Removing Chronic Disease Prevention from CDC Would Be a Mistake

It’s early 2016, and there’s an infectious disease outbreak transmitted by mosquitoes. You’re pregnant and worried about contracting the Zika virus that has been discovered to cause birth defects. To protect yourself and your unborn child, you want guidance developed for your doctor from the best experts working on infectious diseases as well as birth defects—which is a chronic disease challenge.

But if the U.S. Centers for Disease Control and Prevention (CDC) did not have responsibility for chronic as well as infectious diseases, that information would have been more difficult for your doctor to receive during the outbreak.

The linkage between chronic and infectious diseases is clear to people who work in public health, but not everyone values it. Some have argued CDC should be made smaller by, among other changes, removing CDC’s chronic disease prevention work and placing those responsibilities elsewhere.

It would be great if there were clear divisions between chronic and infectious diseases, but distinctions aren’t clearcut, which the Zika outbreak highlights. During Zika, the response at CDC was led by an OB-GYN while other agency experts in birth defects, infectious diseases, vector control, maternal health, labs and epidemiology ensured the response was comprehensive and effective.

Health threats are inter-disciplinary requiring experts to come together to rapidly address them. And for our nation and the world to have the protection we need, it’s vital CDC remain engaged in both to protect Americans from ALL health threats.

There are many other examples about why this should continue to be the case.

For instance, during COVID-19 chronic diseases have been exacerbated, which increased the risk of COVID-19. And, during the opioid epidemic, we’ve seen that those using opioids contribute to infectious disease outbreaks, including HIV and Hepatitis C, based on the re-use of syringes and through unprotected sex.

Overall, we have made tremendous improvements in health since the 1990s. This progress wasn’t made by healthcare organizations or regulatory agencies alone. Our nation’s public health organizations are an important part of the improvements, including state, Tribal, local and territorial health departments across the United States—all who work with CDC on a daily basis across all health risks.

These relationships have been quite effective over time. In fact, CDC’s work on all diseases has played a key role in understanding and then reducing deaths from heart disease, stroke and cancer and—until COVID-19 intervened—increased life expectancy in our nation.

That’s because CDC takes healthcare solutions that can improve the health of individuals to the masses through public health protection solutions, guidance and work with partners. Making CDC smaller and dividing up public health into regulatory or health care delivery agencies would weaken and complicate a system that needs to be strengthened and better coordinated.

Let’s be clear, there are things we can and should do to improve CDC, and I agree with those who assert the agency must continue to evolve. As several examples, CDC must:

• be more nimble and respond more rapidly and comprehensively to evolving health threats;
• communicate more effectively with the public and health authorities across the nation;
• ensure its independent voice;
• collaborate more effectively with the private sector on issues, such as lab tests, as well as to improve the quality and availability of data.

I’m pleased CDC is rolling out a new infrastructure that is streamlined and better aligned with protecting our nation for today and tomorrow. This work must continue. In addition, other organizations, like the Bipartisan Policy Center and Center for Strategic and International Studies, as well as individuals have put forward solutions that can be undertaken to strengthen the agency.

But there are other steps our nation should take as well.

For one, we have underfunded public health at all levels for much too long. CDC’s budget, when adjusted for inflation, is 25 percent lower today than in 2004. Congress must provide CDC with the funding it needs to do its job. Also, funding must be stable, and the funding must have some flexibility for emergencies.

Beyond CDC, we need to increase public health funding at all levels of government and some efforts are underway to do so. In Indiana, for instance, the governor is working to increase state funding for public health as a way to improve health and make the state more competitive (Disclosure: I co-chaired the commission that made recommendations to Indiana’s governor).

Linked with funding, we need more people working in public health across the nation. Nationally, we need 80,000 additional workers in public health at the local and state levels.

While we should evolve and strengthen CDC, we should not separate chronic disease prevention from the agency. To become a healthier nation, we need to recognize the relationship between chronic and infectious diseases—and value it.

Smaller doesn’t necessarily mean better. 

Judy Monroe, MD, is president and CEO of the CDC Foundation