The US Centers for Disease Control and Prevention (CDC), the Lancet Commission on Hypertension Group, Resolve to Save Lives (RTSL), and the World Hypertension League (WHL) share a collective goal of expanding the evidence base on hypertension, sodium, and trans fatty acid reduction strategies as a critical pathway to preventing and managing cardiovascular diseases. An important strategy for achieving this goal is to increase opportunities for investigators in low‐ and middle‐income countries to contribute their studies in these areas to the scientific literature.

Although the attention of the Haitian public and international community has understandably turned to the recurrent political challenges facing the country and recovery from Hurricane Mathew, it is important that public health stakeholders take stock of progress made, remaining gaps, and fundamental public health priorities. In the past year, the global community has assessed progress toward the Millennium Development Goals (MDGs) and established new health targets under the Sustainable Development Goals framework.1 Haiti has made progress toward the MDGs and many of the objectives established in the aftermath of the earthquake.1–7 Important lessons regarding the association between various global health emergency responses, such as to human immunodeficiency virus (HIV), tuberculosis (TB), Ebola (Haitian public health professionals deployed to Guinea), and health sector resiliency have been identified.8,9 Yet much remains to be done to increase health service access and to reduce morbidity and mortality from preventable causes in the country. Although the public health system in Haiti has been improved since the earthquake, emergency response and health recovery funding has largely focused on new and acute threats such as Zika virus.10 Moreover, the health-care delivery infrastructure remains fragile, with limited coverage of primary care services, suboptimal health-care performance, and excessive health risk and vulnerability for the Haitian population. It is in this context that the Supplement, entitled “Public Health Progress in Haiti,” was developed. The reports enclosed span HIV, TB, malaria, cholera, immunizations, rabies, water, sanitation and hygiene, and lymphatic filariasis, and also address notifiable disease surveillance reporting and national laboratory capacity.11–20 Collectively, they appraise some of the key programs and services that have been the focus of postearthquake response and recovery planning and which have central roles informing current and future strengthening and prioritization within the health sector.

Following advances in infectious disease control, noncommunicable diseases (NCDs) have overtaken other conditions as causes of premature death and disability in lower-income nations. The largest portion of the NCD burden in low- and middle-income countries (LMICs) is represented by cardiovascular diseases (CVD), followed by cancer, diabetes and chronic respiratory disease (World Health Organization, 2016). Although NCDs are often considered to be diseases of ageing, the NCD crisis in developing countries does not appear to be explained solely by longer life spans; the growth in NCD deaths and disability in these countries has occurred at a faster rate than the contemporaneous decline in communicable diseases (Stuckler, 2008). Specific circumstances that worsen NCD outcomes in LMICs relative to high-income countries are the timing of disease onset and the level of treatment after onset. NCDs in LMICs tend to occur earlier in life (WHO, 2016; (Institute for Health Metrics and Evaluation, 2013)), and may not receive adequate treatment once they occur (Cameron et al., 2011). Health systems in LMICs may not be equipped to address the needs of the chronically ill, and long-term treatment may not be accessible. This adverse combination of factors results in NCD outcomes that have broad societal, economic, and health security consequences in developing countries. Recognizing the role of NCDs as an impediment to international development, the 2030 Agenda for Sustainable Development has identified the reduction in premature NCD mortality among its primary targets (United Nations, 2015).

Acore principle of good public health practice is to base all policy decisions on the highest-quality scientific data, openly and objectively derived.1 Determining whether data meet these conditions is difficult; uncertainty can lead to inaction by clinicians and public health decision makers. Although randomized, controlled trials (RCTs) have long been presumed to be the ideal source for data on the effects of treatment, other methods of obtaining evidence for decisive action are receiving increased interest, prompting new approaches to leverage the strengths and overcome the limitations of different data sources.2-8 In this article, I describe the use of RCTs and alternative (and sometimes superior) data sources from the vantage point of public health, illustrate key limitations of RCTs, and suggest ways to improve the use of multiple data sources for health decision making. | In large, well-designed trials, randomization evenly distributes known and unknown factors among control and intervention groups, reducing the potential for confounding. Despite their strengths, RCTs have substantial limitations. Although they can have strong internal validity, RCTs sometimes lack external validity; generalizations of findings outside the study population may be invalid.2,4,6 RCTs usually do not have sufficient study periods or population sizes to assess duration of treatment effect (e.g., waning immunity of vaccines) or to identify rare but serious adverse effects of treatment, which often become evident during postmarketing surveillance and long-term follow-up but could not be practically assessed in an RCT. The increasingly high costs and time constraints of RCTs can also lead to reliance on surrogate markers that may not correlate well with the outcome of interest. Selection of high-risk groups increases the likelihood of having adequate numbers of end points, but these groups may not be relevant to the broader target populations. These limitations and the fact that RCTs often take years to plan, implement, and analyze reduce the ability of RCTs to keep pace with clinical innovations; new products and standards of care are often developed before earlier models complete evaluation. These limitations also affect the use of RCTs for urgent health issues, such as infectious disease outbreaks, for which public health decisions must be made quickly on the basis of limited and often imperfect available data. RCTs are also limited in their ability to assess the individualized effect of treatment, as can result from differences in surgical techniques, and are generally impractical for rare diseases.

