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Follow the Data Podcast Episode 9: Allison Jaffin Interviews Dr. Tom Frieden on What It Takes to Protect the World

Noncommunicable Diseases, or as we sometimes abbreviate as NCDs, are health illnesses such as heart disease, stroke, cancer, diabetes and chronic respiratory diseases. These and injuries (including ones from road crashes) are responsible for 43 million deaths each year – almost 80% of all deaths worldwide.

Through strategic partnerships with the world’s leading health organizations like the US Center for Disease Control and Prevention (also known as the CDC), Bloomberg Philanthropies is working to improve the lives of people around the globe by analyzing public health data and working with partners to implement strong policies preventing these deaths.

In this episode, we’ll hear from Dr. Tom Frieden, former Director of the CDC and Former New York City Health Commissioner and Allison Jaffin of Bloomberg Philanthropies as they discuss the importance of organizations like the CDC and how progress is possible when it comes to the prevention of NCDs.

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Full Transcript:

KATHERINE OLIVER: In August of 2016, the Director of the World Health Organization – Margaret Chan – named our founder Mike Bloomberg the Global Ambassador for Noncommunicable Diseases and Injury Prevention.

It’s a startling fact that millions of people every year around the world die from preventable causes which brings us to our data point for today:

Non-Communicable Diseases, or as we sometimes abbreviate as N-C-Ds, are health illnesses such as heart disease, stroke, cancer, diabetes and chronic respiratory diseases. These and injuries (including ones from road crashes) are responsible for 43 million deaths each year – almost 80% of all deaths worldwide.

Through strategic partnerships with the world’s leading health organizations, the Bloomberg foundation is working to improve the lives of people around the globe by analyzing public health data and working with partners to implement strong policies preventing these deaths.

One of our key partners in all of this work is the US Center for Disease Control and Prevention (also known as the CDC). With the mission to protect public health and safety through control and prevention of disease, injury and disability across the world – during his tenure Former CDC Director Tom Frieden played a pivotal role in combating outbreaks such as Ebola virus and the Zika virus.

To tell us more about his work at the CDC, we welcome Tom Frieden, former Director of the CDC and Former New York City Health Commissioner and Allison Jaffin of Bloomberg Philanthropies – they’ll discuss the importance of organizations like the CDC and how progress is possible when it comes to the prevention of NCDs.

ALLISON JAFFIN: Hi Tom.

TOM FRIEDEN: Hi Allison.

JAFFIN: Welcome back to New York.

FRIEDEN: It’s great to be back.

JAFFIN:  We’re really glad to have you on the show today.  And we’re excited to talk to you about your work, both as the former Director of the U.S. Centers for Disease Control as well as your longstanding partnership with our foundation. Before you were the CDC Director, we shared the same boss, New York City Mayor Mike Bloomberg. I remember when Mayor Bloomberg appointed you as Health Commissioner in 2002.  What was going through your mind at the time?

FRIEDEN: I was just coming back from India then. In fact my plane landed at 10:00 p.m. and I was sworn in at 9:00 a.m. the next morning.

JAFFIN: Really?

FRIEDEN: So it was a big transition but I had worked at the City Health Department before and I knew a lot of the people there and I knew it was a terrific Health Department and with the privilege of being the first Health Commissioner in history to have a boss who had a public health school named after him with the Bloomberg School I knew there were great things we could do in New York City.

JAFFIN:  And we did. As Health Commissioner you led a lot of key initiatives that made New York City healthier and much of that work continues to inform our work at the foundation today from obesity prevention to tobacco control to reproductive health. I can remember in the time you were in the City we banned smoking in restaurants and bars, required chain restaurants to post calorie counts, eliminated trans fats.  And you even introduced the NYC condom.  Let’s just say you had some friends and also some enemies.  What gave you the guts to do all of this?

FRIEDEN: When I interviewed with Mike Bloomberg, we had a very blunt discussion. Before I even flew back from India for the interview I had said to Al Sommer after downloading the data from New York City, I had been really immersed in tuberculosis control in India, and when I looked at the data from New York City I was actually shocked by how big a problem tobacco continued to be. And I said to Al there’s no point in my coming back to New York City for an interview unless Mike is willing to take on the tobacco industry.  And Al said don’t worry.  And, boy, was he right.

JAFFIN:  Seriously.  And then in 2009 President Obama selected you to be his Director of the Centers for Disease Control.  Can you talk a little bit about the CDC, what it does, and your experience there?

FRIEDEN: The Centers for Disease Control and Prevention works 24/7 keeping America safe from threats whether those threats are from this country or anywhere in the world, whether they’re infectious diseases or non-communicable diseases, whether they’re intention manmade or naturally occurring. And we do that by having the best of science, the best of implementation all around the U.S. and all around the world.

