Boris D. Lushniak, MD, MPH RADM, USPHS Deputy Surgeon General Department of Health and Human Services Office of the Surgeon General of the United States of America Boris D. Lushniak, MD, MPH RADM, USPHS Deputy Surgeon General For more information, call us at 1–800–279–1605 or visit our Web site at www.usphs.gov. We look forward to hearing from you. Thank you. 1

DISCLOSURE OF CONFLICTS OF INTEREST Boris D. Lushniak, MD, MPH I do not have any relevant financial relationships with any commercial interests No off-label discussion of drugs or devices Work supported by US Government (DHHS, PHS, FDA, CDC/NIOSH)

The United States Public Health Service Who we are What we do I’m the special assistant to the assistant secretary for health for the U.S. Public Health Service Commissioned Corps Transformation. I play a highly critical role in the efforts to significantly grow the 6,000 officer active-duty force and provide increased opportunities for the Corps to help advance public health service, policy, and support through expanded assignments in Federal agencies and other organizations across the Nation. In my 20-year Federal career, I have had the opportunity to serve in policy and managerial assignments of progressively increasing responsibility and scope, including executive and leadership roles at the National Institutes of Health, the Health Resources and Services Administration, and the Centers for Medicare and Medicaid Services. I have also represented HHS in regional/State assignments and activities, serving as the Regional Health Administrator for Region 1 (New England) and assisting the hurricane response efforts in Louisiana and Florida in the fall of 2005. I directed the HHS field response to Hurricane Wilma in November of that year, working closely with the Florida State Department of Health. I joined the Commissioned Corps as an Epidemic Intelligence Service (EIS) officer and preventive medicine resident with the Centers for Disease Control and Prevention. I am a board-certified fellow of the American College of Preventive Medicine and received my medical, public health, and bachelor’s degrees from the University of Michigan in Ann Arbor.

Seven Uniformed Services of the United States DOD Armed Military Non-DOD Armed Military (DHS) Non-DOD Non-Armed Can Be Militarized (HHS) (DOC)

The USPHS Commissioned Corps The Surgeon General is the Commander of the USPHS Commissioned Corps Regina M. Benjamin, MD, MBA VADM, USPHS 18th Surgeon General

The Mission of the Commissioned Corps Protecting, promoting, and advancing the health and safety of the nation

US Public Health Service Mission As America’s uniformed service of public health professionals, the Commissioned Corps achieves this mission through: Leadership and excellence in public health practice The advancement of public health science Rapid and effective response to public health needs

The United States Public Health Service 1798 Act provided care for sick and injured merchant seamen (loose hospital network) 1870 Marine Hospital Service (national system) 1871 Supervising Surgeon (later Surgeon General) Dr. John Maynard Woodworth 1878 Quarantine functions (smallpox, yellow fever, cholera) 1889 Legislation creating Commissioned Corps 1891 Immigrant services 1902 Public Health and Marine Hospital Service 1912 Public Health Service (with broadened powers) I’m the special assistant to the assistant secretary for health for the U.S. Public Health Service Commissioned Corps Transformation. I play a highly critical role in the efforts to significantly grow the 6,000 officer active-duty force and provide increased opportunities for the Corps to help advance public health service, policy, and support through expanded assignments in Federal agencies and other organizations across the Nation. In my 20-year Federal career, I have had the opportunity to serve in policy and managerial assignments of progressively increasing responsibility and scope, including executive and leadership roles at the National Institutes of Health, the Health Resources and Services Administration, and the Centers for Medicare and Medicaid Services. I have also represented HHS in regional/State assignments and activities, serving as the Regional Health Administrator for Region 1 (New England) and assisting the hurricane response efforts in Louisiana and Florida in the fall of 2005. I directed the HHS field response to Hurricane Wilma in November of that year, working closely with the Florida State Department of Health. I joined the Commissioned Corps as an Epidemic Intelligence Service (EIS) officer and preventive medicine resident with the Centers for Disease Control and Prevention. I am a board-certified fellow of the American College of Preventive Medicine and received my medical, public health, and bachelor’s degrees from the University of Michigan in Ann Arbor. 8