Public health surveillance is the foundation of effective public health practice. Public health surveillance is defined as the ongoing systematic collection, analysis, and interpretation of data, closely integrated with the dissemination of these data to the public health practitioners, clinicians, and policy makers responsible for preventing and controlling disease and injury.1 Ideally, surveillance systems should support timely, efficient, flexible, scalable, and interoperable data acquisition, analysis, and dissemination. However, many current systems rely on disease-specific approaches that inhibit efficiency and interoperability (eg, manual data entry and data recoding that place a substantial burden on data partners) and use slow, inefficient, out-of-date technologies that no longer meet user needs for data management, analysis, visualization, and dissemination.2–4 Advances in information technology, data science, analytic methods, and information sharing provide an opportunity to substantially enhance surveillance. As a global leader in public health surveillance, the Centers for Disease Control and Prevention (CDC) is working with public health partners to transform and modernize CDC’s surveillance systems and approaches. Here, we describe recent enhancements in surveillance data analysis and visualization, information sharing, and dissemination at CDC and identify the challenges ahead.

Five years ago, the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, and partners launched a public–private initiative to prevent 1 million heart attacks and strokes by 2017.1 Although final results will not be known for several years, data suggest that the initiative made substantial progress and will achieve about half of its goal. Policies, partnerships, and programs prevented cardiovascular events and yielded important lessons. This article outlines the actions taken, progress made, and implications for health improvement in the United States. | Cardiovascular disease (CVD) remains our leading cause of death, killing 800 000 Americans and costing $316 billion annually.2 CVD event and mortality rates have declined since the 1960s, but this decline decelerated around 2011.3 The Million Hearts initiative began in 2012 and faced the challenge of overcoming this trend. The purpose of the initiative was to scale effective interventions in order to prevent CVD events to resume and accelerate the decline.1 Communitywide goals were to reduce tobacco use and sodium intake and to eliminate artificial trans fat consumption. Clinical priorities were to improve management of the ABCS: aspirin use, blood pressure control, cholesterol management, and smoking cessation. More than 120 partners, including federal, state, local, and private sector organizations, are working to achieve targets.

The Centers for Disease Control and Prevention (CDC) transformed its approach to preparing for and responding to public health emergencies following the anthrax attacks of 2001. The Office of Public Health Preparedness and Response, an organizational home for emergency response at CDC, was established, and 4 programs were created or greatly expanded after the anthrax attacks: (1) an emergency management program, including an Emergency Operations Center; (2) increased support of state and local health department efforts to prepare for emergencies; (3) a greatly enlarged Strategic National Stockpile of medicines, vaccines, and medical equipment; and (4) a regulatory program to assure that work done on the most dangerous pathogens and toxins is done as safely and securely as possible. Following these changes, CDC led responses to 3 major public health emergencies: the 2009-10 H1N1 influenza pandemic, the 2014-16 Ebola epidemic in West Africa, and the ongoing Zika epidemic. This article reviews the programs of CDC's Office of Public Health Preparedness, the major responses, and how these responses have resulted in changes in CDC's approach to responding to public health emergencies.

In 2010, the US Centers for Disease Control and Prevention (CDC) identified 6 focus areas termed Winnable Battles, in which concerted effort could lead to substantial health improvement in a short time.1 Teams selected a limited set of strategies that could enable rapid progress, established ambitious targets, aligned efforts within the CDC, and worked with federal and other partners to leverage each entity’s capacity. | Principles and Selection | Each of the 6 selected focus areas represented a leading cause of illness, injury, disability, death or presented large societal costs. For each problem, proven, effective, scalable, but underused interventions were identified. Measurable improvement could be achieved with increased implementation, but was unlikely to occur without intensified effort. Results could be achieved in less than 5 years. | The focus areas involved infectious diseases (including health care–associated infections and human immunodeficiency virus [HIV]), injury (motor vehicle fatalities), chronic disease prevention (smoking), and reproductive health (teen pregnancy). One focus area combined nutrition, physical activity, obesity, and food safety.

