Centers for Disease Control and Prevention (CDC)

Definition: One of the divisions of the US Department of Health and Human Services and the highest governmental health organization in the United States

Role in the United States

The Centers for Disease Control and Prevention (CDC) headquarters is located in Atlanta, Georgia. The mission of the CDC is to promote health and improve quality of life by preventing and controlling disease, injury, and disability. The organization is charged with protecting the public health of the United States by providing leadership and direction in preventing and controlling disease and other preventable conditions and responding to public health emergencies.

The CDC is responsible for maintaining, recording, and analyzing disease trends of all types of diseases, including communicable diseases and diseases resulting from lifestyle, occupational, and environmental causes. The CDC also publishes reports on all these diseases, including the Morbidity and Mortality Weekly Report (MMWR), which reports updated incidence and prevalence statistics for a number of reportable diseases. The MMWR also provides a means of disseminating and describing new regularity changes or health information pertinent to public health and safety. As a federal government health agency, the CDC supports state and local health departments and cooperates with similar national health organizations of other countries. The CDC also provides guidelines for disease prevention. The structure of the CDC is formed by centers, institutes, and officers, which carry out the diverse functions of disease prevention and control. Its various divisions are responsible for specific aspects of public health.

The mission of the National Center for Environmental Health (NCEH) is to provide national leadership through science to promote health and improve quality of life by preventing or controlling disease, birth defects, disabilities, or deaths that result from interactions between people and their environment, such as from exposure to toxins. NCEH especially is committed to safeguarding the health of populations that are particularly vulnerable to certain environmental hazards, including children, older people, and people with disabilities.

NCEH conducts research in the laboratory and in the field to investigate the effects of the environment on health. NCEH tracks and evaluates environment-related health problems through surveillance systems. NCEH also helps domestic and international agencies and organizations prepare for and respond to natural, technologic, humanitarian, and terrorism-related environmental emergencies. The scope of NCEH work also includes educating various audiences about environmental health, developing new standards and guidelines in this field, helping to formulate public policy, and providing training and technical assistance to officials of state and local health agencies in preventing and responding to public health challenges.

The National Center for Health Statistics (NCHS) is the US government’s principal vital and health statistics agency. The mission of NCHS is to provide statistical information that will guide policies to improve the health of the American people. Since 1960, when the National Office of Vital Statistics and the National Health Survey merged to form NCHS, the agency has provided a wide variety of data to monitor national health. NCHS data systems include data on vital events, such as birth and death, as well as information on health status, lifestyle, exposure to unhealthy influences, the onset and diagnosis of illness and disability, and the uses of health care. These data are used by governmental policymakers, by medical researchers, and by others in the health community.

The National Vital Statistics System in NCHS includes birth data, mortality data, fetal death data, and linked births/infant deaths. Some of the important NCHS health data systems include the National Health Interview Survey, National Health Interview Survey on Disability, National Health and Nutrition Examination Survey, National Health Care Survey, Ambulatory Health Care Data, National Hospital Discharge Surgery Data, National Home and Hospice Care Survey, National Nursing Home Survey, National Employer Health Insurance Survey, National Survey of Family Growth, National Maternal and Infant Health Survey, and National Immunization Survey.

Prevention and Health Promotion

The mission of the National Center for Chronic Disease Prevention and Health Promotion is to prevent death and disability from chronic diseases; to promote maternal, infant, and adolescent health; to promote healthy personal behaviors; and to accomplish these goals in partnership with health and education agencies, major voluntary associations, the private sector, and other federal agencies.

Chronic diseases are health conditions that last longer than three months. In the United States, the leading causes of death are chronic diseases, such as heart disease, cancer, stroke, and diabetes, which often stem from an unhealthy lifestyle. Within the center, there are divisions of cancer prevention and control, diabetes, heart disease and stroke, smoking and health, nutrition and physical activity, population health, reproductive health, and oral health.

Within the National Center for HIV, Viral Hepatitis, STD, and TB Prevention there are several divisions. The mission of the Division of HIV Prevention is to prevent HIV infection and reduce illness and death related to HIV and AIDS. In collaboration with community, state, national, and international partners, the Division of HIV Prevention conducts research on behavioral intervention, program evaluation, and epidemiology of HIV/AIDS. It also provides community assistance, technical information, training, and prevention services related to HIV/AIDS.

The Division of Sexually Transmitted Diseases Prevention provides national leadership through research, policy development, and support of effective services to prevent sexually transmitted diseases (STDs) and their complications, such as infertility, adverse outcomes of pregnancy, and reproductive tract cancer. The Division of STD Prevention assists health departments, health care providers, and nongovernmental organizations through the development of goals and policies; synthesis, translation, and dissemination of timely science-based information; and the development and support of science-based programs that meet the needs of communities. The Division of STD Prevention also conducts surveillance; epidemiological, behavioral, and operational research; and program evaluation related to STDs, including syphilis, gonorrhea, chlamydia, human papillomavirus, and genital herpes. The Division of Viral Hepatitis focuses on control and prevention of hepatitis A, B, and C.

