viernes, 18 de abril de 2014



MMWR Supplements
Vol. 63, Supplement, No. 1
April 18, 2014



April 18, 2014 / 63(01);1-2

Thomas R. Frieden, MD, MPH
Director, CDC
In public health, a key challenge is moving from accurate monitoring to effective intervention. Selected findings for health determinants and outcomes were reported in the CDC Health Disparities and Inequalities Report—United States, 2011 (1); a second report was released in 2013 (2). This supplement is a companion to the two earlier health disparity reports. It highlights health interventions included in those reports that are proven effective or show promise in reducing health disparities.
Taken together, these three reports offer real-world examples of how public health programs can achieve their intended impact. As previously described (3), there are six key components to effective public health program implementation:
  1. Innovation. Whether in areas of science and medicine, information systems, data collection and analysis, issue framing, operations, program management and evaluation, or communications, innovation is essential for developing technical aspects of program implementation.
  2. Technical package. A small number of synergistic, evidence-based interventions can make a major impact on specific, high-priority goals.
  3. Performance management. Rigorous real-time monitoring and evaluation incorporating feedback mechanisms helps to ensure continuous program improvement and avoid misplaced confidence in results.
  4. Partnerships. Coalitions with public- and private-sector organizations are often essential to successful program implementation.
  5. Communication. Effective communication can save lives during emergencies and drive long-term behavior change. Perhaps more importantly, effective communication strategies can change public perception of health issues and create new contexts for public health action.
  6. Political commitment. Supported by the other five elements, effectively engaged political commitment provides the resources and support needed for effective public health action.
The interventions described in this supplement demonstrate several of these components of effective program implementation. For example:
  • The Many Men, Many Voices (3MV) intervention for black men who have sex with men (MSM) (4) demonstrated in a randomized clinical trial that it could reduce participants' high-risk sexual activity and increase rates of testing for human immunodeficiency virus. The strong performance management component of this evidence-based technical package has led to continuous quality improvement. The program has been expanded to serve other MSM of color, including Latinos, Asians/Pacific Islanders, and American Indians/Alaska Natives. Program facilitators have been trained in 37 states, the District of Columbia, and Puerto Rico.
  • Ongoing political commitment has contributed to the long-term success of the Vaccines for Children program (VFC), the largest legally mandated program managed by CDC. VFC provides vaccines at no cost to children who might otherwise not be vaccinated because of inability to pay. The program has substantially increased childhood vaccination rates, and constant cycles of program evaluation ensure that VFC continues to have maximum impact. A report in this supplement (5) evaluates whether VFC has reduced disparities in vaccination coverage among Hispanic, non-Hispanic black, non-Hispanic American Indian/Alaska Native, and non-Hispanic Asian children, compared with non-Hispanic white children. The analysis indicates that VFC has eliminated disparities in coverage for many vaccines and that disparities in coverage for the recommended four doses of diphtheria-tetanus-pertussis/diphtheria-tetanus-acellular pertussis vaccine have been reduced, but still exist, for Hispanic and black children.
  • For American Indians/Alaska Natives, rates of motor vehicle–related death are two to four times higher than for other races/ethnicities. A report in this supplement (6) describes how CDC helped four American Indian tribes use community strengths to increase use of seat belts and child safety seats and decrease alcohol-impaired driving. Effective communication—through billboards, radio and television media campaigns, and school and community education programs—was a major component of these successful public health programs.
CDC's Winnable Battles initiative is directed toward key public health priorities that have large-scale health effects and that have recognized effective strategies to address them (7). All four topic areas covered in this publication (HIV infection, vaccination, motor vehicle injuries, and tobacco use) have been identified as Winnable Battles. The projects described here demonstrate that effective public health interventions not only win the battle of reducing death and disability overall, but can also decrease health disparities among vulnerable populations.


  1. CDC. CDC health disparities and inequalities reportUnited States, 2011. MMWR 2011;60(Suppl; January 14, 2011).
  2. CDC. CDC health disparities and inequalities reportUnited States, 2013. MMWR 2013;62(No. Suppl 3).
  3. Frieden TR. Six components necessary for effective public health program implementation. Am J Public Health 2014;104:17-22.
  4. Herbst JH, Painter TM, Tomlinson HL, Alvarez ME. Many men, many voices: an evidence-based HIV/STD prevention intervention developed by and for black men who have sex with men (MSM). In: Strategies for reducing health disparities—selected CDC-sponsored interventions, United States, 2014. MMWR 2014;63(No. Suppl 1).
  5. Taylor AB, Smith PJ, Kolasa M. Reduction of racial and ethnic disparities in vaccination coverage, 1995-2011. In: Strategies for reducing health disparities—selected CDC-sponsored interventions, United States, 2014. MMWR 2014;63(No. Suppl 1).
  6. West BA, Naumann RB. Tribal motor vehicle injury prevention programs for reducing disparities in motor vehicle-related injuries. In: Strategies for reducing health disparities—selected CDC-sponsored interventions, United States, 2014. MWMR 2014;63(No. Suppl 1).
  7. CDC. Winnable battles. Available at

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