The Centers for Disease Control and Prevention (CDC) has a unique mandate, reach, and breadth and depth of expertise. As CDC Director since 2009, the author has had the opportunity to work with and learn from public health partners at CDC, throughout the U.S., and globally. This article summarizes major initiatives, lessons, and remaining challenges. CDC has helped make Americans safer and healthier by strengthening public health systems, addressing health threats effectively, and protecting health both in our country and around the world (Table 1).

Reducing health disparities is a major goal of public health. Despite the persistence of disparities, progress is being made. Since 2011, CDC Health Disparities and Inequalities Reports and the inaugural Strategies for Reducing Health Disparities report have highlighted effective public health programs that have demonstrably reduced disparities. The reports in this supplement add to this record of progress.

O’Donnell and colleagues cite studies purporting to show increased mortality with low sodium intake, but many studies of sodium and health outcomes are deeply flawed by measurement error, confounding, and reverse causality.1 For studies of cardiovascular disease outcomes, long-term diet, rather than intake on a single day or a small number of days, is the relevant measure of sodium intake.2 Urinary sodium excretion varies enormously throughout the day, from day to day, and according to diet, medications, chronic diseases, and hormonal fluctuations; only multiple, complete, 24-hour urine samples accurately reflect the usual sodium intake in an individual person.1,2 Estimates of 24-hour sodium excretion that are based on spot urine samples, and therefore the apparent association between cardiovascular disease outcomes and spot urine samples, can be substantially biased.3 Analysis without multiple 24-hour urine samples inaccurately categorizes sodium intake for many persons and contributes to an ostensible but invalid J-shaped association with cardiovascular disease in individual studies or in meta-analyses such as that cited by Alderman. In contrast, the use of multiple 24-hour urine collections indicates a positive and linear, not J-shaped, association with total mortality across a broad range of sodium intake, including among participants whose usual sodium intake was less than 2300 mg per day.4

In a recent issue of the Journal, an article by Balcells | et al. provides interesting data on positive Mycobacterium tuberculosis bacteriological results among | contacts of patients with active tuberculosis.1 | There is relevant historical evidence on the | pathophysiology of tuberculosis infection and disease. People newly infected with M. tuberculosis, | whether or not they progress to active tuberculosis, | are, when monitored intensively, often culture-positive.2 This was shown elegantly in a series of studies | conducted on US Navy personnel in the 1960s.3

On January 15, 2016, the Centers for Disease Control and Prevention advised pregnant women not to travel to areas where the Zika virus was spreading. Six months later, more than 60 countries or territories have reported new local transmission of Zika. By August 4, 2016, nearly 1700 cases of travel-associated Zika infection, including 479 in pregnant women, had been reported in the continental United States; Puerto Rico is experiencing rapid and extensive spread of the epidemic.1 Florida has documented 5 symptomatic and 8 asymptomatic locally acquired Zika infections in a 6-block area north of downtown Miami. Comprehensive mosquito control efforts, including reduction of standing water, provision of repellants containing diethyltoluamide (DEET), and application of pyrethroid insecticides and larvicides using backpack sprayers and trucks to eliminate adult and larval forms of mosquitoes, were initiated on confirmation of the first cases. Persistent findings of Aedes aegypti mosquitoes led to a decision to also use aerial spraying with naled and larvicide within 3 days of documentation of the risk of ongoing Zika transmission. | The association between Zika infection (both symptomatic and asymptomatic) and serious birth defects, including microcephaly, has been confirmed.2 Sexual transmission of Zika from both male and female partners can occur, and the virus may be able to remain viable in semen for months. The competent vectors—A aegypti as well as the less efficient vector Aedes albopictus—put 30 and 41 US states, respectively, at risk for local mosquito-borne transmission of Zika. Risk of microcephaly after Zika infection early in pregnancy may range from 1% to 13%; the full spectrum of congenital Zika virus syndrome is not known, nor is it known whether infants exposed to Zika during pregnancy who appear healthy at birth will have neurologic or other problems.

