What if They Had Asked Us? Recommendations From Former CDC Noninfectious Disease Leaders

The past year has been tumultuous for the Centers for Disease Control and Prevention (CDC), marked by staff departures, reductions in force, leadership gaps, and uncertainty.¹ While attention has focused on infectious disease, particularly changes to the childhood vaccine schedule,² CDC’s essential work on noninfectious diseases has been largely ignored. The agency’s centers for chronic disease, injury, birth defects and developmental disabilities, and environmental health address the leading causes of morbidity and mortality in the United States, yet their future remains uncertain.

As former CDC leaders in chronic disease, birth defects, and injury prevention, we highlight the critical role of noninfectious disease programming and offer our recommendations to both the administration and the public health field for moving forward.

CDC’s history with noninfectious diseases dates from the mid-1900s, as advances in treatment and vaccination³ reduced infectious disease mortality and noninfectious conditions, such as heart disease, diabetes, cancer, suicide, and overdoses, became the largest killers of people in the United States.⁴ Today, noninfectious causes drive nearly 90% of all deaths, with heart disease and cancer responsible for more than half. Among people in the United States aged younger than 44 years, injuries are the leading causes of death, due largely to drug overdoses and suicide.⁴ Many of these deaths are preventable.

Prevention is the core function of noninfectious disease work at CDC. Over decades, historic impact was achieved via tobacco prevention,⁵ cancer screening,⁶ newborn screening, and injury prevention.⁷ CDC awards more than 80% of appropriated funds to state, territorial, local, and tribal health departments and partner organizations to implement programs preventing diabetes, cancer, obesity, and overdoses and promoting nutrition and physical activity.

HOW CDC HAS PREVENTED NONINFECTIOUS DISEASE

To address noninfectious diseases, CDC leverages high-quality data to inform action, research, policies, and programs. Injury surveillance identified lack of seat belt use and impaired driving as preventable threats, directly informing laws and norms that reduced motor vehicle fatalities.^8–10 Tobacco surveillance and control supported smoke-free policies, excise taxes, and cessation efforts that drove historic declines in smoking and cancer. Data systems like the Behavioral Risk Factor Surveillance System (BRFSS) and the Youth Risk Behavior Surveillance System (YRBSS) guide prevention efforts related to nutrition, physical activity, and mental health, while overdose, maternal, infant, and birth defects surveillance have informed effective interventions such as opioid overdose prevention, folic acid fortification, and newborn screening. Together, these efforts underscore the critical public health role in noninfectious disease prevention.

IS THE ANSWER THE ADMINISTRATION FOR A HEALTHY AMERICA?

The current federal administration has advanced a narrow vision of CDC focused almost exclusively on infectious disease, asserting—without evidence—that noninfectious disease programs diluted the agency’s pandemic response. In addition, they have argued that CDC should return to its core mission of infectious disease control and that noninfectious programming is redundant with other agencies. Toward this end, a new agency—the Administration for a Healthy America (AHA)—is being proposed. AHA would consolidate selected noninfectious disease functions of CDC, the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and Office of the Assistant Secretary for Health (OASH).¹¹ The details of AHA are relatively opaque and largely come from the fiscal year 2026 and 2027 budget requests,¹¹ which propose to eliminate much of CDC’s noninfectious programming and focus largely on individual health care approaches. There is no clarity about governance, preservation of statutory responsibilities, or protection of infrastructure necessary for accountability. In addition, this proposal, advanced without engagement of existing leadership or expertise, overlooks noninfectious disease monitoring (e.g., YRBSS, BRFSS, Pregnancy Risk Assessment Monitoring System) and population-based approaches to prevention (e.g., injury, diabetes, oral health, obesity programs). As a consequence, state and local health departments are left questioning the future of noninfectious disease efforts.

While AHA may have conceptual appeal, the absence of a coherent strategy that incorporates the population-based programming currently housed at CDC raises serious concerns. Prevention and health equity—the hallmarks of public health—were not prioritized. Proposed cuts and staffing reductions will leave some programs nominally funded but unable to operate. For example, Alzheimer’s funding appears in the budget, but the program staff were eliminated in August of 2025. Other programs such as falls and drowning prevention and almost all of the chronic disease prevention programs (e.g., heart disease, diabetes, adolescent and school health, smoking, nutrition) and monitoring activities are nowhere to be found. Without explicit protections for this data, epidemiology, and prevention capacity, the reorganization risks undermining the federal infrastructure needed to address the nation’s leading causes of death. At the time of this writing, the reorganization is not approved by Congress, lacks dedicated funding, and is stalled by litigation. If there is genuine interest in reorganizing federal noninfectious disease work, it should proceed through deliberate planning with public input. Alternatively, many goals could be achieved through clearer strategic coordination within existing structures.

WHAT IF THEY HAD ASKED US?

As public health leaders, we believe strongly that public health has an important role to play in preventing deaths and disability from noninfectious diseases. The clinical delivery system is ill-equipped to fill these population-based responsibilities at the national, state, or local level. But, while much has been successful in the noninfectious disease space, there are areas ripe for improvement across the Department of Health and Human Services (HHS). The time to consider this is now, for the current administration and for the field. Specific strategies for rebuilding will require feedback from a broad constituency. To begin, we offer a view of major issues that demand attention in efforts to reimagine a new public health, noninfectious disease infrastructure.

