Here’s the transcript of last Wednesday’s interview with Dr Julie Gerberding, Director of the Centers for Disease Control and Prevention (CDC). Julie is talking in a panel in track 4, the CEO/CFO Summit on Tuesday at 11:10 am -11:50 am. The panel is called A Corporate CEO Calls for Step-Change in Health Care Productivity, and also features Edward D. Miller, Dean of the Medical Faculty; CEO, Johns Hopkins Medicine, and Julie Fasone Holder, Corporate VP, Human Resources, Diversity & Inclusion and Public Affairs, The Dow Chemical Company.

Matthew Holt; I’m doing another podcast for the World Healthcare Blog for the World Healthcare Congress that is coming up this Sunday, Monday, and Tuesday in Washington, DC. I’m delighted to have Dr. Julie Gerberding with me. Dr Gerberding is the director of the Centers for Disease Control, the CDC. And I guess in that case, Dr. Gerberding, you’re responsible for the federal government in all its public health initiatives, or at least a large part of them. I hope that’s roughly correct.At any rate, good afternoon. How are you doing today?

Dr. Julie Gerberding:  I’m doing great, and I’m very happy to have a chance to talk with you.

Matthew:  Great. Lovely. So I mentioned there that the CDC obviously has a wide-ranging role in all different types of initiatives, obviously connected with public health, but also doing various other things. And obviously you’re going to be representing the CDC at the Congress. Can you give a me a quick top of your mind of what you think are the most important issues the CDC is tackling at the moment, and what the biggest public health issues for the nation are?

Julie:  The CDC thinks of its work in two main portfolios. We focus on the portfolio of the urgent threats, which include the problems related to emerging infectious diseases, things like influenza pandemics, the natural disasters that seem to be increasingly common, particularly in this era of climate change. And of course, terrorism attacks.

But we also have the urgent realities in our portfolio. These include the kinds of problems that people face every day. Things like obesity and heart disease and cancer, the sorts of problems that are present in every family and every community, and problems that can be prevented if we invest in and expand the kinds of prevention programs that we know work.

Matthew:  So given that, that obviously there’s a part of all of this that connects to the healthcare system, which is mostly the people who will be taking part in the Congress. But there’s also a part of this that is much wider than that. You mentioned obesity and also obviously pandemics and the rest of it. That connects not only other government agencies, but also, of course, the private sector and society as a whole. What kinds of techniques and approaches is the CDC taking to look at both those angles? To work better and more closely with the healthcare system around things like pandemics and influenza, but also to work at the wider issues like obesity, climate change, those kinds of things.

Julie:  Well, it’s very clear that we need to be functioning in a very networked environment. Everyone is familiar with the concept of a flat world, and obviously the world of health has become flatter and flatter as technology and communications have allowed us to reach out and connect with more sectors and more places and even more countries around the world. But that same network can be exploited to bring people together to solve problems more effectively. I think we’re reaching not only to build better connections between public health and healthcare delivery systems; but also we recognize how imperative it is to include business, private sector, faith-based organizations, community organizations, and certainly governments at every level of society in this network. We’re in a world where it really does take a network to solve complex problems, and that’s as true for obesity as it is for pandemic preparedness.

Matthew:  So give me some examples of the kinds of initiatives. Pick maybe one or two of the key issues that you’re going after, the kinds of initiatives that CDC is involved with on its own, and also in cooperation with various other entities in the healthcare system and society.

Julie:  I just came from a global business roundtable that CDC supports in conjunction with its foundation, where we had leaders of international corporations coming together to share their best practices and to learn how we can collaborate more effectively in preparing for urgent health threats like a pandemic. Part of what we do is convene the people who need to be at the table to make decisions or to plan together. We’re also involved in developing a curriculum for improving people’s ability to lead a network. We call that brand of leadership meta-leadership, to distinguish it from the traditional vertical leadership.

Meta-leadership is horizontal leadership in a vertical world. We really are recognizing, increasingly, that people not only need to be effective at running their own organizations and making decisions for their own organizational components, but we’ve got to be able to influence the decisions and the directions that unrelated organizations are taking so that we’re moving the whole network in a common direction. That’s not something that’s intrinsic to every leader’s repertoire. Business, in many cases, is ahead of us. They’ve already learned how to train leaders, but they have an intuitive, and sometimes a directive understanding of how to build relationships and partnerships outside of their own organizational units.