The 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa required a massive international response by many partners to assist the affected countries and tested the world's readiness to respond to global health emergencies. The epidemic demonstrated the importance of improving readiness in at-risk countries and remaining prepared for Ebola and other health threats. The devastation caused by Ebola in Guinea, Liberia, and Sierra Leone is well recognized; what is less widely recognized is that in these countries more people probably died because of Ebola than from Ebola. The epidemic shut most health care systems and derailed programs to prevent and treat malaria, tuberculosis, vaccine-preventable diseases, and other conditions.

Hypertension is a common and major risk factor for the leading U.S. killer, cardiovascular disease. Reducing excess dietary sodium can lower blood pressure, with a greater response among persons with hypertension. Nine of 10 Americans consume excess dietary sodium, defined as more than 2300 mg per day. Many leading medical and public health organizations recommend reducing dietary sodium to a maximum of 2300 mg per day on the basis of evidence indicating a public health benefit. Yet this benefit has been questioned, mainly on the basis of studies suggesting that low sodium intake is also associated with an increased risk of cardiovascular disease. In science, conflicting evidence from studies with methods of different strengths is not uncommon. Studies that measure sodium intake vary widely in their methods and should be judged accordingly. Accurate measurement matters. Paradoxical findings based on inaccurate sodium measurements should not stall efforts to improve the food environment in ways that enable consumers to reduce excess sodium intake. Gradual, stepwise sodium reduction, as recommended by the Institute of Medicine, remains an achievable, effective, and important public health strategy to prevent tens of thousands of heart attacks and strokes and save billions of dollars in health care costs annually.

Although sodium reduction has been proposed as a public health strategy in the United States for more than 4 decades, there has been no progress reducing consumption. One reason for this lack of progress is the continued ubiquity of dietary sodium in the US food supply. The Food and Drug Administration (FDA) has released draft proposed voluntary guidelines1 to encourage companies to steadily reduce sodium in processed and restaurant foods, a change that would increase consumers’ control over their sodium intake. The proposed guidelines set targets for the gradual reduction in sodium across a range of food categories for both manufactured and restaurant products and would lead to a sustained reduction in the amount of sodium added to the food supply before foods reach consumers’ hands. This Viewpoint provides answers, based on the best available science, to important questions about why this action is needed.

Public health, like politics, is the art of the possible. To maximize effectiveness, public health officers in any jurisdiction should (1) get good data and ensure timely and effective dissemination; (2) prioritize and tackle more difficult initiatives first; (3) find, fight, and win winnable battles in areas where progress is possible but not ensured without focused, strategic effort; (4) support and hire great people and protect them so they can do their jobs; (5) address communicable diseases and environmental health effectively; (6) do not cede the clinical realm-public health programs depend on clinical care and on effective coordination between health care and public health; (7) learn and manage the budget cycle; (8) manage the context; (9) never surprise their boss; and (10) follow core principles. (Am J Public Health.

The annual number of deaths from prescription-opioid overdose has quadrupled in the United States in the past 15 years, driving dramatic increases in mortality. Efforts to improve pain management resulted in a quadrupling of rates of opioid prescribing, which propelled a tightly correlated epidemic of addiction, overdose, and death from prescription opioids that is now further evolving to include increasing use and overdoses of heroin and illicitly produced fentanyl. | The pendulum of opioid use in pain management has swung back and forth several times over the past 100 years. Beginning in the 1990s, efforts to improve treatment of pain failed to adequately take into account opioids’ addictiveness, their low therapeutic ratio, and their lack of documented effectiveness in the treatment of chronic pain. Increased prescribing was also fueled by aggressive and sometimes misleading marketing of long-acting opioids to physicians.1 It has become increasingly clear that opioids carry substantial risks and uncertain benefits, especially as compared with other treatments for chronic pain. | On March 15, 2016, the Centers for Disease Control and Prevention (CDC) released a “Guideline for Prescribing Opioids for Chronic Pain” to chart a safer, more effective course.2 The guideline is designed to support clinicians caring for patients outside the context of active cancer treatment or palliative or end-of-life care. More research is needed to fill in critical evidence gaps regarding the effectiveness, safety, and economic efficiency of long-term opioid therapy. However, given what we know about the risks associated with long-term opioid therapy and the availability of effective nonpharmacologic and nonopioid pharmacologic treatment options, the guideline uses the best available scientific data to provide information and recommendations to support patients and clinicians in balancing the risks of addiction and overdose with limited evidence of benefits of opioids for chronic pain.

