What changes and priorities can we expect at the Centers for
Disease Control and Prevention? The new Director of CDC, Dr. Thomas Frieden,
spoke to these and other questions raised by the audience at a forum convened by
the CDC Foundation Wednesday afternoon in Washington, DC.
His prepared remarks
were rooted in ‘partnerships’ – the necessity for them and the need to
strengthen them at the local, state, national and global levels. The bookends
were the theme of ‘public health achieves its greatest triumphs when we
remember the faces behind the numbers.’ More on that later.
Dr. Frieden identified 5 ‘areas for improvement’ at CDC;
these included (1) enhancing surveillance and epidemiology, (2) strengthening
local and state support functions at CDC, (3) strengthening public health
institutions across the globe, (4) increasing the impact of health policies
(noting that there was more prevention that could be done through policy), and
(5) addressing the leading causes of disabilities, diseases and death.
He did field a number of questions from the audience
including H1N1 preparedness, and – this being DC - health reform and what he
saw as the opportunities to incorporate public health into it (and various
elaborations on that theme).
What I found curious in his responses was his
constant reference to tobacco control initiatives (not that surprising as he
was one of the forces behind the Bloomberg Family Foundation's Global Tobacco Control Project), and
to the number of people with uncontrolled high blood pressure and high blood
cholesterol levels where better medical treatment could reduce unnecessary
deaths. Someone finally asked him what he thought the 3 major initiatives for
improving public health were and, after the caveat of how leaving something out will wind up making
500 new enemies, he suggested two: global tobacco control and nutrition policy.
The third he (wisely) left open for future developments.
I then had to comment that up to that point in time (about
40 minutes) the word ‘behavior’ had yet to be uttered by him. I also reflected
that all the preventive strategies to incorporate into health reform he
presented were medical ones (including EHRs) - the word medicalize even came out of my mouth. Yet, I suggested, what lies
between data and faces are many different behaviors by people on the street,
patients, health care providers, legislators and public health professionals. What are
his views on the importance of behavior research and behavioral interventions
at CDC, including communication and marketing programs?
After a few minutes of talking about something else (and I
learned after years In DC to tune that out), he finally came back to the
question and said: My view is that behavior change follows policy change.
Period. Nothing about behavioral research, forget about risk behavior change,
no other determinants… elegantly – simple?
It will be interesting to see what now happens at CDC as it reorganizes and staff begin to shift their focus (some views compiled by Kaiser Health News). I
have written before about how one’s theory shapes everything from how you frame
a problem to how you research and address it, the outcomes you desire and what
you consider success. How this theoretical (ideological?) perspective is
translated into $373 million of cooperative agreements for putting prevention to work will begin to give
us a sense of where this may be heading.