CLINICAL INNOVATORS
Interview by
KATLYN NEMANI, MD
CLINICAL INNOVATOR:
Thomas R. Frieden, MD, MPH
The Future of Public Health
T
om Frieden. MD, MPH, has been the director of the U.S. Centers for Disease Control and Prevention (CDC) since being appointed by U.S. President Barack Obama in 2009.
He served as Commissioner of the New York City
Department of Health and Mental Hygiene from
2002-2009. During this time, he championed
efforts to combat cardiovascular disease including
eliminating trans fats from restaurants, launching
a campaign that reduced the number of smokers
in NYC by 350,000, and establishing the country’s
largest community-based electronic health records
program. Dr. Frieden received his medical degree
and masters of public health degree from Columbia University and he completed infectious disease
training at Yale.
How did you become interested in public health?
My father was a gifted cardiologist. He practiced
rigorous, evidence-based medicine before anybody
talked about evidence-based medicine.
As I was in the process of trying to decide a
career path, my father and I went hiking in the
mountains. We talked about our mutual desire to
help people through medicine, and my interest
in public policy. He suggested I consider public
health. One of his favorite sayings was, “You
gotta help the people.” That is why I chose public
health—to improve not only the health of individuals but entire communities.
In your recent New England Journal of Medicine article, “The Future of Public Health,” you
emphasize the interdependence of the health
care and public health fields and allude to the
history of distrust and disrespect between
them. How did this dynamic evolve, and how
can the two fields work together better?
Medicine and public health are becoming increasingly and necessarily interdependent. This is a
time of change in our health care system with increased insurance coverage, payment reform, and
ACC.org/CSWN
new models of care that create new opportunities
for health care and public health to work together
and to improve the health of entire communities,
not only individual patients.
edicine and
M
public health
are becoming
increasingly
and necessarily
interdependent.
This is a time of
change in our health
care system.
One way to think about the impact of health interventions is a pyramid divided into five sections.
At the base of the pyramid are social determinants such as housing, education, and income.
Public health can have impact by measures such as
increasing healthcare coverage to reduce disparities in access to clinical care due to poverty. At the
next level up—level 4—are public health interventions that make the default choice the healthy
choice. A good example is clean drinking water.
Level 3 includes long-lasting protective actions
which require one-time or intermittent action by
clinical providers, such as vaccination. At level 2
are clinical interventions that require long-term or
daily care, such as blood pressure control. Lastly,
level 1, at the tip of the pyramid, helps people find
gains from counseling and education—think nutrition and exercise plans for weight loss.
Interventions at the bottom of the pyramid
usually help more people than the interventions
at the top of the pyramid. But it is on levels 3 and
4 that public health and clinical medicine can
cooperate more effectively. We can work together
to make the default choice the healthy choice,
and to encourage wider adoption of long-lasting
protective actions.
You launched a “Tips from Former Smokers”
campaign that helped at least 300,000 smokers quit. What made this campaign so effective?
CDC’s Tips campaign was unprecedented in scope
and success. It was the first-ever paid national
tobacco communication campaign. The ads are
effective because they are emotional and hardhitting. We used real people, not actors. The ad
participants show the tragedies that real people
face every day as a result of smoking in a way
that statistics cannot. These courageous people
let the public know that smoking doesn’t just
kill; it disables, disfigures, and robs its victims
of independence. A man named Roosevelt began
smoking in his teens, had a heart attack at 45,
and later needed coronary artery bypass surgery.
The ads also showed smokers whose loved ones
were impacted by it, such as Kristy’s baby, who
was born too early because of Kristy’s smoking.
Each real story represents tens of thousands of
Americans suffering from similar illnesses caused
by smoking.
This is money well spent. This campaign saves
lives and saves dollars. We asked smokers and
they said these are the kinds of ads that they
want to help motivate them to quit. Running Tips
ads for just 12 weeks in 2012 resulted in 1.6
million quit attempts, 100,000 smokers quitting
for good, and averted at least 17,000 premature
deaths. The Tips campaign costs less than $500
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