Adecade ago, we called for applying public health principles to the human immunodeficiency virus (HIV) epidemic in the United States.1 Over the past decade, U.S. health departments, community organizations, and health care providers have expanded HIV screening and targeted testing, and as a result a greater proportion of HIV-infected people are now aware of their infection2,3; the number of reported new diagnoses of HIV infection has decreased4,5; and people with HIV infection are living longer.6 We have more sensitive diagnostic tests; more effective medications and medications with better side-effect profiles; rigorous confirmation that treatment prevents the spread of HIV and improves the health of infected people; and documentation of the potential benefit of preexposure prophylaxis for some high-risk people.7-12 | Despite this progress, most people living with HIV infection in the United States are not receiving antiretroviral treatment (ART)3; notification of partners of infected people remains the exception rather than the norm; and several high-risk behaviors have become more common. Anal sex without a condom has become more common among gay and bisexual men13 and there appears to be an increased number of people sharing needles and other injection paraphernalia.14,15 The number of new infections has increased among younger gay and bisexual men, particularly black men. Although surveillance has improved, data-driven targeted interventions are not being rapidly and effectively implemented in most geographic areas. Much more progress is possible through further application of public health principles by public health departments and the health care system and, most important, through closer integration of health care and public health action.

Since Ebola virus disease was identified in West Africa on March 23, 2014, the Centers for Disease Control and Prevention (CDC) has undertaken the most intensive response in the agency's history; >3,000 staff have been involved, including >1,200 deployed to West Africa for >50,000 person workdays. Efforts have included supporting incident management systems in affected countries; mobilizing partners; and strengthening laboratory, epidemiology, contact investigation, health care infection control, communication, and border screening in West Africa, Nigeria, Mali, Senegal, and the United States. All efforts were undertaken as part of national and global response activities with many partner organizations. CDC was able to support community, national, and international health and public health staff to prevent an even worse event. The Ebola virus disease epidemic highlights the need to strengthen national and international systems to detect, respond to, and prevent the spread of future health threats.

The field of public health aims to improve the health of as many people as possible as rapidly as possible. Since 1900, the average life span in the United States has increased by more than 30 years; 25 years of this gain have been attributed to public health advances.1,2 Globally, life expectancy doubled during the 20th century,3 largely as a result of reductions in child mortality attributable to expanded immunization coverage, clean water, sanitation, and other child-survival programs.4 | Public health focuses on denominators — what proportion of all people who can benefit from an intervention actually benefit. Maximizing health requires contributions from many sectors of society, including broad social, economic, environmental, transportation, and other policies in which government plays key roles; involvement of civil society; innovation by the public and private sectors; and health care and public health action. Although there has sometimes been distrust and disrespect between the health care and public health fields,5 they are inevitably and increasingly interdependent; maximizing potential health gains is a defining challenge for both fields.

The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. Out of this human calamity has come renewed attention to global health security--its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities, as demanded by the International Health Regulations? What counts as a global health security concern? In the context of the governance of global health, including WHO reform, it will be important to distil lessons learned from the Ebola outbreak. The Lancet invited a group of respected global health practitioners to reflect on these lessons, to explore the idea of global health security, and to offer suggestions for next steps. Their contributions describe some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed. Their common goal is a more sustainable and resilient society for human health and wellbeing.

Non-communicable diseases are responsible for two-thirds of deaths worldwide, with 80% occurring in low-income and middle-income countries (LMICs).1 Cardiovascular disease causes more deaths than any other non-communicable disease, and hypertension is the leading remediable risk factor for cardiovascular disease.2 Hypertension kills an estimated 9·4 million people annually worldwide—about as many as all infectious diseases combined.3 | Hypertension is probably the easiest chronic non-communicable disease to treat, since blood pressure measurement for diagnosis and monitoring is simple, drug regimens can be once daily and inexpensive, and treatments exist that do not need laboratory monitoring. However, hypertension is adequately controlled in only about 13% of people with the disorder worldwide.4 | Although there is some scepticism about the ability of LMICs to implement programmes to treat chronic disorders, antiretroviral treatment for HIV, which is substantially more complex and expensive than treatment for hypertension, has been successfully scaled up to reach at least 37% of HIV-infected people who are eligible for treatment. Most of these patients live in LMICs.5 This experience suggests that rapid expansion of treatment and control of hypertension in LMICs should be achievable.