A Proud History From Ellis Island… …To tribal lands Across America… 1918 From Ellis Island… …To tribal lands Across America… …Around the World The earliest predecessor of the Commissioned Corps was the Marine Hospital Service. At the time—the early 1800s—our country relied on a healthy merchant marine for trade and security. Our seamen traveled widely. Often, those who became ill brought their sicknesses back home, which made their health care a Federal concern. The Marine Hospital Service eventually grew into the Public Health and Marine Hospital Service. In 1912, Congress shortened this name to the U.S. Public Health Service, with the Commissioned Corps as its uniformed service. The responsibilities of the U.S. Public Health Service also changed, as new threats to our country’s public health emerged. Congress charged the U.S. Public Health Service with preventing the introduction and spread of major epidemic diseases such as smallpox, yellow fever, and cholera. To meet this responsibility, the service and its Corps took over many national quarantine, disinfection, and immunization functions. Congress also charged the U.S. Public Health Service to carry out the medical inspection of arriving immigrants, such as those landing at Ellis Island in New York. The workplace environment and its effect on the health of workers became a major concern for the service in the early 1900s. By 1912, the U.S. Public Health Service was authorized to investigate human diseases (such as tuberculosis, hookworm, malaria, and leprosy), sanitation, water supplies, and sewage disposal. The Office of International Health Relations was established in 1943. Today’s Commissioned Corps officers work abroad as well as in the United States to help prevent the spread of infectious and communicable diseases. New threats to our public health, such as SARS, avian flu, drug-resistant TB, and MRSA—continue to develop. That’s a very brief history of the Corps. 9 9

Categories of Commissioned Corps Officers Over 6,500 officers in 800 locations, worldwide 11 Professional Categories Medical Dental Nursing Pharmacy Scientist Health Services Engineer Therapist Veterinarian Dietitian Environmental Health

US Duty Stations

Federal Agencies Utilizing Commissioned Corps Officers (Not all agencies and programs are represented)

Public Health & Prevention Missions of the Surgeon General: Overweight & Obesity Combat overweight epidemic Target Obesity

Public Health & Prevention Missions of the Surgeon General Smoking Underage Drinking

Public Health & Prevention Missions of the Surgeon General: Deep Vein Thrombosis & Healthy Homes Best DVT Prevention Practices Promoting Healthy Homes

Public Health & Prevention Missions: Healthy Youth for a Healthy Future National Outreach Campaign - Encourage healthy eating habits - Help kids stay active - Promote healthy choices - Local roundtables with non-traditional partners Faith-based organizations Businesses Chambers of Commerce - Recognition of “Community Champions”

The Surgeon General’s Vision for a Healthy and Fit Nation

Major Actions of OSG A Report of the Surgeon General How Tobacco Smoke Causes Disease The Biology and Behavioral Basis for Smoking-Attributable Disease December 9, 2010

Major Actions of OSG The Surgeon General’s Call to Action to Support Breastfeeding 2011 January 20, 2011

Upcoming Actions March 8, 2012 – release of “Preventing Tobacco Use Among Youth and Young Adults” (Washington DC) Other OSG initiatives – prescription drug misuse in teens, youth violence Let’s Move campaign Million Hearts Hearts campaign Prevent 1 million heart attacks and strokes in 5 years Aspirin, Blood Pressure, Cholesterol, Smoking www.millionhearts.hhs.gov

Medical Reserve Corps

Public Health The science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals. CEA Winslow, 1920

10 Great Public Health Achievements-US 1900-1999 Vaccination Motor-vehicle safety Safer workplaces Control of infectious diseases Decline in deaths from heart disease and stroke Safer and healthier foods Healthier mothers and babies Family planning Fluoridation of water Recognition of tobacco as a health hazard MMWR 1999 Apr 2;48(12):241-3.

