“Public health is a best buy. It has a great return on the investment.”
Dr. Tom Frieden, MD, MPH, is the director of the Centers for Disease Control and Prevention (CDC) and the administrator of the Agency for Toxic Substances and Disease Registry. He served as commissioner of the New York City Department of Health and Mental Hygiene from 2002–2009 where he directed a successful program to control tuberculosis. Frieden graduated from Oberlin College, Columbia University College of Physicians and Surgeons, and Columbia University’s Mailman School of Public Health. Frieden has focused his work on controlling health threats from infectious diseases, responding to emergencies, and battling the leading causes of suffering and death in our nation and around the world.
STATE LEGISLATURES: What are the biggest health concerns facing Americans today?
DR. FRIEDEN: We have both infectious and non-infectious problems. Our infectious disease problems reflect a perfect storm of vulnerability. We have resistant infections. New organisms. Globalization of travel and trade and medications. And we have the intentional creation of medicines. To deal with those infectious diseases we need to find them faster, stop them sooner and figure out how to prevent them better. And we do that by working with state and local governments and internationally to find problems and stop them. On the other side are the noncommunicable diseases: heart disease, stroke, diabetes. These are killing the most people today, and a lot are preventable. What we need to do is identify those things that work and make sure we do them—like hard-hitting ads to encourage smokers to quit. Like improving the rates of control of high blood pressure. Like ensuring that patients who are at risk for diabetes get the national diabetes prevention program so they don’t progress to having diabetes. So, focusing on what works, identifying the problems, and then running programs with state and local governments that improve the outcome.
SL: In which areas of public health has the CDC been most effective and why?
FRIEDEN: We’ve seen tremendous progress in the area of immunization, where we’ve seen a drastic reduction in disease after disease. Immunization is one of the great success stories of the past century that we need to preserve and extend as new vaccines become available. People sometimes forget that these diseases can be deadly. More recently, we’ve seen terrific progress with our tips from former smokers’ campaign. Real Americans talk about the disability they have from smoking. As a doctor, I’ve cared for so many patients suffering because of their smoking. They would say to me, “I wish I didn’t smoke.” What we’ve been able to do with this campaign is to bring that message, to draw back the curtain of the examination room and let people see the real impact of smoking. Hard-hitting anti-tobacco ads work, and I hope state governments will increase their investment in proven tobacco control interventions because tobacco use remains the leading preventable cause of death in this country.
SL: What role can or should state lawmakers play in preventing disease and promoting health?
FRIEDEN: This is a federal system so what we do, we do through state and local governments. We don’t go into any state unless we are invited. We provide about two out of every three dollars that are in our budget to state and local governments. And we focus on what is frankly a tough love approach, where we will provide the guidance. We will imbed staff for long term. We will send in short-term teams if desired. But fundamentally, we will work on getting to an outcome that will increase health for all.
SL: What are some of the common denominators among states with the healthier populations?
FRIEDEN: The healthiest states have three things in common. One is totally unrelated to health or public health. They have a society that is less unequal because they’ve improved education and housing and jobs and other things that give everyone an opportunity to thrive. Second they’ve focused on the data and they’ve used data to drive policies. They don’t favor one particular policy or another. What they favor is basing policies on data, on what they know works. And third, they’ve invested in public health. Public health is a best buy. It has a great return on the investment. In fact there was a public health leader a hundred years ago—Herman Biggs—who said that public health is purchasable. Within natural limitations a community can determine its own death rate. We need for state governments to invest in their state health departments. That’s their responsibility. We are there to help, but we can’t replace what the state has a responsibility to do.
SL: As the director of the CDC, what are your top goals?
FRIEDEN: My goals are quite straightforward. Save as many lives as possible. Prevent illness, injury, disability and death. And do that by growing the evidence on what and where the problems are, geographically and demographically. Then implementing programs with continuous feedback to see if they work, then tweaking them or changing them so we can get the most possible health benefit for every precious dollar that we have to spend.
Editor’s note: This interview is part of a series of conversations with opinion leaders. It has been edited for length and clarity. The opinions expressed are of those interviewed, and not necessarily NCSL’s.