US Public Health Alphabet Soup Explained: What is the CDC?

“What is the CDC?” is a logical question to ask, because the full name is Centers for Disease Control and Prevention. What happened to the “P” for prevention in the initials CDC? The COVID-19 pandemic shows what happens if “prevention” is neglected – disease “control” becomes impossible.

But if you’ve already read my other posts about agencies like NIH and NAM, you might wonder what role exactly is left for the CDC. I’ll try to delineate that here.

What is the CDC?

The United States (US) Centers for Disease Control and Prevention (abbreviated CDC) is a major component of DHHS. Its mission is not very clear. Part of the mission is “to protect America from health, safety and security threats, both foreign and in the US”.

But the CDC was barred by law from studying gun violence, and does not focus at all on White nationalist domestic terrorism, which is a currently huge public health threat in the US after the recent political insurrection. And as I mentioned about the APHA and NIH, nobody seems to care about “police shooting Black people” enough to make it a priority, even though for a long time, I have felt this is the number one public health issue in the US.

What does the CDC do?

Like the NIH, the CDC has a bunch of offices (or similarly-named components), and each is in charge of a different topic. The one that jumps out at me is National Institute for Occupational Safety and Health (NIOSH), which, like the AHRQ, is what I like to call “deliberately underfunded”. It’s the agency that does workplace studies to try to come up with better policies for worker health.

And as with AHRQ, I’d just love to take even one line item from the NIH budget and knock it into the NIOSH budget. The first thing I’d study is safety for nurses. I think nurses are getting killed physically and mentally, but the NIH institute that focuses on nursing, which is the National Institute of Nursing Research (NINR), does NOT have it in their mission to study nurse health! I was appalled when I found this out after much inquiry several years ago when I innocently tried to pitch to them a nurse burnout prevention program (note the “P word” – they didn’t buy it).

So in addition to worker research, the CDC obviously does infectious disease research and policy, as we all saw during the COVID-19 pandemic. It has offices for surveillance which include surveilling for both infectious and non-infectious disease. The CDC is essentially the federal operational face of day-to-day public health practice in the US.

My Take on the CDC

My take on the “federal operational face of day-to-day public health” is that the face has grown ugly. When I graduated in 2003 with my MPH from the University of Minnesota, the head of the CDC at the time, Julie Gerberding, spoke at my graduation. I was beside myself with inspiration and hope! This all popped like a balloon when she was replaced with Tom Frieden.

Why should Tom Frieden have never run the CDC and been fired long ago? Let me count the ways:

1. He pled guilty in 2019 to groping a family friend, so it makes you wonder how long he’s been involved in that behavior, and who his other victims are.
2. As of 2014, he continued to employ people who did a terrible job of preventing virus spills.
3. During his reign, he stood up for literally NOTHING. He did absolutely no advocation for public health. He stayed away from all the important topics: guns, police violence, racism, medical errors, you name it – everything that took us down in the COVID-19 pandemic.
4. Frieden was handed a perfect situation when he started in the job in 2009. There had just been the Bruce Ivins anthrax kerfuffle he was hired to clean up. Obviously, he didn’t do it by 2014. This behavior is consistent with white male privilege, as he seemed impossible to fire no matter what he did.
5. Frieden did literally no oversight of Massachusetts when our state public health commissioner was forced to resign after not doing proper oversight, leading to what is known locally as the “Dookhan scandal”.

So when I ask, “What is the CDC?” my answer is that it’s the federal face of US public health, and it is only as good as its director. I feel the new director, Rochelle Walensky, is much more responsible than Tom Frieden, but I am not fond of her leadership style, and I do not like her approach to public health communication and policy development so far. But what’s more important to me are her public health priorities. It’s too early for me to know, so I’ll have to wait and see.

Updated July 22, 2021