The Division of Tuberculosis Elimination works to provide leadership in preventing, controlling, and eventually eliminating tuberculosis (TB). The activities that are carried out in the Division of Tuberculosis Elimination include developing and advocating effective and appropriate TB prevention and control policies; supporting a nationwide framework for monitoring TB morbidity and mortality; detecting and investigating TB outbreaks; conducting clinical, epidemiological, behavioral, and operational research to enhance TB prevention and control efforts; evaluating prevention effectiveness; providing funding and technical assistance to state and local health departments; and providing training, education, and technical services to state and local health departments.

The mission of the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) is to prevent illness, disability, and death caused by infectious disease in the United States and around the world. Infectious diseases are diseases that are caused by bacteria, viruses, or other microorganisms and can be transmitted from one person to another as well as from animals to people. With widespread immunization and effective antibiotics, the public health threat of infectious diseases has been lessened in industrialized countries. However, infectious diseases are among the leading causes of death worldwide. Deaths from infectious disease in the United States have been increasing because new diseases emerge, old diseases rebound, inappropriate use of antibiotics results in drug-resistant germs, and rates of childhood immunization have been falling due to unfounded fears causing vaccine hesitancy. To meet this challenge, NCEZID conducts surveillance, epidemic investigations, epidemiological and laboratory research, training, and public education programs. NCEZID also develops, evaluates, and promotes prevention and control strategies for infectious diseases.

As the lead federal agency for injury prevention, the National Center for Injury Prevention and Control (NCIPC) works closely with other federal agencies; national, state, and local organizations; state and local health departments; and research institutes to prevent and reduce injury, disability, death, and costs associated with injuries outside the workplace. Injury is a leading cause of death and disability among children and young adults. Injury is a serious public health problem because of its impact on the health of the United States, including premature death, disability, and the burden on the health care system. Common sources of unintentional injuries are falls, fires, drownings, poisonings, motor vehicle accidents, recreational activities accidents, and playground and day care accidents. Intentional injuries are related to suicide, youth violence, family and intimate partner violence, and homicide. Injury prevention strategies focus primarily on environmental design (such as road construction that permits optimum visibility), product design, human behavior and education, and legislative and regulatory requirements that support environmental and behavioral change.

Vaccination and Immunization

The National Vaccine Program Office of the US Department of Health and Human Services is designated to provide leadership and coordination among federal agencies, including the CDC, and to oversee that they work together to carry out the goals of the National Vaccine Plan. The National Vaccine Plan provides a framework, including goals, objectives, and strategies, for pursuing the prevention of infectious diseases through immunizations. This office develops and implements strategies for achieving the highest possible level of prevention of human diseases through immunization and the highest possible level of prevention of adverse reactions to vaccines.

The CDC's National Center for Immunization and Respiratory Diseases (NCIRD) provides leadership for the planning, coordination, and conduct of immunization activities nationwide. NCIRD provides consultation, training, and statistical, educational, epidemiological, and technical services to assist health departments in planning, developing, and implementing immunization programs. NCIRD assists health departments in developing vaccine information management systems to facilitate identification of people who need vaccinations, to help parents and providers to ensure that all children are immunized at the appropriate age, to assess vaccination levels in state and local areas, and to monitor the safety and efficiency of vaccines by linking vaccine administration information to adverse event reporting and disease outbreak patterns. NCIRD also administers research and operational programs for the prevention and control of vaccine-preventable and respiratory diseases.

Other Agencies and Offices

As a federal agency, the National Institute for Occupational Safety and Health (NIOSH) is responsible for conducting research into the full scope of occupational disease and injury and making recommendations for the prevention of work-related disease, injury, and disability. The occupational diseases range from lung disease in miners to carpal tunnel syndrome in computer users. Approximately each day in the United States, workers sustain disabling injuries on the job, die from an injury sustained at work, and die from work-related diseases. The economic burden of occupational health problems is high. NIOSH is a diverse organization made up of professionals representing a wide range of disciplines including industrial hygiene, nursing, epidemiology, engineering, medicine, and statistics. NIOSH investigates potentially hazardous working conditions when requested by employers or employees and provides training to occupational safety and health professionals.

