Given the amount of time I spend here, and at other sites, talking about the things we do in medicine that fail to live up to our expectations, it can sometimes feel like trying to improve the health of our nation is an impossible task. In a recent paper in JAMA, however, Tom Frieden and colleagues wrote about six "Winnable Battles" that they've been fighting since 2010.

That year, the US Centers for Disease Control and Prevention (CDC) picked six focus areas where they believed that work could yield substantial improvements in health. They were interested in quick returns in areas that constituted a real burden in terms of disease, disability, injury, or death that could be measured on a societal scale.

They collaborated with the Centers for Medicare & Medicaid Services to improve the ways we use antibiotics in hospitals and long-term facilities across the nation. They also worked with the largest US grocery retailer to reduce the risk of infection through chicken products.

They created policies to reduce smoking indoors so that fewer people would be exposed to secondhand smoke. They also increased media engagement through their "Tips from Former Smokers" campaign, coupled with increased promotion of data from Vital Signs and MMWR.

They worked to strengthen graduated driver license laws. They also worked to help prioritize motor vehicle injury prevention strategies to reduce accidents.

They established guidelines to improve HIV testing and follow-up. They also released the first true clinical practice guidelines for HIV preexposure prophylaxis. They also pushed most states to start reporting CD4 and viral load counts to health departments to improve tracking and continuity of care in patients with HIV.

They improved the evidence-based guidance that we use to provide family planning service delivery, especially for adolescents. They also encouraged state Medicaid programs to pay for long-acting reversible contraception use after delivery.

They partnered with the US Department of Agriculture and others to create the MyPlate program, and encouraged new mothers to breastfeed.

Not all of these efforts met with the hoped-for success. They didn't achieve their goals with respect to nutrition, physical activity, obesity, and food safety. Specifically, childhood obesity remains a real problem.

But they saw progress in three other areas, even though they didn't hit their predetermined goals. The diagnosis and awareness of HIV infection increased, and the rates of death due to car accidents decreased. And although they didn't reach target goals, the reductions in health care-related MRSA infections and in the rates of central line-associated and surgical site infections are expected to hit target goals soon.

Moreover, there were unequivocal success in the two remaining focus areas. Smoking rates declined from 20.6% of adults in 2008 to 15.1% in 2015. Teen pregnancy rated dropped from 37.1 births per 1000 female teens in 2009 to 22.3 births in 2015, which is pretty much an all time low.

Of course, we have no controlled trials here, and it's difficult to know what gains might have been made without the efforts of the CDC and public health departments. Still, we should commend them for their methods here. They set goals, they planned strategies to achieve them, and then they measured and reported honestly on their progress. While we hope for the best (ie success in all domains), given the difficulty in moving the needle in some of these areas, it's heartening to see progress made over time. It's also a call to increase our efforts in other areas, where success has not been as robust.