• system impacts from changes in health program structure and funding such as managed care, Medicaid changes, and block grants. The information system should also monitor the capacity of state and local health departments to execute essential public health functions and services. The CDC should provide adequate technical assistance to state and local health agencies to support the development of STD-related surveillance and other information systems and data analysis capacity at the local level.
  • STD-related performance measures should be included in the Health Plan Employer Data Information Set (HEDIS) and other health services performance measures to improve quality-assurance monitoring of STDs. The National Committee for Quality Assurance and other relevant organizations, in conjunction with public health agencies and health plans, should continue to develop and promote performance measures related to STD prevention.

Strategy 3:

Focus On Adolescents And Underserved Populations

Strategy 3 is to design and implement essential STD-related services in innovative ways for adolescents and underserved populations. Specific populations requiring special emphasis in an effective national system for STD prevention include adolescents and disenfranchised populations. Reasons for the greater risk of STDs among these groups and their importance in prevention strategies are documented in Chapters 2 and 3. Many members of these groups lack access to STD-related services and are difficult to reach through traditional clinical settings and approaches. Under Strategy 3, the committee recommends that prevention of STDs be a central focus in designing interventions for these populations and that innovative methods for delivering STD-related services to such populations be immediately implemented.

Focusing On Prevention

Ultimately, social norms regarding sexual behavior need to change before a sustained reduction in STDs can be realized. Population-based preventive services are the primary means for changing social norms and attitudes by creating an environment that supports such changes. A national strategy for STDs needs to emphasize prevention because averting illness is desirable, many STDs are incurable, and STD-related complications may be irreversible. As summarized in Chapter 4, there are many existing prevention-oriented approaches that are effective in averting long-term health problems and costs. The committee believes that an approach to STD prevention involving multiple interventions at the individual and the community levels is critical. This is because many interventions are highly effective, but no single intervention is sufficient on its own. Complementary behavioral and biomedical approaches to STD prevention are essential. Interventions



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