A Perspective on Public Health

I’ve had the privilege to see the power of public health from numerous perspectives.

As a practicing physician, I regularly depended on guidance from the Centers for Disease Control and Prevention (CDC) when treating and advising patients. When I served as the state health officer for Indiana, I saw the impact public health can have on local communities and how essential coordination with CDC is to understand outbreak trends and assess emerging threats.

Then, during my time as director of CDC’s Office of State, Tribal, Local and Territorial Support, I was able to coordinate with health departments and partners across the nation to respond to fast-moving issues like the Ebola epidemic. More recently, in my current role at the CDC Foundation, our team has partnered with CDC to extend its life-saving public health protection work for addressing infectious and chronic disease threats as well as for emergency responses. ?

In each of these roles, I have seen the difference public health and CDC make in the health, safety and economic well-being of a community and the individuals within it. Trust in CDC was high and following the agency’s guidance was the gold standard.

However, a lot has changed in the three years since the COVID-19 outbreak and response began, including a serious and concerning drop in the public’s trust of public health overall and CDC’s role as the United States’ leading public health agency. Today, there is a long way to go to rebuild that trust, but I’m committed to the work, and I know the outcome is critical to the health and economic prosperity of our nation and world.

This commitment is why I’m a proud signatory of the newly-released Building a CDC the Country Needs report. Developed with bipartisan support by The Center for Strategic and International Studies (CSIS) and its Commission on Strengthening America’s Health Security, the report reaffirms that the United States needs a strong, effective and accountable public health agency and includes nine specific recommendations on how our nation can work with CDC to achieve that goal.

One of the greatest needs and most critical recommendations from the report is to improve the speed and quality of data collection and reporting, particularly during a crisis.

CDC needs accurate and timely data to inform its guidance and ensure all recommendations are evidence-based. The current antiquated data collection processes, including those used by health departments across the nation, make it challenging for CDC to act quickly and decisively on emerging issues. Modernizing how data is collected, shared and acted upon is a national public health effort we’re championing at the CDC Foundation, and it is an essential element in protecting us all.

As the CSIS report also points out, strong external partnerships with state and local health entities and the private sector are critical for epidemic preparedness and response. While CDC sets policy and guidance, their implementation happens at the state and local level. Clear communication, evidence-based recommendations and open channels of two-way communication between CDC and health departments are essential to effective public health along with budget flexibility as recommended in the report.

Whether in data, partnerships or the other key areas listed in the report, gaps in a community’s public health infrastructure can have devastating consequences.

In 2015, as one example, the Indiana Department of Health began an investigation into an outbreak of HIV and hepatitis C virus (HCV) linked to individuals sharing syringes when injecting prescription opioid medication. What began as small outbreak grew to more than 170 new cases of HIV, where almost all those infected with HIV were coinfected with HCV.

Better screening measures, faster data sharing practices, more robust opioid addiction services and more comprehensive prescription guidelines for clinicians would have likely reduced the severity of this outbreak. During this time, I was working at CDC and able to provide federal support to key partners and decision-makers in Indiana to help respond to this fast-moving public health crisis. This type of work is public health in action, and we need a strong, well-resourced and trusted CDC in this role working with partners.

No matter how you look at the role of public health, it’s hard to argue against the need for a robust, effective and timely national infrastructure and strong CDC to lead it. I encourage you to read the full report for more details on how we can rebuild our nation’s public health response and the public’s trust in it.?