A qualified CDC director would restore America’s trust in the agency

Although the recent resignation of Centers for Disease Control and Prevention Director (CDC) Dr. Brenda Fitzgerald was primarily based on her personal conflicts of interest, her appointment highlights a deeper problem and a continual challenge with political appointments: Ensuring those appointed to public health physician leadership positions have adequate training and background in public and population health.

Clinical specialties such as obstetrics and gynecology — Dr. Fitzgerald’s training — focus on the assessment, diagnosis and treatment of individual patients.

{mosads}In contrast, public health requires an in-depth understanding of the health of populations, including the dynamics of how disease and injury move through populations, how risk factors are distributed in populations, and how to address both individual and community risks to stop these processes.

The CDC director should serve as the nation’s doctor, using his or her experience and training in assessing, diagnosing, treating, and communicating with populations — not just individual patients — to keep the American public safe from new and emerging health threats and addressing widespread causes of preventable chronic diseases.

Unfortunately, city, county, and state public health departments and Federal public health agencies do not conduct a credentialing process for public health physician leaders to assure their training, skills, and qualifications are suitable.

It is common to find physicians practicing in these positions, of enormous impact on the public, for which they have no specialized training. Not only should this constitute medical malpractice on the part of the physicians occupying these positions, it is a failure of governance on the part of our elected officials who oversee these agencies.

Fortunately, an entire specialty exists to train physicians in the practice of population health. The American Board of Preventive Medicine is the certifying body for trainees who complete rigorous postgraduate residency training that focuses on both clinical prevention and the population dynamics critical for improving the public’s health.

The American College of Preventive Medicine (ACPM) is a medical professional society that represents and supports preventive medicine physicians in their roles as public health and health systems leaders.

Prior to Dr. Fitzgerald, CDC directors have all been highly qualified, either trained and certified in Preventive Medicine and Public Health or having had significant career-long experience serving in a variety of public health positions prior to their appointments.

The CDC has enjoyed a long history as one of the most respected agencies of the Federal government. This history and reputation are not without merit. The science, decision-making, and communication from CDC is a public trust that is based on the expertise and integrity of the CDC staff and leadership.

During my 25 years at CDC, I was privileged to be part of many decision-making processes that resulted in public facing recommendations or communications. Most of those decisions were based on clear scientific evidence.

On the occasions when the evidence had not yet been determined and a decision had to be made, it was made based on what was known, what had to be assumed, and a careful analysis of the pros and cons of many options. My confidence in these decisions was laid in a foundation of trust in my leadership’s integrity and qualifications.

Secretary of Health and Human Services Alex Azar must now identify a new CDC Director; someone who can restore the public’s trust in an agency that is entrusted with America’s health.

I implore him to identify someone with authentic public health training and qualifications — as outlined in ACPM’s letter to the Secretary — to serve in this critical role.

Stephanie Zaza, MD, MPH, FACPM is a retired Captain of the US Public Health Service and medical officer at the Centers for Disease Control and Prevention (CDC), and President-Elect of the American College of Preventive Medicine. The views expressed do not reflect official positions of the US Public Health Service or the CDC.