Tom Frieden, New York City’s Health Commissioner, is about to take up one of the most important public health positions in the world: director of the U.S. Centers for Disease Control. Bringing New York to Atlanta will surely shake things up, and that’s a good thing for global health.Frieden is an outstanding choice for this important agency, which has a strong and noble reputation, but suffers from the vicissitudes of political funding cycles – receiving money and attention when a health catastrophe looms, but fighting for scraps to support the steady work of surveillance and public health education....never mind new public health needs. Frieden has two traits in common with President Obama that could help shine a light on CDC’s critical role. He’s willing to try game-changing solutions to problems and he brings the passion and zeal of a former community organizer to the job. He’s applied those traits successfully in New York City to drug resistant tuberculosis and to “lifestyle” health problems like hypertension and smoking. Frieden has impeccable credentials in the flashy world of infectious disease control, having been an officer in CDC’s Epidemiological Intelligence Service. When multi-drug resistant TB cases began popping up in New York, Frieden’s TB team carefully searched for patterns in hospital and other records showing patients not responding to the normal TB treatment protocol. Individual patients were then tracked down and brought in for the intensive treatment required to cure MDR-TB. This aggressive action brought the incidence of MDR-TB cases in New York down by 80%. Similarly bold action is required to slow the increase in resistant TB globally, and it should start with the kind of careful surveillance that occurred in New York. Unfortunately, with an estimated 60% of TB cases in the world still undetected, it will take vastly improved awareness of where resistant TB is occurring to be able to act. The CDC could play a much bigger role in this than it currently does, if Frieden is successful in getting the Global Disease Detection program expanded. These six regional centers try to serve the world with sophisticated lab facilities, specialty training, and superb disease investigators. But they have too few resources for the vast array of bugs they are expected to track -- including drug resistant pathogens which get virtually no attention from the GDD right now. If they get scaled up and linked to other laboratory expansion efforts, these centers could be linchpins in a future global resistance surveillance information system. For further discussion of resistance surveillance, sign up for the CGD’s Drug Resistance E-Update which will feature this topic in next week’s edition. (instructions below*)But Frieden’s actions to reduce chronic disease risks among New Yorkers (and visitors – thank you!) are where his community organizer stripes show the most. Serving as a not-quite Boy Wonder to Mayor Bloomberg’s Batman, Frieden has reduced smoking and transfats in New York, posted calories on menus and restaurant walls, and is working on reducing salt consumption. Many of these actions have been imposed by fiat, and many have sparked controversy. But the results – and Frieden is a great believer in measuring results – are impressive: 300,000 fewer smokers in New York (did they move?), a reduction in teen smoking by half, and far greater awareness of “lifestyle” health risks, not only among New Yorkers but across the country. At the CDC, he will have plenty of opportunity to make progress on chronic disease risks. The CDC’s National Center for Chronic Disease Prevention and Health Promotion includes some world-renowned experts doing fine work to measure and prevent the nation’s biggest killers such as heart disease and diabetes, but with only 9% of the agency budget. Reportedly, requests for additional funding in the past have not made it out of the CDC director’s office and into agency budget submissions. I suspect the new director will not be an obstacle. Indeed, perhaps Frieden’s most important legacy as New York Health Commissioner will be jump-starting a movement for healthier public policy across the US and globally. It won’t be easy and it won’t be quick, but as the song goes, “If he can make it there, he can make it anywhere.” We hope that’s true.*If you are interested in the global problem of drug resistance and what can be done about it, please see the Center for Global Development’s Drug Resistance Working Group and sign up for the monthly newsletter.