The public health of the United States depends on the health status of its minority populations. The major minority groups in the United States include Black Americans, Asian and Pacific Islander Americans, American Indians, and Hispanic Americans. Compared to the United States as a whole, minority populations, particularly Black Americans, suffer higher rates of morbidity and mortality. American Indians and Hispanic Americans also have worse health outcomes than the total population. Although Asian Americans and Pacific Islanders overall have reasonably good health indicators, some subgroups have very poor health status. By providing health promotion and communication strategies, policy recommendations, research, and program development, the Office of Minority Health and Health Equity is committed to developing cooperative and interagency agreements among various federal, state, local, and private agencies and organizations concerned with minority health.

Because of the globalization of the world economy, health problems associated with global movements of people and commerce are increasing. One country’s health problems today can become another country’s health problems tomorrow. Diseases have lost their boundaries, and global health efforts are necessary. The mission of the Center for Global Health is to improve health worldwide by providing leadership, coordination, and support for the CDC’s global health activities in collaboration with the CDC’s health partners worldwide. This center provides leadership in the development of cross-cutting policies, plans, and programs related to the CDC’s global health interests; assists the CDC’s divisions, other federal agencies, or nongovernmental agencies in the implementation of appropriate policies, plans, and programs for which they have responsibilities; and enhances global health partnerships by serving as the entry point for external organizations with an interest in the CDC’s global health activities.

Advances in human genetics have demonstrated the potential public health impact of effectively applying genetics to disease prevention. Several CDC programs have been heavily involved with genetics for many years. The Office of Genomics and Precision Public Health works to integrate advances in human genetics into public health research, policy, and program development and evaluation and to provide a coordinated focus for the CDC’s genetics efforts with particular emphasis on communication and training.

Perspective and Prospects

The CDC had its origin in the US antimalaria program of World War II and was recognized as the Communicable Disease Center in 1946, when the main health problems were infectious diseases. It became the Center for Disease Control in 1970, then the Centers for Disease Control in 1980, and the words “and Prevention” were added in 1992, though Congress requested that “CDC” remain the agency’s initials. The CDC conducts research into the origin and occurrence of communicable diseases as well as noncommunicable diseases and develops methods for their control and prevention. The CDC is a powerful leader in public health in the United States and worldwide.

The CDC proved particularly influential, and was subsequently highly scrutinized, during the United States' response to the coronavirus disease 2019 (COVID-19) pandemic declared by the World Health Organization in March 2020. Once information became available about the first identification of the novel coronavirus in China in late 2019, the CDC began monitoring and guidance efforts that included activating its Emergency Operations Center. As the virus continued to spread rapidly across the world and the CDC confirmed the first case of COVID-19 in the United States in January, it developed and, with Emergency Use Authorization, distributed the first laboratory COVID-19 diagnostic panel test in February. From there, CDC staff worked with state and local health departments to coordinate contact tracing and case identification efforts as well as with airports conducting traveler screening. The agency was also involved in the nationwide campaign to roll out COVID-19 vaccines following their approval in late 2020.

Because the pandemic continued into 2022, due initially to a dearth of understanding of the novel virus as well as a lack of vaccines and later also due to the identification of variant, highly transmissible strains, the CDC provided and updated guidance and recommendations related to symptoms as well as control measures such as wearing masks, social distancing, quarantining, and isolating; this guidance was looked to by businesses, schools, and the general public.

However, by 2022, some people, including public health experts, had expressed criticism of the CDC's performance and its tendency to be politically influenced through the pandemic. They argued that it had made crucial missteps including initially holding off on recommending the wearing of masks while at other times issuing guidelines allowing for reduced use of masking among vaccinated populations despite evidence ultimately indicating differing vaccine efficacy against variant strains. Additionally, some pointed to the flaws in several of the diagnostic tests originally sent out by the CDC and perceived their direct communication to be too irregular, their guidelines to often be confusing, and their data collection methods to be outdated. While the CDC held a telebriefing in January 2022 to address some concerns such as transparency, others also noted that the agency had been required to be decisive during a quickly changing pandemic.

An enormous challenge faced by CDC leadership in regard to its pandemic response, unfortunately stemmed from the politicized nature of the American electorate. This was a division that existed during the height of a public health emergency and in the course of a tightly-contested 2020 American presidential election. While many of the CDC's responses could, in hindsight, be viewed with criticism, an underlying factor of the tensions resulting from its recommendations stemmed from viewpoints held by the two major political parties. Detractors of the CDC highlighted the impediments to their conceptions of civil liberties in light of mandatory measures such as social distancing. Proponents of the CDC believed the nation to be in the midst of an existential health crisis where the needs of the general welfare superseded personal inconvenience.

Amid these developments, Walensky also ordered a number of bureaucratic and administrative changes, namely the establishment of a new executive committee in charge of determining how the CDC would spend its annual budget. Many public health experts felt this move, among the other planned changes, could lead to a major reorganization of the agency.

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