“Public health is at its best when we see, and help others see, the faces and the lives behind the numbers.” — William H. Foege, MD, former director of the Centers for Disease Control and Prevention and of the Carter Center
“Sympathy with suffering … may … go so far as to enable a man to be moved emotionally by statistics.” — Bertrand Russell, 1926
Some numbers as we enter into February, which is National Heart Month:
· 18 million deaths a year from cardiovascular disease globally
· More than 1 death every minute in the U.S.
· Millions of Americans living with disability from heart attacks and strokes.
But, as epidemiologists, we think of more than just numbers. We think of stories.
Louis Salinas was a public health advisor at the Centers for Disease Control and Prevention (CDC). In 1992, I was finishing my 2-year service-learning program as an Epidemic Intelligence Officer in New York City. We had just documented and would soon publish data showing a dramatic increase in multi-drug resistant tuberculosis. Then-New York City Health Commissioner Margaret (Peggy) Hamburg asked me to become Director of Tuberculosis Control and Assistant Commissioner of Health. At age 32, never having run anything large, I was suddenly in charge of controlling one the most dangerous and highest-profile disease outbreaks in the United States. The CDC assigned Louis to be my mentor, partner, and project manager. I’ll never forget our first meeting, in a small, dingy health department office sitting on schoolroom-style chairs around a rutted round table. “Tom,” Louis said, putting his hand level with and an inch above the floor, “the TB program is right here. You have nowhere to go but up.” At the end of the meeting, I smiled with relief and said, “Louis, I think this is the beginning of a beautiful friendship.” And it was. Twenty years later, when President Obama asked me to become CDC Director, I appointed Louis director of transition, and he played a pivotal role finding, recruiting, selecting, and orienting the new CDC leadership team.
Louis gave me a wonderful gift: brutally honest feedback. It was painful. He taught me that what I intended as focus on work appeared to others to be insensitivity. What I believed to be efficient, others saw as micromanagement. What I intended as constructive feedback was experienced as unhelpful criticism. In the nearly 30 years since Louis’ gift of this feedback, I’ve tried to follow his advice. I’m sure I’ve failed often, but his feedback enabled me to have the good fortune of leading two of the greatest public health agencies in the world: the New York City Health Department and CDC.
The secret sauce of CDC’s success in smallpox eradication and other areas has been pairing an epidemiologist with a public health advisor. Epidemiologists may know WHAT to do; public health advisors know HOW to get it done and what’s possible. Louis and I worked closely together for the 5 years it took for New York City to get control of the largest outbreak of multidrug-resistant tuberculosis ever to occur in the United States. And Louis provided invaluable advice as I worked in India, became NYC Health Commissioner, and when I re-joined CDC as Director.
Tragically, on July 13, 2013, Louis died of a stroke, at age 66. He wanted to — and could have — spent many more years working in public health, helping others, and enjoying time with his family. Louis had hypertension — something I hadn’t known until he had a smaller stroke, several weeks before his fatal stroke.
Louis was the inspiration for one of the programs I’m most proud of from my time as CDC Director: the Public Health Associates Program (PHAP). PHAP takes recent graduates from college or master’s programs and provides two years of hands-on, frontline public health experience. Already, more than 1,000 people have completed the program and are well on their way to becoming the next generation of public health leaders. PHAP participants have been approximately 40% African American and 15% Latino, and have included several Native Americans. The Louis Salinas Award recognizes an outstanding member of each class. Interest in this program is so intense that thousands apply in just a few days, so CDC accepts applications for only a one-week window. This year, applications are open now, from January 22–28. There’s no better way to honor Louis’ dedication and legacy than to encourage graduating students with an interest in public health to submit an application and follow in his footsteps of effective service.
Health statistics represent lives — families, communities, coworkers. Each preventable death is a universe ended before its time. When I read and write about the unfathomable number of preventable deaths — a billion people in this century from smoking; 10 million deaths from high blood pressure each year; one in 4 early deaths from cardiovascular disease — I think of Louis, and try to work harder, smarter, and with more of the public health advisor wisdom about the ‘how’ of making progress.
Dr. Tom Frieden is the former director of the US Centers for Disease Control and Prevention, and commissioner of the New York City Health Department. He is currently president and CEO of Resolve to Save Lives, a global non-profit initiative housed at Vital Strategies, working with countries to prevent 100 million deaths and make the world safer from epidemics. Twitter @DrTomFrieden.