Background

Considered the cornerstone of public health practice, public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of health-related data.^[1] Surveillance provides essential information for monitoring the health of the public, identifying health problems, and triggering action to prevent further illness.^[2]

For example, data from a public health surveillance system can be used to:

• measure the burden of a disease (or other health-related event), including the identification of populations at high risk and the identification of new or emerging health concerns;
• monitor trends in the burden of a disease (or other health-related event), including the detection of epidemics (outbreaks) and pandemics; and
• detect changes in health practices and the effects of these changes.^[3]

Epidemiology, the basic science of public health, provides the foundation and scientific and analytic tools for such surveillance (specifically, epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems ).^[4] Epidemiologists carry out much of this work with assistance from federal, state, and some local public health laboratories.

Despite the central role of epidemiology and public health laboratories in monitoring the health of communities, the nation’s epidemiologic capacity has declined over the past decade—with a marked decline in the number of state-level epidemiologists since 2006—due in part to reduced federal funding and the overall decline of state budgets.^[5] Moreover, many states do not have the technological capacity to conduct state-of-the-art disease surveillance. This deficiency results in less timely and complete reporting, reduced ability to rapidly detect outbreaks and monitor conditions that affect large numbers of people, such as HIV and diabetes, and reduced ability to describe and respond to disparities in health.^[6]

Given the decline in epidemiologic and laboratory capacity, both Healthy People 2010 and the draft Healthy People 2020 call for the US to “increase the proportion of tribal, state, and local public health agencies that provide or assure comprehensive epidemiology” and “laboratory [tribal and state agencies only] services to support essential public health services.”^[7][8]

Changes Made by the Health Reform Law
P.L. 111-148, § 4304

The health reform law amends the Public Health Service Act^[9] by establishing an Epidemiology and Laboratory Capacity Grant Program to award grants to state, local, and tribal health departments, and academic centers that assist such agencies. Local and tribal health departments, and academic centers that assist these agencies, may be required to meet certain criteria, as the CDC determines, to be eligible for an award.^[10]

Grants will be awarded to “assist health agencies in improving surveillance for, and response to, infectious diseases and other conditions of public health importance.”^[11] Awards will focus on four key areas:

“1) Strengthening epidemiologic capacity to identify and monitor the occurrence of infectious diseases and other conditions of public health importance;

2) Enhancing laboratory practice as well as systems to report test orders and results electronically;

3) Improving information systems including developing and maintaining an information exchange using national guidelines and complying with capacities and functions determined by an advisory council established and appointed by the Director; and

4) Developing and implementing prevention and control strategies.”^[12]

Implementation

Agency

The Centers for Disease Control and Prevention, an agency within the U.S. Department of Health and Human Services, is responsible for establishing, implementing, and administering the grant program.

Key Dates

No implementation dates are assigned to this section of the law.

Process

The CDC Director must determine what criteria, if any, local and tribal health departments must meet to be eligible for funding. The Director must also determine whether academic centers that assist state and eligible local and tribal health departments will be eligible for funding.

The law provides no additional direction to CDC regarding how the law should be implemented. The agency therefore has the discretion to use a range of tools to implement the statute, such as publishing regulations in the Federal Register with a public notice and comment period or using other types of approaches such as posted policy instructions, announcements of funding availability, official letters to affected entities, and posted rulings and notices. The Federal Register and agency websites can be regularly checked for updates.

Key Issues

• Appropriations: How much money will Congress actually appropriate for this grant program? Will funding for this program be taken out of the Prevention and Public Health Fund (Section 4002 of the PPACA)? If Congress appropriates less than the $187,000,000 authorized amount, how will that money be divided among the three required funding categories (see Authorized Funding Levels, below)?
• Funding Criteria: How will CDC determine which agencies receive awards? What criteria will CDC use to determine eligibility of local and tribal health departments? What criteria will CDC use to determine whether academic centers receive awards?
• Timeline: When will CDC make the first awards under the grant program?
• Awards: How many awards will CDC make and for what amount of funding? What is the duration of each award? May grantees receive awards for multiple years?
• Disease types: How will “other conditions of public health importance” be defined?
• Activities: How will “prevention and control strategies” and “information exchange” be defined?
• Outcomes measurement: How will CDC measure the grant program’s success? How will it determine whether the grants are strengthening the four key areas described above?

Recent Agency Action

No action has been taken as of this writing.

Authorized Funding Levels

Funding is “subject to the availability of appropriations.”^[13] The law authorizes an appropriation of $187,000,000 for each of fiscal years 2010-2013. The law requires that appropriated amounts fund projects in the following manner:

• At least $95,000,000 each fiscal year for activities related to strengthening epidemiologic capacity to identify and monitor the occurrence of infectious diseases and other conditions of public health importance, and for developing and implementing prevention and control strategies;
• At least $60,000,000 each fiscal year for activities related to improving information systems, including the development and maintenance of an information exchange and complying with capacity and function requirements as the CDC requires; and
• At least $32,000,000 each fiscal year for activities related to enhancing laboratory practice and electronic reporting systems.^[14]