NewPublicHealth Q&A: Thomas Frieden and Moving Public Health Into the Future

Oct 20, 2011, 5:15 PM, Posted by NewPublicHealth


Thomas Frieden, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), spoke at the Opening Session of the Association of State and Territorial Health Officials (ASTHO) Annual Meeting yesterday, with a focus on a vision for the public health of the future. NewPublicHealth caught up with Frieden to talk about the CDC’s efforts to move public health into the future, despite economic constraints.

NewPublicHealth: The theme of the ASTHO opening session is a vision for the "new" public health. What does this mean to you and the CDC?

Thomas Frieden: Public health has to consistently and newly demonstrate our value to society, both through the traditional efforts in communicable diseases and environmental health as well as the newer challenges of dealing with cancer, heart disease, stroke and diabetes. What we’ve tried to do is to identify Winnable Battles where we can save a lot of lives and save a lot of money with a big impact on health. We can succeed at these by getting many different parts of society working together. We’re encouraging stories from around the country of getting everything from school boards to housing projects to workplaces to WIC [Women, Infants and Children] programs involved in promoting health.

NPH: This year CDC and other partners launched the Million Hearts initiative to prevent 1 million heart attacks and strokes over the next five years. What are the strategies for accomplishing this goal?

Frieden: Million Hearts is, I think, an incredibly exciting initiative, and I’m confident that within five years, this initiative will prevent one million heart attacks and strokes. It will do that by reducing the number of people who need treatment and improving the quality of care for those who do need treatment. It will reduce the number of people who need treatment through tobacco control and improved nutrition, particularly reducing artificial trans-fats and excess sodium intake.

And it will improve the quality of care by addressing the ABCS – Aspirin, Blood Pressure, Cholesterol and Smoking Cessation. Currently the U.S. does very poorly on the ABCS. Less than half of the people who should be on aspirin are on it, less than half of the people with high blood pressure have it under control, only a third of people with high cholesterol have it under control and less than a quarter of smokers who see their doctor get advice to quit. Now what we know is that highly performing systems can do dramatically better. They can do that by focusing on key outcomes like using health information technology and getting all members of the healthcare team to be used to their fullest potential.

NPH: What will be happening at the community level to meet these goals?

Frieden: Well we have the Community Transformation Grants, and those have as key components, tobacco control, improved nutrition and control of blood pressure. We also have a large number of community partners – the YMCAs, which are expanding the Diabetes Prevention Program and doing other programs at the local level, the American Heart Association, community pharmacies and chain pharmacies, health insurers and health providers. Really it’s a question of getting everyone on deck to prevent heart disease and strokes.

NPH: Tell us about how CDC is placing a major emphasis on prevention with the Community Transformation Grants and Communities Putting Prevention to Work programs. What are some examples of success stories?

Frieden: Community Transformation Grants are just starting now so it’s too early to show successes with them, although it’s been exciting to see how many community coalitions have been created to implement the program. For the Communities Putting Prevention to Work program, there are remarkable success stories from all over the country. We’re in Portland now, where the CPPW program affected schools – improving safe routes to schools, improving the quality of food and the quality of physical education – improved workplaces that involved employers in promoting health, improved the ability to reduce tobacco use at every step of the way including where public services are provided, and increased the number of farm-to-school programs so more local produce is supporting nutrition. In places like Kentucky and Texas and South Carolina, communities and farmers have been better connected to increase access to fruits and vegetables. In many parts of the country, there have been farmers’ markets and healthier corner stores that accept EBT [Electronic Benefits Transfer] and SNAP [Supplemental Nutrition Assistance Program]. There are smoke-free air policies in workplaces including bars and restaurants in 25 states, D.C. and two territories*. And there have been efforts to increase awareness of healthy nutrition, to increase water consumption and to increase walking and biking to school.

NPH: What is the role of national public health department accreditation in the future of public health?

Frieden: Accreditation is a new process. It’s really up to all of us to make it a successful endeavor. There’s also the tremendous potential that it will help transform public health – to standardize, to improve quality, to focus on innovation and to ensure that we provide effective public health services throughout the country.

NPH: What are the implications of the economic crunch that public health is facing for your vision of the "new" public health?

Frieden: Well first off, we’re facing challenges that are really unprecedented and are likely to continue for many years. Compared to 2008, there are 50,000 fewer people working in public health at the state and local levels. Almost all health agencies have had to reduce services and many have had to cut entire programs. We’re dealing with tremendous fiscal austerity, and that requires us to be really creative and thoughtful about how we can get the job done with limited resources, or where we have to reduce services how we can limit the negative impact of those services being reduced. I think we can do that most effectively by ensuring that we have effective, accurate, timely data on what’s working, what programs are having an impact and where they can best be targeted. It requires us to manage even smarter in choosing scarce resources as effectively as possible.

It also requires us to demonstrate our value – how we can save money and save lives – and to remind everyone that public health works 24/7 to keep Americans safe from threats to our health and safety.

*Note these numbers have been updated from a previous version of this post.

>>Follow continued coverage of the ASTHO 2011 Annual Meeting here.

This commentary originally appeared on the RWJF New Public Health blog.