This MMWR Supplement presents data related to disease patterns across the United States and describes recent national trends in health status. Indicators of health status (i.e., measures of observed or calculated data on the status of a health condition) were chosen to reflect the range of health issues relevant to CDC's programs that are used across the agency to monitor health. In response to the status of these health issues, CDC works with state and local health systems across the United States on these diseases and others to save lives and protect persons.

CDC has a long history of monitoring the use of clinical preventive services to provide public health agencies, health-care providers, health-care organizations, and their partners with information needed to plan and implement programs that increase use of these services and improve the health of the U.S. population. Increased use of clinical preventive services could improve the health of infants, children, and adolescents and promote healthy lifestyles that will enable them to achieve their full potential. The Affordable Care Act (ACA) expands insurance coverage, consumer protections, and access to care for the U.S. population and places a greater emphasis on prevention. Through implementation of ACA, new opportunities exist to promote and improve use of these valuable and vital services. This supplement provides a baseline assessment of the use of key services before ACA implementation.

Despite being nearly 100% curable, tuberculosis remains a major public health problem, representing the second leading cause of death from infectious diseases globally, with drug-resistant tuberculosis increasingly common. In 2012, an estimated 8.6 million people developed tuberculosis worldwide—a global incidence rate of 122 persons per 100 000 population—and 1.3 million people died. Incidence rates vary from high in southern Africa (550/100 000 population in Mozambique and Zimbabwe and 1000/100 000 population in South Africa) to fewer than 10/100 000 population in the United States, Canada, and most of Western Europe.1 Although the global prevalence of multidrug-resistant tuberculosis was estimated at 3.6% of newly diagnosed and 20.2% of previously treated patients, these rates were 20% to 35% for newly diagnosed cases and 50% to 69% for retreatment cases in the Russian Federation and some other former Soviet republics. | In sub-Saharan Africa, the tuberculosis epidemic is driven by HIV through both increased reactivation of latent tuberculosis infection and the increased risk of rapid development of disease soon after exposure to Mycobacterium tuberculosis because of HIV-induced immunodeficiency. There is lower tuberculosis incidence in Asia, but because Asia’s population is so much larger than Africa’s—more than 4 billion compared with about a billion—75% of the 5 million tuberculosis cases in the 22 highest-burden countries are in Asia. In these countries, crowding, poverty, and inadequate tuberculosis treatment completion rates contribute to the epidemic.2

Since Ebola virus was first identified in 1976, no previous Ebola outbreak has been as large or persistent as the current epidemic, and none has spread beyond East and Central Africa. To date, more than 1000 people, including numerous health care workers, have been killed by Ebola virus disease (EVD) in 2014, and the number of cases in the current outbreak now exceeds the number from all previous outbreaks combined. Indirect effects include disruption of standard medical care, including for common and deadly conditions such as malaria, and substantial economic losses, insecurity, and social disruption in countries that were already struggling to recover from decades of war.

The health of Americans continues to improve. Life expectancy at birth, 78·7 years (76·2 years for men and 81·0 years for women), has never been higher.1 Age-adjusted death rates for the four leading causes of death—heart disease, cancer, chronic lower respiratory diseases, and stroke—are all falling.1 Immunisation rates for young children are high, racial and ethnic disparities in childhood vaccinations have largely been eliminated, and most vaccine-preventable diseases of childhood are now at historically low levels.2, 3 Deaths from motor vehicle crashes are at their lowest levels since 1950, and teen pregnancies have fallen to their lowest rate in seven decades.4, 5 What's wrong with this picture? | Although increases in US health-care costs have recently slowed, health spending reached US$2·8 trillion in 2012, or $8915 per person, and accounted for 17·2% of gross domestic product.6 These expenditures exceed those of other high-income countries in Europe, Asia, and North America, but a recent report found US life expectancy and other health outcomes generally poorer than in other high-income countries.7 A fragmented health-care delivery system, physical and social environments, and individual risk behaviours all play a part.

The rate of death from overdoses of prescription opioids in the United States more than quadrupled between 1999 and 2010 (see graph), far exceeding the combined death toll from cocaine and heroin overdoses.1 In 2010 alone, prescription opioids were involved in 16,651 overdose deaths, whereas heroin was implicated in 3036. Some 82% of the deaths due to prescription opioids and 92% of those due to heroin were classified as unintentional, with the remainder being attributed predominantly to suicide or "undetermined intent."

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; a second report was released in 2013. 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.