For more than 70 years, the U.S. Centers for Disease Control and Prevention (CDC) earned a well-deserved reputation as one of the world’s preeminent public health institutions — and the trust of the American people along with it. Following an uneven response by CDC to COVID-19, however, many people’s faith in the agency has been shattered.
The first step to regaining trust is to admit mistakes. CDC’s director, Dr. Rochelle Walensky, has been upfront about the agency’s failures during the pandemic and has committed to a series of reforms in response to reviews of the agency’s missteps. But if our nation is to finally have the public health system that has so long eluded us, it is incumbent upon CDC and policymakers who fund and oversee the agency to make a fresh and sustained commitment to health equity.
The goal: a nation where every person — irrespective of zip code, income, race, ethnicity, gender, disability, sexual orientation or occupation — has a fair and just opportunity to not just survive, but thrive. A new paper from the Robert Wood Johnson Foundation (RWJF), the organization we lead, explains why and how CDC must commit to that vision.
Both of us are proud to have worked with and for CDC. (Dr. Besser worked at CDC for 13 years, including serving as acting director during the H1N1 pandemic in 2009 and the head of its emergency response office for four years. Dr. Morita is a current member of CDC’s advisory committee to the director.) We each served in the agency’s Epidemic Intelligence Service, investigating and responding to outbreaks and other public health emergencies. We believe strongly in CDC’s mission and deeply respect its more than 10,000 employees.
CDC has already taken important steps to prioritize health equity. Last year, Dr. Walensky rightly declared racism — the discrimination against racial and ethnic groups baked into our nation’s laws, policies, and institutions — a public health threat. Among the steps in CDC’s own reform blueprint is creating a new equity office within the agency. Last week, CDC announced a promising new investment of $3.2 billion in more than 100 health departments across all 50 states to help rebuild a decimated public health workforce. These funds will build on previous CDC grants to address COVID-19 health disparities and empower community health workers that will build stronger relationships between CDC and trusted local voices.
These moves are welcome but more is needed. For example, RWJF’s paper recommends modernizing America’s public health data collection systems. From the outset of the pandemic, our public health system was unable to pinpoint the disparate impact of COVID-19 on people of color. This deficiency helped drive the subsequent disproportionate impact of severe disease and death, which led to significant declines in life expectancy for Black and Indigenous people.
CDC can chart a new course by developing minimum standards for data collection and aggregation that empower state and local health departments to not only document health disparities but connect those disparities to underlying inequities in housing, employment, education and other social determinants of health. Without addressing these inequities, the next pandemic is likely to play out just like this one, and the emergency conditions that affect so many people’s everyday lives — from poverty to chronic disease — will persist.
Additional areas of focus can comprise this health equity vision. CDC’s declaration of racism as a public health threat should be more than a one-time announcement; agency leaders must regularly use the agency’s platforms to explain how racism — not race — creates persistent health disparities. CDC must build its own internal capacity to address racism by working to diversify its staff and leadership. And it should partner with trusted messengers in communities who can draw on their own lived experiences to illuminate our path forward.
Public health’s biggest strength is its people. In spite of chronic underfunding, the proliferation of misinformation and disinformation undermining their credibility and threats to their personal safety, public health officials still managed to save hundreds of thousands of lives in the United States and millions more around the world during the COVID-19 pandemic. These officials deserve our gratitude and appreciation.
From an institutional standpoint, CDC is not singularly responsible for and cannot alone fix all that ails our current system. CDC lacks the standing authority to require states to share data, even during public health emergencies. Antiquated data systems prevent public health officials from collecting and reporting critical health information. Sufficient, stable and flexible funding has long been denied to health agencies at all levels of government.
Our entire nation experienced the consequences in 2020 when political interference kept CDC and other health leaders sidelined from the pandemic response at the time they were needed most. Everyone in America — even people who no longer have faith in the agency — has a vested interest in addressing these shortcomings.
It is because of our professional affiliations with and personal connections to CDC that we believe so strongly in our foundation’s recommendations to improve it. The pandemic’s devastating impact affirms — rather than undermines — America’s need for a strong and well-functioning CDC.
Thankfully, the hard work of restoring trust and reimagining its mission is already underway. With fresh thinking, sustained funding, and a commitment to equity, CDC can regain the trust it has lost while leading the charge to improve health and well-being for all.
Richard Besser MD is the president and CEO of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention (CDC). Julie Morita MD is the executive vice president of the Robert Wood Johnson Foundation and member of CDC’s Advisory Committee to the Director.