Where would you start if you were charged with keeping the nation healthy? Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, has chosen six priorities — winnable battles, he calls them.
They are smoking, AIDS, obesity/nutrition, teen pregnancy, auto injuries and health care infections. These are long-standing, major challenges that get a lot of attention already.
But elevating a handful of problems above dozens of others is a bold move for a public health official. So far, it’s been received like a bucket of cold water — invigorating some, infuriating others.
Many advocates, legislators and others in public health have devoted their lives to problems that did not make Frieden’s short list. So there are complaints.
A CDC employee blog is peppered with postings like, “I guess climate change is not a battle worth winning,” and “Don’t we still owe the patients of tomorrow an investment in things that may not pay off immediately?” Some advocates wonder aloud just how targeted federal public health dollars are going to be. A particular point of concern is hepatitis C, a long under-recognized liver-destroying virus which has infected more than 3 million Americans.
Some experts consider the issue a ticking time bomb and have called for the government to step up efforts to prevent it and better diagnose and treat people who already are infected.
Hepatitis B and C already are “badly neglected” by the CDC, and their omission from Frieden’s winnable battles list is more bad news, said Bruce Burkett, past president of the National Hepatitis C Advocacy Council.
“I was very disappointed that it wasn’t on there. This is going to affect millions by not being on there,” he said.
Frieden, who took over CDC in June last year, already had a reputation as something of a public health maverick.
When he started his previous job as New York City’s health commissioner in 2002, he began by identifying the city’s most pressing health issues. He led campaigns to ban smoking in the workplace, tax soda, cut salt in processed foods, and ban artificial trans fats in restaurants.
It’s no surprise that he is boldly painting targets at the CDC, said Dr. Jo Ivey Boufford, president of the New York Academy of Medicine. She’s a fan of Frieden’s who worked with him as a member of an advisory council to the city health department.
Frieden’s CDC job, ironically, does not provide the same kind of power he had in New York City to engineer bans or tax increases.
But Frieden calls his new short list “winnable battles” because, he says, proven programs can save lives and reduce harm from each of these health problems. He believes government can make dramatic improvements if available money and manpower are focused.
“In each of these areas we know what to do to make a difference and we need to do it to a much greater extent,” he said in an interview.
Frieden, with a low-key demeanor, has said relatively little about this to the public, though he seems to be building support within the public health community.
There is some nervousness about how far Frieden’s going to take this.