Public Health US 2009 6.22 infant deaths per 1000 live births (45) 78.11 life expectancy in years (49) Health care expenditure 17.6 % GDP (1) $2.5 trillion $8160 per person

Core Public Health Functions Assessment and monitoring of the health of communities and populations at risk identify health problems and priorities - surveillance The formulation of public policies designed to solve identified local and national health problems and priorities Assure that all populations have access to appropriate and cost-effective care including health promotion and disease prevention services evaluation of the effectiveness of that care

to attain public health Use policies, research agendas recommendations, to attain public health goals The Vision

Healthy People www.healthypeople.gov Developed in 1979 by the Department of Health and Human Services Science-based, 10 year national objectives For promoting health and preventing disease Includes a vision, mission, goals, focus areas, criteria, objectives and action plans for achieving the targets

Healthy People 2020 Launched Dec 2010 600 objectives, 1300 measures Each objective has a reliable data source, a baseline measure, and a target for specific improvements www.healthypeople.gov/HP2020

Healthy People 2020 Implementation Framework MAP-IT Mobilize -- partnerships Assess – needs and assets Plan – clear objectives and concrete steps Implement – workplan, POC, communication plan Track – evaluate and track progress Using Healthy People to make the case for funding www.healthypeople.gov/HP2020

The Affordable Care Act Unique Opportunities for Prevention

National Prevention Council Bureau of Indian Affairs Department of Labor Corporation for National and Community Service Department of Transportation Department of Agriculture Department of Veterans Affairs Department of Defense Environmental Protection Agency Department of Education Federal Trade Commission Department of Health and Human Services Office of Management and Budget Department of Homeland Security Office of National Drug Control Policy Department of Housing and Urban Development White House Domestic Policy Council Department of Justice

Advisory Group 17 non-federal members Statutory Role: Develop policy and program recommendations Advise National Prevention Council on prevention and health promotion practices

National Prevention Strategy Extensive stakeholder and public input Aligns and focuses prevention and health promotion efforts with existing evidence base Supports national plans

Vision Working together to improve the health and quality of life for individuals, families, and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness.

National Prevention Strategy

Healthy and Safe Community Environments Clean air and water Affordable and secure housing Sustainable and economically vital neighborhoods Make healthy choices easy and affordable

Clinical and Community Preventive Services Evidence-based preventive services are effective Preventive services can be delivered in communities Preventive services can be reinforced by community-based prevention, policies, and programs Community programs can promote the use of clinical preventive service (e.g., transportation, child care, patient navigation issues)

Empowered People People are empowered when they have the knowledge, resources ability, and motivation to identify and make healthy choices When people are empowered, they are able to take an active role in improving their health, supporting their families and friends in making healthy choices, and leading community change

Elimination of Health Disparities Health outcomes vary widely based on race, ethnicity, socio- economic status, and other social factors Disparities are often linked to social, economic or environmental disadvantage Health disparities are not intractable and can be reduced or eliminated with focused commitment and effort

Priorities Tobacco Free Living Preventing Drug Abuse and Excessive Alcohol Use Healthy Eating Active Living Mental and Emotional Well- being Reproductive and Sexual Health Injury and Violence Free Living Source: National Vital Statistics Report, CDC, 2008

Federal Implementation Provide coordination and ongoing leadership at the Federal level, and among all Federal departments Establish processes for continual public input Establish specific and measureable agency- specific actions to address recommendations Monitor and track federal actions Annual Status Report

Optimal Implementation

What’s Next Regional meetings Execute and coordinate NPS actions across Council agencies Encourage partners to create and execute their own NPS action plans Monitor and track progress Share successes! Keeping accountability of the Strategy progress; begin tracking reporting for the Annual Status Report Sharing success, specifically cross-cutting and innovative examples

nationalpreventioncouncil For more information go to: www.healthcare.gov/ nationalpreventioncouncil Contact the National Prevention Council at: prevention.council@hhs.gov

Deputy Surgeon General boris.lushniak@hhs.gov Boris Lushniak, M.D., M.P.H. RADM, USPHS Deputy Surgeon General boris.lushniak@hhs.gov WWW.SURGEONGENERAL.GOV WWW.USPHS.GOV