The White House announced this morning that it has tapped NYC Health Commissioner Tom Frieden to run the overworked, underfunded U.S. Centers for Disease Control and Prevention. It’s a bolder, potentially more consequential choice than it appears to those not familiar with Dr. Frieden. In his seven years as our city’s top doc, the man has pissed off just about every constituency—left and right, grassroots and industry. But in doing so, he’s led some of the most inspired public health crusades urban America has seen. My grassroots colleagues will roast me for saying so (and I may come to regret it), but Frieden may be exactly what the nation’s beleaguered public health agency needs.
The primary rap against Frieden is, well, he’s a jerk. He shows little interest in the human finesse necessary to manage the many competing interests involved in public health. Community groups say he’s dismissive. Businesses say he’s a bully. Ultimately, he’s a geek who picks his battles by looking at the science, and not much else. In that much, he perfectly fits the president’s professed standard for his administration.
Frieden came into the NYC job with a bang, and hasn’t let up. He told Mayor Mike Bloomberg—who recruited Frieden away from anti-tuberculosis work—that he wouldn’t take the job unless he could attack smoking. Bloomy said fine and made it clear from jump that he’d fully back Frieden’s many crusades. Since then, Frieden has enraged local businesses by banning smoking in public places, severely restricting the use of trans-fats and forcing food chains to put calories on their menus. (You’d be shocked how much this impacts your lunch choices!) He’s been unapologetic—even pugnacious—about doing all of this, pointing to obesity and diabetes rates in places like Harlem, which are dense with fast food chains.
He’s also expanded the city’s long-controversial needle exchange, dramatically ramped up HIV testing, pushed cutting-edge drug addiction solutions and handed out millions of NYC-branded condoms (though, they’re widely panned as too small). You’d think progressive public health advocates would love him for all of this. But the problem with Frieden is he’s not interested in teamwork—with anybody. He’s just as dismissive to community activists as he is to business lobbyists. The only input that interests him is the data.
That’s great, to a point. Frieden seems to me less of a bully than a geek—think of the impatient tech guy, sneering along while you try to explain that he hasn’t, in fact, fixed your computer. It’s nice to say we want to take the politics out of public health. But success also demands engaging and meaningfully consulting the communities who you claim to be helping. Unless you get them on board, you’ll get nowhere, and you’ll likely miss all kinds of ground-up ideas that don’t make it into medical journals. I profiled Frieden’s effort to expand needle exchange back in 2004, and the tragedy of it was just how much more he could have achieved with a little community input.
Another good example of where the data-only approach fails is circumcision. Yes, circumcision. Research has shown that circumcised men are less likely to contract HIV, so Frieden wanted to launch a campaign to get all the city’s men cut. Think this through: He wanted a government agency to go into primarily black and immigrant neighborhoods and tell grown men to chop off parts of their penises. Um, Earth to Dr. Frieden? It’s one of very few examples where Mayor Mike told his health commissioner to sit down and be quiet.
The CDC has wisely spent a lot of energy bringing communities into the public health conversation in meaningful ways. It’ll be a shame if Frieden isn’t smart enough to continue that trend. But what the woefully neglected agency needs more than anything else right now is a smart, aggressive and unapologetic advocate for its work. Tom Frieden is that, if nothing else. So brace yourself Mr. President. I’m guessing you’re going to be making more public health news than you expect in the coming years. Let’s just hope it’s all good.