Faces of Public Health: Thomas Frieden
As we end the year and head into 2013, NewPublicHealth spoke with U.S. Centers for Disease Control and Prevention director Thomas Frieden, MD, MPH, about public health in 2012—and what’s ahead for 2013.
Dr. Thomas Frieden: Two really stand out. First, public health got even better at finding outbreaks quickly and stopping them. We saw that with Listeria, E. Coli, Salmonella and with the fungal meningitis outbreak. That is important because we are seeing that there are an ever-increasing number of ways that outbreaks can start and spread and we need to be on our guard. The second highlight that comes to mind immediately was the Tips from Former Smokers Campaign. This is the first-ever federally funded national anti-tobacco campaign and it was a stunning success. We had very ambitious goals for it. We hoped that half a million people would try to quit and at least 50,000 people would succeed for good. Based on calls to quitlines—and we will know more in the next few months—it looks like the campaign probably had at least twice that impact. This is a campaign that will have saved tens of thousands of lives and probably paid for itself in pretty short order in terms of reduced medical and societal expenses. It shows that when you invest in tobacco control you can make a big difference and save a lot of lives.
NPH: And your hopes for public health in 2013?
Frieden: There are a lot of things that are important and we can make progress on in the coming year. First is to be safer from threats whether they are from this country or abroad, and public health works 24/7 to keep us safe both at the federal level as well as the state and local level. We do have challenges, though, in terms of the fiscal climate that we are in, and we need to ensure that we have the resources needed to keep Americans safe from threats.
The second big trend I think is going to deal with how public health systems and clinical systems intersect most effectively. How can information that we have about how a community’s health be used to improve the delivery of health care? How can we improve clinical and community linkages to maximize health? In these areas I think the leading program is the Million Hearts Program, which is going to prevent a million heart attacks and strokes over a five-year period by helping people become healthier and improving the quality of clinical care. And, finally, for the year to come I hope both at CDC and throughput the public health field we are able to continue to get stronger despite the fiscal challenges, figuring out ways to work more efficiently and effectively, making sure that we can continue doing what we do to keep people safe, healthy and productive.
NPH: Looking at violence in the United States, what is public health’s role and CDC’s role in helping the public both cope and preventing violence?
Frieden: Our hearts go out to all of the people affected. Injury, more broadly than violence, is the leading cause of death in young people in this country. I hope that we can increasingly use science to figure out what works to reduce the risk of injury, including violence, and then make sure that we implement and evaluate the strategies that we use to protect our children.
There is no secret key that we can turn to end violence, but there are different programs that we can work on, on a whole range of areas—from early childhood to mental health treatment to substance abuse and alcohol issues—that we know are effective at reducing violence. There is also a lack of information about some critically important risk factors.
NPH: What was the progress in 2012 on the Winnable Battles campaign you introduced as CDC director, and what battles are you specifically targeting in 2013?
Frieden: We made really good progress in every one of the winnable battles:
- In tobacco we saw important actions by the U.S. Food and Drug Administration, as well as the Tips campaign.
- In food-related issues, we had more rapid detection and control of outbreaks, as well as the beginning signs of progress in reversing childhood obesity in some areas.
- In healthcare-associated infections we have seen continued progress—particularly in the states that have invested in this area—and a terrific coordination between the Center for Medicare and Medicaid Services and CDC to improve information. That will help us control these infections going forward.
- In motor vehicle injuries we saw the lowest number in many decades and we have seen how things like graduated driver’s licenses can contribute to a huge reduction in teen deaths. We have seen teen deaths on the road decrease by more than a third just in a few years.
- In terms of HIV I think we have a better understanding of what our challenges are, including the need for increased testing. But, too many people who are living with HIV aren’t getting optimal care, so focusing on that will be very important in the coming years.
- The rate of teen pregnancy saw another significant decrease in the teen pregnancy rate that is really good news and the lowest rate in many years.
For 2013 we plan to continue in all these areas. Two additional areas to look at that I think are particularly important are The Million Hearts Campaign and the epidemic of prescription opiate abuse. Prescription opiates now kill more people than heroin and cocaine combined. The number of deaths has tripled in just a couple of decades. We are beginning to see places like Washington State make progress reducing opiate overdoses, but we need to make much more progress in the years to come.
CDC also has many important activities on the global front. Not only do we help countries find and stop outbreaks before they come to our shores, but we are also helping lead the global polio eradication program and we have made good progress there. In the past year we have come closer than ever to the finish line, although the recent shootings in Pakistan are just heartbreaking and we have much further to go. But we have made great progress. In HIV, CDC provides about half of all the treatment in PEPFAR (the United States President’s Emergency Plan for AIDS Relief). We have now 4.5 million people in treatment for HIV around the world who are teaching, learning, working, raising kids and who would be dead or dying otherwise. PEPFAR has already helped more than 800,000 babies be born without HIV who would have been HIV positive otherwise. So, both domestically and globally we have done a lot in the past year and we have ambitious goals for the coming year.
NPH: New York and New Jersey were among the most prominent examples of states facing recovery from disaster in 2012. How does CDC aid communities dealing with disasters?
Frieden: CDC protects people in this country in significant part by supporting state and local governments. In fact, about two-thirds of our budget goes out to state and local entities. We have more than 500 staff embedded in state and local entities to help implement programs, and we frequently provide on-site or distance input as requested. Rebuilding in the areas impacted by Hurricane Sandy is going to be challenging and dealing with things like mold is going to be particularly difficult. But we are here to help and we look forward to Congress acting on President Obama’s request for emergency hurricane response funds so that the recovery and reconstruction can move forward.