Técnicas e instrumentos de recolección de datos

(dollars in millions) Budget Authority $769.517 $741.962 $608.253 -$133.709

ACA/PPHF $233.033 $446.000 $469.704 +$23.704

Total Request $1,002.550 $1,187.962 $1,077.957 -$110.005

FTEs 921 921 921

Tobacco Prevention and Control $191.086 $210.767 $210.767 $0.000

ACA/PPHF (non-add) $60.302 $105.000 $105.000 $0.000

Nutrition, Physical Activity and Obesity $43.604 $40.092 $40.092 $0.000

ACA/PPHF (non-add) $0.000 $35.000 $4.000 -$31.000

School Health $13.335 $15.424 $15.424 $0.000

Health Promotion $17.707 $19.483 $19.483 $0.000

Prevention Research Centers $23.946 $25.530 $25.000 -$0.530

ACA/PPHF (non-add) $15.279 $0.000 $25.000 +$25.000

Heart Disease and Stroke $54.417 $130.188 $130.188 $0.000

ACA/PPHF $0.000 $73.000 $73.000 $0.000

Diabetes $64.041 $140.306 $140.306 $0.000

ACA/PPHF (non-add) $0.000 $73.000 $73.000 $0.000

National Diabetes Prevention Program $0.000 $10.000 $10.000 $0.000

Cancer Prevention and Control $337.919 $350.982 $308.012 -$42.970

ACA/PPHF (non-add) $0.000 $104.000 $179.204 +$75.204

Breast and Cervical Cancer (non-add) $197.342 $207.269 $169.204 -$38.065

ACA/PPHF (non-add) $0.000 $104.000 $169.204 $65.204

WISEWOMAN (non-add) $20.216 $21.170 $21.170 $0.000

Colorectal Cancer (non-add) $41.989 $43.410 $39.515 -$3.895

All Other Cancer $0.000 $0.000 -$10.900 -$10.900

New Cancer Demonstration Project (ACA/PPHF) $0.000 $0.000 $10.000 +$10.000

Oral Health $14.906 $15.790 $15.790 $0.000

Safe Motherhood and Infant Health $45.057 $45.589 $45.589 $0.000

Arthritis and Other Chronic Diseases $24.876 $26.806 $26.806 $0.000

Community Grants $160.544 $131.005 $80.000 -$51.005

Racial and Ethnic Approaches to Community Health (REACH)

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

Million Hearts® (ACA/PPHF) $4.612 $4.000 $4.000 $0.000

Workplace Health (ACA/PPHF) $0.000 $10.000 $0.000 -$10.000

Healthy Weight Task Force Obesity Activities (ACA/PPHF)

$4.000 $4.000 $4.000 $0.000

Hospitals Promoting Breastfeeding (ACA/PPHF) $2.500 $8.000 $2.500 -$5.500

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

Summary

CDC's FY 2015 request of $1,077,957,000 for Chronic Disease Prevention and Health Promotion is $110,005,000 below the FY 2014 Enacted level. The FY 2015 request for Breast and Cervical and Colorectal Cancer is a

decrease of $41,960,000 below the FY 2014 level reflecting increased coverage for these services through health reform.

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Chronic diseases are among the most prevalent, costly, and deadly of all health problems—and the most preventable. CDC leads U.S. efforts to prevent and control chronic diseases and associated risk factors by funding programs in states, tribes, territories, and local communities. CDC’s chronic disease prevention and health promotion efforts contribute to CDC’s overarching goal of preventing the leading causes of disease, disability, and death.

Core activities 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

 Maintaining surveillance systems to track and monitor behavioral risk factors

Figure: Chronic Disease Prevention and Health Promotion Funding History¹

1FY 2012 and FY 2013 levels have been made comparable to FY 2014 Enacted to reflect the permanent realignment of the BSS budget line.

Chronic Disease Prevention Grants to States and D.C

In 2013, CDC funded the State Public Health Actions⁶¹ to Prevent Chronic Disease. This program supports states to implement cross-cutting strategies to promote health and prevent and control chronic diseases and their risk factors. The coordinated approach integrates the Diabetes; Heart Disease and Stroke Prevention; School Health;

and Nutrition, Physical Activity, and Obesity state programs. Collectively, these programs support a set of complementary activities and intervention strategies in four domains: epidemiology and surveillance,

environmental strategies, health systems improvements, and community-clinical linkages. In FY 2014, additional funding was made available through the Omnibus Appropriations Bill to support expansions of state chronic disease prevention efforts. CDC will support currently funded State Public Health Actions grantees for expanded