Coordinating Across the HHS

The fragmentation of efforts related to noninfectious diseases across HHS agencies has resulted in redundancy and confusion for the field. For example, numerous maternal and child health programs exist across HRSA, CDC, OASH, and Administration for Children and Families (ACF). This was particularly evident in the efforts to address maternal mortality (e.g., maternal mortality review committees at CDC and health care models funded at HRSA without a unified approach to the issue). Similarly, food and nutrition activities (regulation, safety, surveillance, and community programming) span US Department of Agriculture, Food and Drug Administration (FDA), CDC, and National Institutes of Health (NIH). Chronic disease programs (e.g., heart disease and diabetes) within CDC and across HHS (e.g., NIH, HRSA, and Centers for Medicare and Medicaid Services [CMS]) are not consistently or strategically aligned. Over time, legislative expansions without a shared strategic vision have produced these overlapping efforts without clear roles.

HHS should have responsibility for creating a unified strategic framework that aligns noninfectious disease programs across multiple agencies (i.e., CDC, HRSA, SAMHSA, OASH, NIH, FDA, and CMS), establishes roles and responsibilities, requires alignments of funding opportunities, and utilizes Healthy People 2030 measures to guide coordination.

Aligning Health Care and Public Health

The connections between public health prevention programs and the health care delivery system continue to be underdeveloped despite decades of attention.¹² Opportunities to align population-based public health prevention efforts such as the diabetes prevention program at CDC with new CMS care models (e.g., accountable care communities) and reimbursement strategies (e.g., ACCESS program, 1115 waivers) are missed opportunities. Data sharing between CDC and CMS remains challenging. Addressing these structural disconnects is essential to strengthening the federal role in noninfectious disease prevention. We must build a significant infrastructure bridge between CDC, FDA, NIH, and CMS such that data are shared, initiatives are strategically planned, and the public is clear about how agency responsibilities provide the most impact for the population.

Maintaining and Improving Data and Surveillance

CDC’s public health data systems underpin the nation’s ability to detect emerging threats, monitor trends, guide resource allocation, and evaluate progress. CDC should retain its role as the nation’s lead agency for public health surveillance and epidemiological intelligence. At the same time, HHS must establish clearer policies for data integration across agencies. Decisions about where data reside, how systems are linked, the relationship with the private sector, and how data sets are shared should be intentional and transparent. For example, HRSA data on children’s health should be combined with CDC data on childhood screening and developmental outcomes to create a more complete picture of child health. State, territorial, local, and tribal health departments partners must be actively engaged in planning, governance, and implementation as they are contributors and users of public health data.

Revaluation and Quality Improvement

Progress toward health outcomes should be regularly reviewed, reported transparently to the public, and adjusted accordingly using a formal, data-driven process. Here metrics like Healthy People 2030 are critical and will provide insight into current operations and future considerations. Part of reevaluation efforts includes recognizing when interventions previously implemented by one agency can transition to another. For example, the evolution of community health workers from CDC-supported pilots to CMS-reimbursable services illustrates how this transition can be managed effectively. These decisions should be based on disease burden, equity, effectiveness, reimbursement pathways, and state and local capacity.

Reorganization

The question of reorganization looms large. If HHS pursues reorganization, it should do so through a transparent process that engages Congress; state, territorial, local, and tribal health departments and other critical partners; and the public. There are naturally aligned functions across agencies that merit examination both across agencies and within agencies. Examples where reorganization could be considered include work on substance use, mental health, and suicide prevention across CDC and SAMHSA; child abuse and neglect efforts across CDC and ACF; maternal and child health activities across CDC, ACF, and HRSA; and chronic disease programs addressing shared risk factors like heart disease and diabetes within CDC and across NIH, HRSA, and CMS. Ultimately, reorganization could reduce administrative burden and enable states and localities greater flexibility to respond to local needs.

CHALLENGES

The current system has evolved over time. Line items in HHS agency budgets abound, add to the confusion of fragmented roles and responsibilities, and do not optimize outcomes. The aforementioned actions will take considerable effort and will require legislative support and financial realignment. Perhaps the greatest challenge is obtaining consensus from the myriad of interested parties across private and public sectors. The support for special interest groups, the public’s attention to specific issues, and ofttimes competing agency agendas have led to the current situation. We must create a unified and compelling vision for the future of noninfectious disease interventions, and we urge the field to come together in this effort. Abrupt restructuring without safeguards risks disproportionately affecting communities already experiencing higher burdens of chronic disease, injury, and maternal and child health disparities.

Public health’s role in preventing noninfectious disease is long and successful. Past achievements were not accidental; they were the result of deliberate choices based on data to prioritize prevention, build state and local capacity, and align science with policy. The leading causes of death and disability in the United States are overwhelmingly noninfectious, preventable, and shaped by social, environmental, and behavioral conditions that fall squarely within the purview of public health. Weakening the federal infrastructure that supports surveillance, prevention, and data-to-action programming risks reversing decades of progress.

At a time when noninfectious conditions account for nearly 90% of US deaths, retreating from prevention will represent a fundamental misalignment between federal priorities and the nation’s health needs. As a nation, preserving the federal government’s core strengths in data, science, and state partnership while improving coordination, reducing duplication, and modernizing systems offers a pragmatic alternative to dismantling capacity. The choices made now will determine the future of America’s health for years to come.