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The Future of the CDC

January 11, 2009

cdc_logoI’m still not terribly happy with that last post, so let me try one on the CDC Director.

The AJC first reported that President-elect Obama asked for CDC Director Julie Gerberding’s resignation effective January 20th at noon. This is an important time, because it’s the moment that President Obama will take office. President Obama will not serve with the CDC headed by Dr. Gerberding. The COO, William Gimson, will be interim Director until a new Director is appointed. Some of the names I saw in an earlier version of the AJC article are as follows:

Among the candidates for CDC director whose names have surfaced in the public health community, according to advocates, are CARE president Gayle, New York City health commissioner Dr. Thomas Frieden, Baltimore health commissioner Dr. Joshua Sharfstein, and Los Angeles health director Dr. Jonathan Fielding.

For my money, Helene Gayle sounds like a great choice.

One thing I’ve seen being inserted into the discussion of the future of the CDC is a bit disconcerting. This is the idea that preparedness and public health are competing for funding and attention. There is a hope that the existing level of public health funding will shift away from preparedness issues back to traditional public health. Dr. Georges Benjamin, Executive Director of the APHA, is the most high profile and direct proponent of this way of thinking that I’ve seen.

I can’t really begrudge older public health folks for thinking this way. Public health has been underfunded (per capita and by ROI) for decades. Public health workers have come to understand that there is a ceiling on public health funding, and every year it that ceiling gets a bit lower. Then, after 2001, and under the watch of Dr. Gerberding, that funding ceiling has stayed the same, but a large amount of that funding was shifted to preparedness activities. Now public health has to do more–with less money. A natural reaction is to hope that a change in administration will bring about a return to the “normal” funding balance in public health.

Like I said, I certainly can’t begrudge these folks. It’s just that I disagree.

There should, instead, be a concerted effort to change the idea of what “normal” public health funding and prioritization looks like. Public health funding should be raised–across the board. The choice should no longer force us to rob Peter to pay Paul. Chronic and infectious disease control is just as important as vector control and food safety, which is just as important as preparedness. Focusing on one over the other leaves the public’s health exposed to problems, it’s as simple as that. We get to pick what will be the leading cause of mortality and morbidity, just look at what’s being underfunded in the public health budgets. That we have to make that choice is an indictment of the state of public health.

There also should be a greater focus on collaboration between traditional public health and preparedness. As I’ve said plenty of times before, preparedness planning supplements traditional public health work in unusual situations, while traditional public health thinking and relationships boost preparedness planning. There is plenty of things we can, and should, learn from each other; this animosity only serves to weaken the field. I’m encouraged by President-elect Obama’s transition plan website where it explicitly states: 

The Obama-Biden plan will promote public health. It will require coverage of preventive services, including cancer screenings, and increase state and local preparedness for terrorist attacks and natural disasters.

It’s this goal of advocating for public health, developing creative funding sources and working in various public health fields that makes me lean toward Dr. Gayle as a sound choice for CDC Director.

We need a new way of thinking about public health, not the old, red-headed step-child way of thinking. We do work that saves lives–all of us–we certainly should get our proper level of funding and priority in the federal government. Instead of hoping for a resumption of the underfunded times, at the expense of preparedness, we should stand up and yell for a new public health reality, a better reality where we can properly protect the public’s health both from chronic disease, infectious disease, disasters and bioterrorism.

Image courtesy: CDC

3 Comments leave one →
  1. January 12, 2009 1:41 am

    Some great reading here, thanks

  2. January 17, 2009 11:27 am

    While you have opined quite a bit here on the challenges of biosurveillance, there remains a substantial gap in public health policy bridging situational awareness, preparedness and response… and basic daily activities of public health. An early warning capability remains a requirement for the US.

    The capabilities actually do exist to begin sewing daily FYI-based information to local and state public health, but a major transformation of the public health culture needs to occur.

    I am not a fan at all of throwing money at public health- this has clearly had limited benefit. However, evolution can and will occur with the right individuals taking the mission forward.

    • January 21, 2009 6:24 pm

      Dr. Wilson:

      Thanks for stopping by. My apologies for not replying sooner.

      I appreciate your comment, and certainly defer to your expertise on biosurveillance issues. (BTW, your blog is quite good) I agree that movement in the right direction is possible, and without just throwing money at the problem. It is my hope that the new Administration will take the lead in, as you say, “sewing” the influx of health data together into a coherent picture.

      The current landscape of biosurveillance is so fractured, mostly as a result of a panicked response to the idea that comprehensive biosurveillance is critical and — not happening. New programs sprung up throughout the federal agencies, and local and state HDs, with one taking charge and creating a plan to make it make sense.

      Thanks again for stopping by and I look forward to reading your posts,

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