Matthew:  I see. Very interesting. Do you want to narrow down a couple of issues? If you were to pick the one or two major issues that are overriding for you at the moment as places you want the CDC to focus its attention, what would they be?

Julie:  The overarching health problem that we face here in the United States, and that I think people are facing around the world, can be summed up in one word, and that word is complacency. It’s the requirement to motivate people to take the steps that we know will be effective to either prepare for a threat or to promote and protect their health. You can see that play out in preparedness. We get energized around avian influenza for awhile, but when the story is no longer in the news, it becomes harder and harder to keep people focused on what we really need to be able to do for what we believe will be an inevitable epidemic or pandemic someday.

Likewise with obesity. When you have a problem that’s so common and so present in everyone’s family and community, it becomes a non-problem just because it’s common. And in order to really do what we need to do as a society and take the multi-sector steps necessary to truly create a healthier future for our children, we’ve got to get past our own tolerance of what truly is a tragic health threat for all of us, and especially for our very young people. We know that for obesity, for example, we need to start inventing prevention before people are even pregnant because the stage for obesity is set in the gestational stage of the child. So the prerequisites that increase the chance of obesity are really present when mom is not nutritionally optimized, shall we say? We know that children learn their eating habits and preferences at a very early age, and that when they get to school those bad habits can be reinforced by institutional policies around nutrition, as well as physical education programs or lack thereof. A sedentary lifestyle is promoted through our increasing reliance on video games, and we’ve got to combat that, mobilizing kids to be active, but also to be active in safe and healthy neighborhoods where they really can play outside without physical threat or fear of harm.

That obviously carries right into the workplace. Employers are probably leading the edge right now in promoting wellness in the workplace, for many reasons. One is that they recognize that physical fitness increases employee productivity and decreases absenteeism or presentee-ism, but also it is a major driver of the increasing, I should say spiraling, healthcare cost associated with supporting employee benefits. Our country cannot sustain this level of economic investment and still become competitive in the business environment. So business is really leading the way to supporting better health for its workers and their families as a humanitarian perspective, but also as a business imperative.

Matthew:  Now that’s pretty interesting, because you’re talking about everyone taking their part in various places and going back and looking at preventative care. You mentioned stopping people playing video games, or getting kids out of a more sedentary lifestyle and getting them into exercise and activities. There’s been a lot of push in that direction from employers and also schools, and in the public consciousness, I think. Even things like Fast Food Nation and what have you. On the other hand, we do know that there’s a huge industry out there in various areas which are promoting: obviously video game manufacturers and people selling fast food and all the rest of it. How do you work with those ‘opposing’ forces who are in society? How are you approaching food manufacturers and others to try to find common ground where we can make change without necessarily having to go into one of these antagonistic modes?

Julie:  Well, the first step to any of this is to get the science. I think that CDC plays a key role that many people don’t recognize, as a research agency in getting the information about what really promotes healthy behavior or unhealthy behavior. What are the determinants for people at various stages of their life? And what are the most critically relevant aspects that influence those kinds of behavioral decisions at either the individual, family, or community level, that are most amenable to intervention? Once we have the kind of research and demonstration programs that show us yes, these are the most important things. You need to do at least these three things if you want to have a powerful impact. Then we need to do the research to figure out how to scale things effectively and make them relevant to the diverse set of communities that are in need of our information and services.

So step number one is science. Step number two is engagement, and it’s really a process of getting the involved stakeholders around a table to really understand that science and to have accurate information about what can be done and what should be done. And then to figure out how to support the execution of those steps at the community and personal level. Sometimes that needs to involve the healthcare providers. Sometimes that needs to involve educators. Sometimes it needs to involve decision makers or policy makers at the community level.

But it also involves the private sector. I think one of the things we’ve learned in the context of preparedness is how valuable private sector partners are in influencing decisions and support at the community level. Now in Katrina, if it wasn’t for the private sector coming in and really helping to restore services and get people supplied and back on their feet, we would be even further behind than we are in overcoming the aftermath of a devastating natural disaster. So we see the private sector beginning to engage both because they have values that are reinforcing, but also sometimes because it’s good for their business and it’s good for their employees.

An example of that is really obvious to me in some of the domains of food safety, where, for example, the cattle or beef industry recognized that it was bad for business to have people getting sick from eating hamburger. Now they could have waited until there was a whole new cadre of government regulations, but what they did do is get together themselves as an industry and say, look. We’ve got to solve this problem. This is not good for our customers and it’s certainly not good for our business. So what do we need to do to clean up our beef, so to speak. They took the kinds of industrial steps necessary to solve the problem themselves, because they had every motivation to do that.

