Seven Questions with Public Health Leader Thomas R. Frieden

Finding calm amid confusion and carving clarity out of chaos can serve as a sort of real-life superpower. It’s one Thomas R. Frieden, MD, former director of the Centers for Disease Control and Prevention (CDC), possesses and has put into practice multiple times over the course of his career. These include navigating New York City’s tuberculosis outbreak while he was serving as the city’s health commissioner; leading the nation’s health in the aftermath of Sept. 11, 2001; and guiding the U.S. Ebola response.

Now, he has a new book out that draws from his decades of insider knowledge. In The Formula for Better Health, Frieden uses his lived experiences and unique perspective on the frontlines of many of the nation’s top crises to provide a pragmatic view of what public health could be through a formula that is based on “seeing, believing, and creating.”

Last month, Frieden visited Rollins for a book talk and a candid—yet hopeful—discussion about public health today. Afterwards, he sat down with us to share his thoughts on a few additional topics.

Your book emphasizes the importance of surveillance and seeing the invisible. Yet, we’ve been watching various surveillance systems being paused or ended.  How do these disruptions impact public health? 

It's dangerous to fly without a navigation system. I think there's some ability to limit damage, but every time we lose a surveillance system, we lose one of our defenses. We may need to think about ways to do surveillance that's more accurate, timelier, and more efficient.

See, believe, create is a formula that works. And if you look at what industries like tobacco and junk food have done, they intentionally try to impair all three of those so that we don't see the harms that are being caused so that we don't believe that anything abnormal is occurring or can be changed, and they block efforts to create a healthier future. I think the damage to the tracking systems is dangerous for all Americans and people around the world, because we are less likely to hear about the next health threat in time to stop it.

What advice do have for Rollins graduates, or others working at the CDC, who were recently fired or are just tired?  

First off, you can still do good at CDC There are thousands and thousands of very dedicated employees there, and I think we must look at the verbal commitments of this administration and do what we can to make them real. Because the concerns raised about things, our environment or other health problems are real concerns, and CDC is the best place to address them. So, for those who are still there, stick with it. Do good work, stick to the facts, and communicate well. To those who got [reduction in force notices]: This isn't your fault.

On a related note, what would you say to current students who just started their program here?

Being a student is a construction project, and what you're constructing is yourself, your capacities, your tools. You are building your ability to analyze data, to communicate well, and to work efficiently. Constructing a better version of yourself is never a waste of time. It's going to serve you well whatever job you work in. It's a hard time for public health, and the job market will be tighter for a while in public health. But facts are stubborn things, and we're an aging society. There are huge needs in the health and public health areas. Ultimately, that new you that you've constructed is going to be helpful in protecting and promoting health.

We are seeing increased rates of multidrug-resistant tuberculosis occurring in the United States. Since you are someone who successfully led New York through its outbreak, what advice can you give to cities and states right now in terms of things that work?

We know how to stop tuberculosis, and we have better tools than ever. We have better diagnostics, better genomics, and better treatment. So, tuberculosis is a disease of neglect, but it is also a reflection. Tuberculosis reflects societal patterns, and tuberculosis control reflects governmental competence. So, a good, focused response can result in very rapid control.

What are some individual actions people can take during this time, whether in the public health space or just as members of the community who want to advance public health in a constructive way?

One thing is supporting your local health department. This could be through donations, volunteering time, or writing a letter of thanks. In terms of specific actions, there is citizen science, and we don't do a lot of that in public health, but maybe we should crowdsource more information about all sorts of risks. I think we need to work together to build forward, to create a base for public health that's faster, higher impact, communicates better, and has stronger alliances.

In looking at what's happening right now to public health and CDC, there is an opportunity potentially to rebuild the CDC with a stronger foundation. If you were the director at that time in the future, what would that look like? What would building a stronger foundation for CDC and for public health look like?

It starts with organizing well, managing well, and getting the top-level right (technical, operational, political). All three of those pillars need to be right. It means modernizing surveillance so that we've got as close to real-time data as possible and surveillance of everything important to know, including attitudes, and using partnerships to get data well, publicly, and transparently. It means strengthening clear and trusted communication. It means building belief in the possibility of progress through phased programs that try things out and then scaling up what works. And then always keeping to this simple focus on impact and maybe saying maybe we can't do everything. What are the most important things to do? And doing those well.

You talked in the book about how data and clear visuals can help to get people in power to pay attention. How do we do this with people who distrust science?

Personalizing your language is crucial. Stories are important. It’s stories that convince people, not numbers. You must find out who's making the decision and who's influencing them, and how you can influence the influencer. But where there are economic interests, then you've got to recognize that that may not be possible. That where someone is just trying to enrich themselves, that is going to be their priority.