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32. Examples - What Should a National Strategy Address?

So, what are some of the things that a national strategy ought to address? Again, this is putting aside at least points for discussion for the rest of our time here. Hopefully what this does is trigger you to say "yeah, I agree with him" or "no, I disagree with him" or "gee, he left this out or didn't think about it." This is for discussion - this is, to start, a series of examples. First, we need to go back to our recommendations, and ask do we need new ones? Do we need to revise ones that we have, and this is in all of the areas of immunization, screening, diagnosis, medical management, treatment. I know there are some people in this room thinking, "oh my gosh, not another set of recommendations!" But, some of these need to be looked at, and the question is are we at the right place, do we have the right sets of these at this time? We need to talk about implementation - and yes, I wear a public sector hat, but I feel - and I think we at CDC feel - very strongly that there should be no differentiation between public and private sector in terms of how we make these things happen. And addressing issues of health systems guidelines, how you integrate these activities into existing clinical and public health programs is something that needs to be addressed. We need roadmaps for this. Practice guidelines - this is becoming more and more of a way of life for those of us in the clinical sector, when we are practicing. Recommendations are just that - they are recommendations. But when you start developing practice guidelines, that takes it to a different level. Engaging groups of all levels, in terms of how is it that we ought to be doing things, is something that has been an evolution in terms of medical care and public health practice. Education - both the provider as well as the public. As we have all seen in the area of viral hepatitis, most people don't know the alphabet. They don't know A from B from C, they don't know what the issues are and getting out better education is a key issue in terms of implementation. Clearly there is a need for additional research and evaluation - figure out what has been working. Much of what I have shown you today has been a lot of things that have worked. So let's figure out what has worked, what has made it work, and how we can apply it to the areas where we see the gaps. Issues around health services delivery - how do we really deal with very large populations for which you are not going to have a specialist taking care of every one of those patients, and providing both the clinical support as well as all of the support that is needed in order to get through treatment. We heard from Mr. Simpson last night that these are difficult, and we need a system that begins to address this. And then there is a tremendous need for behavioral research. We have vaccines out there and yet we have a lot of people who don't want to be vaccinated. What is it that makes people not want to be vaccinated? And we know from a research standpoint, we have never addressed that issue. That is just one example of the behavioral research. And then we have the other aspects of behavioral research that are needed in terms of a very difficult issue with these diseases and infections, which has to do with drug use. And at the bottom I put resources. Obviously that's been a bit unspoken, though it was spoken very well last night. We need to figure out how to get the resources. And it is not all just money, and not all just new money - but we need to get the resources to address these issues. Again, those are some of the things that at least need to be laid out in the strategies - and if you have a roadmap of where you are headed, and those of you who work in communities know that it is much easier to take that, looking for resources.