Obama’s public health chief: ‘We can’t build a moat around the US’

Of all the reasons President Obama’s public health chief gives when asked why the country  spends billions on global health, it’s the story of a south Indian man he treated 15 years ago that stands out.

Long before he took over the Centers for Disease Control and Prevention (CDC), Thomas Frieden ran New York City’s tuberculosis control program. One patient, plagued with an “extremely drug-resistant” strain of the disease, had to be subject to toxic experimental drugs and a lung operation that left him disabled and cost more than $100,000.

“Years later,” Frieden said, “I was in India and I helped his village set up a program that would have prevented his case of drug-resistant TB for $10.

“It really shows how we are all connected by the air we breathe and the water we drink and the food we eat. We can’t build a moat around the U.S.”

That’s the message the 51-year-old infectious diseases specialist has been championing since taking the helm of the CDC in June 2009.

Frieden is not a newcomer to the CDC. Other than an eight-year stint as New York City’s health commissioner from 2002 to 2009, he’s been with the CDC his entire career.

“As a doctor, I want to save lives,” Frieden said. “And the place where you can save the most lives is in global health.”

After receiving medical and public health degrees from Columbia, Frieden completed infectious diseases training at Yale before joining the CDC in 1990 as an Epidemic Intelligence Service officer assigned to the New York City Health Department. From there, he took over the city’s tuberculosis control program from 1992 to 1996 before the CDC loaned him to a World Health Organization tuberculosis control program in India, where he was stationed for five years.

As the head of the Atlanta-based CDC, Frieden has made 20 trips to 16 countries. His background dovetails with the agency’s origins in the wartime effort to control malaria around military training bases during the 1940s.

“CDC has global health in its genes,” he said. “We are many things for the world, including de facto the world’s reference laboratory for many pathogens, environmental samples, cholesterol, even.

“You’d be hard-pressed to find any one of CDC’s programs that didn’t have some global interaction.”

The agency is well-known and respected around the world, and emulated by other countries looking to create their own public health programs. 

China, for example, celebrated the 10th anniversary of its public health agency this year with a giant billboard and a new campus outside Beijing. Its model, from its mission down to its name, is the U.S. agency.

“Everywhere I go, people ask: ‘How can we set up a CDC?’ ” Frieden said. “China, of course, did exactly that — and it’s called China CDC.

“It doesn’t mean anything in Chinese, but the CDC has such a good brand that it’s used very effectively.”

U.S. voters by and large also support the agency, even as federal spending — particularly on foreign aid — has been targeted in efforts to cut the deficit. A nationwide poll by the Kaiser Family Foundation two years ago found 65 percent of Americans thought U.S. spending on “improving health in developing countries” was too little or about right.

Bipartisan support for global health has only grown in recent years, particularly with the surge in funding to fight AIDS and malaria under President George W. Bush. 

“It’s a great thing that there’s a bipartisan sense of support for global health,” Frieden says, “because it is good for America and it’s a great thing for us to do as a country.”

The main argument for spending on global health work, Frieden says, is protecting Americans. Whether it’s identifying influenza strains in China or eradicating polio in India, he said, the agency is helping to prevent future outbreaks.

“That concept of rapid detection, rapid and effective response is the essence of what CDC does in this country and abroad,” he said. “You could make an analogy with the FBI: You don’t just try to find a terrorist when they’re on your shores, you try to figure out what’s going on around the world so you can tamp down risk. And the same is true for infectious and other health threats.”

Frieden said another benefit is preventing disease outbreaks that could destabilize or impoverish countries with which the United States does business, fostering good will. Plus, he said, it’s simply the right thing to do. 

“It should make us proud,” Frieden said. “I wish Americans could come with me when I go around the world … and see the kind of difference we’re making.”

Still, the CDC is under the same political and fiscal pressures as the rest of government.

Unprompted, Frieden is quick to point out that he’s visited many more states than foreign countries: “We do see our domestic mandate as our core mandate,” he said.

Domestic efforts include the “Million Hearts Campaign” to prevent 1 million heart attacks and strokes over five years and efforts to prevent prescription painkiller overdoses, which now kill more Americans than cocaine and heroin use combined.

And he’s worried he won’t be able to shield his agency forever from the bitter debate over the healthcare law.

Of the $11.2 billion the president’s budget sets aside for the CDC and the Agency for Toxic Substances and Disease Registry, $903.2 million is the health law’s Prevention and Public Health fund, which Republicans have vowed to gut. The House is scheduled to vote Friday on student loan legislation that’s paid for by repealing the $12 billion left in the fund.

“Funding is a challenge because public health tends to be good for the general public but doesn’t necessarily have the same strong advocacy as some other areas,” Frieden said. “If the prevention fund were to go away, that would be a very unsafe situation for Americans.”