61 http://www.cdc.gov/chronicdisease/about/state-public-health-actions.htm

FY 2012 FY 2013 FY 2014 FY 2015 PB

Total $1,211.366 $1,002.550 $1,187.962 $1,077.957

ACA/PPHF $411.050 $233.033 $446.000 $469.704

Budget

Authority $800.316 $769.517 $741.962 $608.253

$0.000

$200.000

$400.000

$600.000

$800.000

$1,000.000

$1,200.000

Dollars in Millions

Chronic Disease Prevention and Health Promotion

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action at the state and local level to address diabetes, heart disease and stroke as well as their associated risk factors. The expanded cooperative agreement will increase access to diabetes self-management education;

increasing control of A1c, blood pressure and cholesterol; improving medication adherence for adults with high blood pressure and expand State capacity in epidemiology and surveillance, environmental strategies, and health systems improvements. Coordinating these efforts into a single program encourages states to implement a cohesive set of evidence and practice-based interventions that address four inter-related chronic diseases and risk factors. These interventions are implemented in multiple settings, such as schools, communities, health care, and work sites. Under the new program, states will implement interventions that are more purposefully aligned and coordinated. They will be more likely to efficiently achieve measurable health impacts related to each of the categorical programs. This combined approach reduces duplication, allowing states to target more funds for program activities. This new program also provides all states with core funding to build expertise and capacity in core areas that are fundamental to the success of all categorical chronic disease and risk factor prevention programs.

The program contains two components:

Basic, Non-Competitive

Supports basic strategies resulting in measurable impacts to address school health, nutrition and physical activity risk factors, obesity, diabetes, heart disease, and stroke in all 50 states and the District of Columbia. CDC continues to hold states accountable for achieving specific outcomes in the core public health functions related to cross-cutting expertise, such as surveillance, policy, communications, evaluation, and health systems. Funding for this component is determined by a formula based on factors, such as population size and poverty. Some cross-cutting activities conducted under the basic component include: 1) partnership engagement; 2) workforce development; 3) guidance and support for programmatic efforts; 4) strategic communications efforts to

translate data for stakeholders, decision-makes, partners, and the public; and 5) ongoing collection, analysis and release of data and information about chronic disease burden, solutions, and programmatic impact. The average funding award for this component was approximately $550,000 in 2013.

Competitive, Enhanced

Builds on and extends activities supported with basic funding to achieve even greater reach and impact. In FY 2013, CDC funded 32 states to implement evidence and practice-based interventions that improve physical activity and nutrition and reduce obesity, diabetes, heart disease, and stroke. Enhanced strategies include the following: 1) implementing environmental approaches to promote health and support healthful behaviors (e.g.

access to healthy food, beverages, and physical activity); 2) expanding health system interventions to improve delivery and use of clinical and other preventive services; and 3) enhancing community clinical linkages to support cardiovascular disease and diabetes prevention and control efforts. For states that successfully

compete, award amounts were determined by a funding formula based on population size. The range of awards for the enhanced component was $1.0–1.7 million in 2013.

At the end of five years, grantees will demonstrate measurable improvements in the following:

 Increased state, community, worksite, school, and early child care and education environments that promote and reinforce healthful behaviors and practices across the life span related to diabetes, cardiovascular health, physical activity and healthful foods and beverages, obesity and breastfeeding.

 Improved quality, effective delivery and use of clinical and other preventive services to support prevention and management of hypertension and diabetes.

 Increased community clinical linkages to support prevention, self-management and control of diabetes, hypertension and obesity.

 Improved prevention and control of hypertension, diabetes, and overweight and obesity.

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Contextual Indicator Most Recent Result FY 2015 Target Coronary Heart Disease: Reduce the annual age-adjusted

rate of coronary heart disease deaths (per 100,000 population).

FY 2010: 113.6 108.6

Stroke: Reduce the annual age-adjusted rate of stroke

deaths (per 100,000 population). FY 2010: 39.1 36.4

Diabetes: Reduce the annual age-adjusted rate of diabetes-related deaths (per 100,000 population).

FY 2010: 70.7

68.5

Table: The State Public Health Actions to Chronic Disease Prevention Program^{1, 2} (dollars in millions)

FY 2013 Final¹

FY 2014 Enacted

FY 2015 President Budget

2015 +/-2014

Number of Awards 51 51 51 0

- New Awards (core) 51 TBD TBD N/A

- Continuing Awards (core) 0 TBD TBD N/A

- New Awards (enhanced) 32 TBD TBD N/A

- Continuing Awards (enhanced) 0 TBD TBD N/A

Average Award (core) Average Award (enhanced)

Range of Awards (core) $0.502 to $0.745 TBD TBD N/A

Range of Awards (enhanced) $1.000 to $1.700 TBD TBD N/A

Total Awards $67.572 $197.444 $197.444 $0.000

1In FY 2013, CDC issued a new five-year combined cooperative agreement as described in the summary section of this request; the cooperative agreement contains four programs, including Nutrition, Physical Activity and Obesity, School Health, Heart Disease and Stroke and Diabetes. It consists of two components: Basic (Core) component that will fund all 50 states and Washington, D.C.; and a Competitive (Enhanced) component that will fund up to 32 states with an average award size of $1.7 million.

2FY 2014 and FY 2015 total grand awards reflect an addition of $5.872 million from a prior diabetes state cooperate agreement that was closed out in FY 2013.

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