CDC has more than 10,000 health professionals.  They’re usually at the top of the field that they’re in.  They’re the world’s experts in virtually everything in public health.  And the ability to find out what’s happening, to respond rapidly to stop it, and to prevent it if that’s possible, those are the three key things that you need to do to succeed as a health officer.

JAFFIN:  You make it sound so simple but when you were there you had a pretty tough job.  We had some serious outbreaks.  We had a flu pandemic.  There was Zika, Ebola.  But there also must have been rewarding moments where you said that, gosh, I love my job.

FRIEDEN: There were both programmatic things that were really satisfying and there were individual things. Programmatically we did something very like what we had done in New York City with hard-hitting anti-tobacco campaigns.  This had never been done before at the federal government.  We did the first ever paid national anti-tobacco campaign.

It was called “Tips from Former Smokers” and what we did, as we had done in New York City, we found real people, Americans from middle America who had had terrible problems from smoking.  And they told people what it was like to live with those problems and they drove hundreds of thousands of people, they helped hundreds of thousands of people to quit.

Most smokers have already quit.  Most people who continue to smoke want to quit.  And when you run hard-hitting stories like that, people do quit.  And it saves lives.  And seeing the data come in was really satisfying cause we knew that lives were being saved.

The other thing programmatically that was striking was the moment when we knew that we had broken the back of the epidemic of Ebola in West Africa.  It was incredibly difficult.  We sent 1,400 people there.  We went to virtually every community where Ebola was spreading.  And there were times when it looked hopeless.  There were times when it looked like it was going it spread all over Africa for years to come.

We flooded people in.  We had 75,000 work days in West Africa and with that we, with others, turned this tide, broke the back of the epidemic, and ultimately ended it.  And when we could see that happening it was so satisfying.

But one of the things that was really enjoyable about the CDC job was the chance to just sit down and get to know some of our scientists.  These people who spent 10, 20, 30, in one case 50 years, working on a problem, becoming the world’s expert in it.  And their passion, their knowledge, their commitment was just very inspiring.

JAFFIN:  I’m sure.  During an outbreak like Ebola that you just mentioned, the entire nation if not the world is looking to you in your role to lead and protect them.  People are concerned for their safety, also the safety of their children.  How do you find the balance between alerting people about the dangers of a situation but at the same time keeping calm?

FRIEDEN: The key is to tell it like it is. Don’t exaggerate.  Don’t underplay it.  Give people the information.  Tell them what you know, what you don’t know.  For the things you don’t know, tell them what you’re trying to do to find it out.  And if at all possible give people very specific things to do rather than having a free floating anxiety or concern or activities that are not helpful, when you can give people something productive to do like using mosquito repellent in the case of Zika, that’s helpful.  And that’s one of the reasons it was so difficult to deal with Ebola cause there really wasn’t anything most people could do because it wasn’t a risk to most people. That made it a very big communication challenge.

JAFFIN: As one of our long-time partners, you’re well aware that public health is a major focus area of Mike Bloomberg’s philanthropic work.  How important is it for foundations and individuals to invest in public health issues?

FRIEDEN: It’s absolutely critical. Government can only be successful when it has support from civil society.  The work that the Bloomberg Philanthropy has done has literally saved tens of millions of lives.  At CDC, at the CDC Foundation, created by Congress 20 years ago, raised over $50 million for Ebola and tens of millions of dollars of products for Zika and allow us to do more faster.  It’s crucial that individuals get engaged with government, support government, keep government honest, but also figure out ways to work together for common aims.

JAFFIN:  At our foundation we’re constantly using data to evaluate our programs, new opportunities, and to measure our impact.  Having worked for Mike Bloomberg, you know what he always says.  If you can’t measure it, you can’t manage it.  Of course this is especially relevant to public health where data is used in so many ways: from research to surveillance and even to shift policy.  Can you share some examples of how the CDC uses data to dramatically change the way we tackle public health issue?

FRIEDEN: Do you have all day? Because that’s really our central theme: use data to improve performance. In laboratory work, for example, we began something called Advanced Molecular Detection.  It allows you to get the genome of the microbe and to figure out things like is it resistant to antibiotics, is it part of an outbreak, where is it coming from.  That has allowed us to get contaminated food off the shelves faster and save lives.

Globally we implemented something called The Global Health Security Agenda.  That essentially rates every country in the world and identifies in an objective, transparent, accountable way how ready they are to find, stop, and prevent an epidemic.  That is now an accountability framework for progress.

