 Final¹

FY 2014 Enacted

FY 2015 President Budget

2015 +/-2014

Number of Awards 12 12 12 0

- New Awards 0 0 0 0

- Continuing Awards 12 12 12 0

Average Award $0.405 $0.425 $0.425 $0.000

Range of Awards $0.200–$0.500 $0.200–$0.500 $0.200-$0.500 N/A

Total Awards $4.869 $5.100 $5.100 $0.000

In FY 2013, CDC funded California, Michigan, and New York City for lupus surveillance activities through

competitive cooperative agreements. CDC plans to fund lupus surveillance in three sites in FY 2014 and 2015 to focus on identifying disparities in lupus among specific populations, including Hispanics, Asians, American Indians/Alaska Natives, and African Americans. Follow-up cohort studies are expected to add to the understanding of the natural history of lupus, risk factors, and treatment.

Table: Lupus Grant (dollars in millions)

FY 2013 Final¹

FY 2014 Enacted

FY 2015 President Budget

2015 +/-2014

Number of Awards 3 3 3 0

- New Awards 0 2 0 -2

- Continuing Awards 3 1 3 +2

Average Award $1.075 $0.800 $0.800 $0.000

Range of Awards $0.750–$1.238 $0.400–$1.800 $0.400–$1.800 N/A

Total Awards $3.227 $2.400 $2.400 $0.000

169 Budget Authority $14.204 $101.005 $80.000 -$21.005 ACA/PPHF $146.340 $30.000 $0.000 -$30.000

Total $160.544 $131.005 $80.000 -$51.005

Partnerships to Improve Community Health $0.000 $80.000 $80.000 $0.000

Racial and Ethnic Approaches to Community Health $14.204 $51.005 $0.000 -$51.005

ACA/PPHF (non-add) $0.000 $30.000 $0.000 -$30,000

Community Transformation Grants (ACA/PPHF) $146.340 $0.000 $0.000 $0.000

1FY 2013 levels have been made comparable to FY 2014 Enacted to reflect the permanent realignment of the BSS budget line.

Overview

Community-approaches play an important role in improving health and wellness as they are designed to reach the greatest number of people outside of traditional health care venues. Settings, such as schools, worksites, and communities, provide opportunities to reach people through existing structures and maximize impact as people often have high levels of contact across these settings. A community approach to healthy living can have far-reaching effects above and beyond the efforts of individuals working on their own to make healthy changes and improve health outcomes. CDC’s Partnerships to Improve Community Health is a new community-based chronic disease prevention initiative designed to strengthen community-level health efforts throughout the nation and to help communities prevent death and disability and promote healthy living. The Partnerships to Improve Community Health program supports local communities in implementing evidence-based interventions and innovative promising practices to achieve the critical local changes necessary to prevent chronic diseases and their risk factors. The program mobilizes community leadership and resources to bring change to the places and organizations that touch people’s lives every day – at work sites, schools, community centers, and health care settings – to reduce the burden of chronic disease. Special emphasis is directed toward populations that bear a disproportionate burden of disease and lack of access to preventive services.

Budget Request

CDC's FY 2015 request of $80,000,000 for Community Grants is $51,005,000 below the FY 2014 Enacted level. In FY 2015, CDC will continue to support the Partnerships to Improve Community Health program, initiated in FY 2014. The FY 2015 budget request eliminates funding for the Racial and Ethnic Approaches to Community Health (REACH) program. The Partnerships to Improve Community Health Program will build on past program successes and lessons learned from CDC’s community-based programs. This effort will also adopt best practices and lessons learned from the REACH program into its strategy in program planning and implementation.

Through the new Partnerships to Improve Community Health program CDC will fund a mix of urban, rural, and tribal communities to: 1) develop and implement effective models for local action in communities, worksites, schools, and health care; 2) work collaboratively with partners to improve and increase access to quality preventive health services; 3) mentor other communities that want to take action and replicate successful strategies; and 4) support the elimination of racial and ethnic health disparities. In addition, CDC will fund selected national organizations, which will provide support to communities in the form of technical assistance, provision of linkages to resources such as national experts and nontraditional partners, leadership in community evaluation methods, and sustainability planning.