Frieden head shot

Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, spoke with Public Health Newswire on the state of public health for 2014. Photo by CDC

Last year Public Health Newswire launched its first annual “state of public health” with Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, to address the nation’s health breakthroughs from the previous year and emerging health challenges for the year ahead.

In our second conversation, Frieden speaks to the public health community on CDC’s health priorities, challenges in having a “2002 budget but living in a 2014 world,” how the Affordable Care Act intertwines with prevention, and how APHA and public health professionals can improve the nation’s health with “six essential components for success.”

Q: CDC has identified five health urgent health threats that we can address effectively in 2014: antibiotic resistance and advanced molecular detection; prescription drug abuse and overdose; global health security; human papillomavirus, or HPV; and polio. What are your specific goals for addressing these health challenges over the next year?

We already know much about how to address of these threats — we just need to implement effectively. The needs are urgent and the clock is ticking. That’s why these are CDC’s five most urgent priorities for 2014.

We have a four-part response to the challenge of antimicrobial resistance. First, we will continue to expand the prevention of infections, particularly those acquired in hospitals.  Second, we are developing better diagnostic tests, including advanced molecular detection, to track drug resistant infections and focus prevention and control efforts. Third, in cooperation with the Food and Drug Administration, U.S. Department of Agriculture, Centers for Medicare and Medicaid Services and others we will promote more responsible use of antibiotics. Fourth, we support development of new drugs and diagnostic tests to improve treatment and detection capabilities.

Public health needs new tools not only to track the rise of drug-resistant pathogens, but also to keep up with the globalization of the world’s food supply. CDC’s advanced molecular detection pilot effort last year showed the power of these new tools; genetic characterization of a pathogen sped our response to a Listeria outbreak. Americans depend on state and local public health agencies and on CDC to protect them from microbial threats, whether these threats emerge in nature or are created by those who wish us harm. We require state-of-the-art technologies to expand and speed our ability to respond to these threats.

New technologies will also improve global health security. Only one in five nations now can effectively detect, respond to or prevent emerging threats from infectious agents. By contributing to improvements overseas such as training public health experts, strengthening lab surveillance and strengthening facilities to investigate disease outbreaks, we not only make these nations safer but also make the United States more secure.

Prescription drug overdose now kills twice as many Americans as overdoses from heroin and cocaine combined. Most people using such drugs non-medically get them from people they know, who originally got them from doctors. In 2014 we will support state efforts to implement prescription monitoring programs, real-time reporting by pharmacists, patient review and restriction programs, and required e-prescriptions for all controlled substances to prevent prescription theft and forgery.

A few weeks ago I was in Nigeria, one of the last nations in the world in which polio has never been stopped. CDC is part of the partnership that will eradicate this disease from the face of the earth.  Now is the time to cross that finish line. Without eradication a polio resurgence could paralyze more than 200,000 children a year within a decade.

HPV — human papillomavirus — is a cancer virus. The HPV vaccine can protect the next generation against deadly cancers. Uptake has been too slow, but doctors can make all the difference as a doctor’s recommendation is the single most important factor in parent’s decision whether to vaccinate their children. CDC has developed evidence-based tools to help doctors have this important discussion with parents. This is a great example of the impact public health can have improving the health return from our investments in clinical medicine.

Q: How big a threat do funding challenges present if we hope to tackle these and other public health concerns?

CDC is working with a 2002 budget, but living in a 2014 world of emerging diseases such as H7N9 and MERS-Coronavirus; drug-resistant microbes; and growing epidemics including prescription drug overdose. We need to fight these with the latest technology and tools available. We’re fighting a good fight but without additional support America’s health security is at increasing risk.

Q: As more people gain access to care under the Affordable Care Act this year, how does public health need to adapt to seize opportunities for improving the health of Americans?

Public health collaboration with clinical care has never been more important. As public health experts, we can support clinical care by providing data and measures; offering high-impact public health services that protect communities; supporting clinical services with maximum health benefit; linking community and clinical services and activities; and focusing on initiatives such as the Million Hearts campaign to prevent 1 million heart attacks and strokes by 2017.

The Million Hearts initiative is a key example of how public health and clinical care can make a huge impact by bringing together communities, health systems, nonprofit organizations, federal agencies and private-sector partners. Americans suffer 2 million heart attacks and strokes each year, causing one in every three deaths and adding more than $300 billion in health-care costs. Million Hearts aims to reduce these human and economic costs by improving access to effective care, focusing clinical attention on the ABCs of prevention, using electronic health records to identify and track the progress of patients who need support, promoting team-based care and activating the public to lead a heart-healthy lifestyle.

Q: APHA is committed to making the U.S. the healthiest nation in one generation. What are some key steps to achieving that goal?

The key is implementation of effective public health programs. There are a lot of worthy concepts that never achieve their potential impact because they lack one or another of the six essential components for success. As I suggested in a recent issue of the American Journal of Public Health, these components are:

  • innovation to develop the evidence base for effective action;
  • a technical package of a small number of high-impact, evidence-based, scalable interventions;
  • performance management through cycles of real-time monitoring, evaluation, and improvement;
  • partnerships with public and private organizations; and
  • political commitment to obtain resources and support for action.

Q: Borrowing lingo from CDC’s Winnable Battles initiative: If there was one “winnable” advancement you would like to see from APHA and other partners this year, what would you ask for?

CDC’s Winnable Battles aren’t our only public-health priorities — but they are major public health issues in which we can make a major impact using tools already available to us. As a doctor I find it heartbreaking to know that so many deaths from cardiovascular disease in young people never had to happen. Getting that last 20 percent of Americans who still smoke to quit would make a huge difference. Most people in this country who ever smoked have already quit, and most current smokers started as kids and want to quit. We can prevent kids from starting to smoke, help smokers quit and protect non-smokers from secondhand smoke.

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