Greetings from the ASTHO Day at the capitol

Wednesday, March 5, 2014 

Greetings from Washington, D.C.,

I’m in Washington for the Association of State and Territorial Health Officials’ (ASTHO) Day on the Hill.  Actually, I’m here for three days, two of which are “on the hill.”  Since I’m on the Board of ASTHO as the Region V representative, I spent the first day of this Washington visit at the ASTHO board meeting discussing the various issues facing states and territories, and preparing for visits with our congressional delegation and Obama administration leadership. 

The fiscal year 15 budget is the biggest issue of immediate concern for ASTHO and MDH.  Congress is in the process of preparing that budget and it has great implications for public health.  Conversations were quite animated because the President released his budget on the same day as our board meeting.  As with most budgets there is some good news and some bad news.  But since congress has to act on a budget of their own, the President’s budget is just the first step in a long and complicated process of coming up with a final budget – if they ever do.  However, the President’s budget served as the basis for the subsequent visits on “the hill.”

Today, I joined a group of 7 ASTHO board members in meetings with agency leaders within the Obama administration at the Hubert Humphrey Office Building. (Please excuse the acronyms that follow.) I got to meet with Tom Frieden, CDC Director; Pamela Hyde, SAMHSA Administrator; Mary Wakefield, HRSA Administrator; Sally Howard, FDA Deputy Commissioner; Nicole Lurie, Assistant Secretary for Preparedness and Response; and Anand Parekh, Deputy Assistant Secretary for Health.  We were scheduled to meet with Marilyn Travenner, CMS Administrator, and Kathleen Sebelious, HHS Secretary, but their visits got pre-empted by some public announcements they were making today. 

Each of the visits dealt with some important and pressing problems.  Each of the meetings could warrant a separate note.  Since I’d lose you before getting to the second visit, I’ll relate the events of just one of the meetings – the one with CDC Director Thomas Frieden, MD.

Dr. Frieden spent a few moments talking about the budget but spent most of the time talking about his priorities and some of his thinking about public health.  In the next fiscal year, CDC has three major priorities:  Global Health Security, Anti-microbial resistance, and prescription drug overdose. 

Global Health Security:  On February 13, 2014 the U.S. joined 26 countries and international partner organizations to accelerate progress toward a world safe and secure from the threat of infectious disease.  From the point of view of CDC, the importance of global health security has never been clearer;  influenza could affect millions, new microbes are emerging and spreading, drug resistance is rising, and laboratories around the world could intentionally or unintentionally release dangerous microbes. Globalization of travel and trade increase the change and speed of these risks, spreading disease. 

Anti-microbial resistance:  Drug resistance is a growing problem and creates risks for all medical procedures.  CDC is looking to work with hospitals and health departments on developing antibiotic stewardship programs in hospitals and with health departments.

Prescription Drug Overdose:  The rapid rise in drug overdoses and deaths in the last few years has highlighted the problem of prescription drug overdosing.  One of the ways to address this is with a Prescription Drug Monitoring Program (PDMP).  Dr. Frieden stated that, in his view, an ideal PDMP has 4 components:  it’s universal (covers all patients and all providers), it’s real time (should be able to get data immediately), it’s embedded into the EMR, and it’s actively managed.  Many states have PDMPs but few contain all of the necessary components which would include monitoring both patients and providers.  Minnesota doesn’t have an ideal PDMP.

After an hour of dialogue, Dr. Frieden ended his time with us by stating that he’s concerned about how public health is viewed.  He said that too often, public health gets criticized for working toward a “Nanny state.”  To combat that, he has started to say that public health is about increasing freedom.  There are three ways that public health increases freedom:

1. Public health provides information to citizens, providers, policy makers so that they can make decisions based on the most recent information and knowledge available.  Public Health information gives people the freedom to choose, knowing the risks, from a list of options.
2. Public health protects individuals from the actions of others.  Public health protects individuals from being injured by a drunk driver, from unsafe food, from  poor quality care, etc.  These protections give people freedom to act without worry.
3. Public health does certain things that could be done by individuals but is more efficiently done for all by a public agency.  For example, everyone could boil his/her water but it’s much cheaper and more efficient to have water made pure and safe by a publically-accountable public agency.  This collective action leads to more freedom for individuals to pursue other activities.

I thought this was one good way to characterize public health. These ways to increase freedom are also relevant to our advancing health equity efforts.  These freedoms, if enhanced, would allow everyone the opportunity to be healthy. 

Tomorrow, I meet with our congressional delegation.  It will be a long day but I’m hoping it will be a productive one.

Ed