The CDC laboratories are the best laboratories in the world.  When I got there we had done the trans fat elimination program in New York City.  There was no way of measuring trans fat in blood.  The scientists at that laboratory invented a new technique so we could track what was happening and potentially do that all over the world.

JAFFIN:  Wow. You must have had a good time in that job. Last year the WHO Director Margaret Chan appointed Mike Bloomberg as the WHO Global Ambassador for Non-Communicable Diseases.  In this role Mike’s working with national and local political leaders around the globe to highlight the burden of NCDs and injuries.  How optimistic are you about the world’s ability to strengthen our health systems’ response to manage and reduce NCDs?

FRIEDEN: I remain hopeful. First off it is now the leading killer around the world.  And it’s driving healthcare costs up.  And there are things that we can do that are best buys.  The work that Bloomberg Philanthropies has done on tobacco control has been phenomenal.  It’s made an enormous difference around the world.

There is much more that needs to be done whether it’s eliminating trans fat around the world or better controlling high blood pressure, reducing road traffic injuries which the Philanthropy has also worked on or addressing many other causes of non-communicable diseases.

Unfortunately when people think about these, they think so much of the end state, someone dying from cancer and that’s a terrible tragedy.  Where the Bloomberg work has been so effective is getting is in at the prevention of that.  Preventing it in the first place.  There are a series of things that we can do to reduce the risk of heart attacks, strokes, diabetes, and cancer that we’re not yet doing as a world.

Countries around the world don’t have to make the same mistakes we’ve made.  They can avoid some of those by learning from our mistakes and we can learn from them as well.  At the same time we can, together, come up with new ways to control blood pressure better, to prevent cancer better, to avoid diabetes.  These are preventable conditions and doing so will save lives and save money.

Even in the United States, most strokes and heart attacks could be prevented with technologies we have today and are low cost, easy to use, they’re just not being used yet.

JAFFIN:  Sometimes when we talk about solving public health issues and ending a disease, the task sounds monumental, almost impossible.  But we’ve seen that with global coordination and effective strategies the seemingly impossible can be done.  As you said earlier, Ebola has been contained.  And we’ve seen a 99% decline in polio cases since 1988.

These public health crises don’t have industry-backed support like big soda or big tobacco working in opposition to you.  So what gives you hope that we can and are making progress in tackling challenges like tobacco use and sugary beverages?

FRIEDEN: The data shows that we are making progress. Tobacco use is decreasing in the U.S. and globally.  Sugar-sweetened beverage consumption has decreased from a peak a few years back.  But these are not easy.  And I said early on when I was Health Commissioner in New York City that the big difference between working on tuberculosis which I had worked on for more than a decade and tobacco control was that tuberculosis bacteria don’t bribe politicians.  They don’t rebrand themselves as light tuberculosis.  And that makes it very, very challenging but it also means that controlling non-communicable diseases, controlling things like tobacco use and obesity, is a cardinal way of evaluating whether governments are responsible.

If you’re the government of a country or a community and you know how you can prevent thousands or even millions of people from dying and you don’t do it because of a powerful interest group, I think Mike Bloomberg would say on the one hand you shouldn’t be able to look yourself in the mirror and say you’re doing the right thing and on the other hand the people who elect you should really wonder whose interests do you really have at heart.

JAFFIN:  Now a question that I’m sure many listeners are wondering, how do you stay active and live a healthy lifestyle?

FRIEDEN: It’s not easy. The best way to stay physically active is to build physical activity into your regular routine.  That may mean walking to work or taking the stairs, biking, doing things that you need to do every day.  If you have to go out of your way to do something active you’re less likely to do it.  So building that in, making it the default value is important.  Similarly rather than deny yourself the things that you like to eat, find things you like to eat that are healthy and eat more of those.

JAFFIN:  That’s very good advice for all of us. Tom, I want to thank you so much for your time with us today.  We wish you the best on your next adventure.  And we think-we thank you for your service to our country.  And for making our nation healthier.  Thanks for listening.

FRIEDEN: Thank you.

OLIVER: We hope you enjoyed this enjoyed this episode of Follow the Data. We’d like to thank Dr. Tom Frieden for his contributions to public health and his service to our nation.

To learn more about the Bloomberg Philanthropies Public Health programs, visit bloomberg.org.

Thank you for listening to our podcast – if you haven’t already, subscribe and send us your feedback at followthedata@bloomberg.org.

As our founder Mike Bloomberg says, if you can’t measure it, you can’t manage it. So until next time, keep following the data.

Special thanks to producers and editors Kelsey McCarthy, Ivy Li and Lindsay Firestone, and music composer Mark Piro