I think we’re beginning to see in the food industry, more broadly, people recognizing that there’s a market for safer and healthier foods. And as people begin to engage in that marketplace and market to those interests, that most parents and clinicians and increasing members of our society have. I think we’re seeing the market move to support the societal interest in healthy food choices. We may see similar changes in the marketing of fuels that decrease the contribution to changes in greenhouse gases, etc.

So we’re really engaging the private sector as part of the solution. That does not require us to name, blame, and shame the industries as part of the problem because I think we all are increasingly recognizing that in this flat world we’d better be moving in the same direction, because it’s an imperative of our business and probably of our individual survival.

Matthew:  Yeah, that’s right. I guess you can say that the Nintendo Wii is a new video game that you actually have to move around when you play it, so maybe even that’s going in the right direction.

Let me ask you about something that’s obviously in the news this week. That is gun violence, given the tragedy that we just had at Virginia Tech. In the 90s, and this is just from a casual observation, it seems to me that the medical profession and the CDC were very involved in identifying gun violence and handguns as actually a a public health issue rather than just a public safety issue. There’s been some criticism in the last couple of days that over the last few years, CDC has backed off that. Where is the whole issue of gun violence as a public health issue, and what is the CDC’s position about that? Where do you think we should be taking that as a public health issue, rather than as a criminal justice and crime issue?

Julie:  First of all, let me say that CDC shares with people around our nation and our world in the sadness about what just happened in the state of Virginia on the university campus.

Matthew:  Of course, yes.

Julie:  It was just a breathtaking tragedy. Our role in violence is first of all, again, to do the science. To understand the epidemiology of the problem. We know, for example, that of children who are victims of homicide in our country, about 1% of those children are killed in situations that involve schools. So school-related violent deaths are tragic and conspicuous, but they are a very small fraction of the overall tragedy of homicide in our youth. We also know that there are things that can be done.

For example, CDC works in partnership with the Department of Education and the Department of Justice to get information and details about violent deaths so we can try to understand the trends and implement some prevention measures. There are some simple things that are common sense, like encourage efforts to improve supervision and to have plans in school environments to handle disputes, especially during school transition times that are the most vulnerable times for violence to be a problem. We also know that students need to have information about where to go when they see someone threatened or when they feel threatened. Because a significant proportion of violent activities in schools are preceded by warning.

So rather than keeping that warning to themselves or holding it in because they don’t have a safe place to bring it up, there are things that schools can do to help create a safe haven for students who feel threatened, and to get an earlier warning that a problem may be brewing. And of course there are the broader issues having to do with general security at schools and making sure that people are trained and understand how to handle threats or actual occurrences.There are many supports for this. You can find many of them on CDC’s home page right now at www.cdc.gov, where we’re highlighting school-associated violent deaths as a resource. Because we know that people are concerned and are worried about this: many parents and school leaders and others.

Our role here is first to try to do what we can to frame this as an important public health issue, but also to direct people to best practices or solutions that school systems have been able to implement in an effort to try to handle this upfront.

Matthew:  Would you say that there’s been a lesser emphasis on this in CDC the last few years than perhaps there was in the 1990s? Might you see that be changing again, or do you think that that’s just not a worry?

Julie:  I’ve only been the CDC director for the last four and a half years, so I can’t comment on what happened at CDC in the 1990s, but I can certainly say that this has been on the radar screen since I’ve been the director. Our National Center for Injury Prevention and Control has a very large and healthy violence prevention program that is one of the better-funded injury programs that we have at CDC. It’s a key issue. We know that injuries, generically, are the leading cause of death for people in our country up to at least age 20, and that for youth and teenage years, motor vehicle accidents may be number one, but homicides and suicides follow right behind. So if we really want to improve the health status of our teenagers, we’re going to have to deal with violence in the form of homicide and suicide.

Matthew:  Let’s go on to a slightly cheerier topic, which is the notion of what you’re looking forward to at the Congress itself. I don’t know when exactly you’re going to be there, but there are a wide variety of people from different parts of the healthcare system and different types of organizations who are going to be there. What types of things are you going to be looking for, and what are you looking forward to?

Julie:  I think the most exciting part of the Congress for me is just simply the convening. It’s getting people together with such a broad set of perspectives and such broad experiences and really focusing in on some of the key challenges that we’re all collectively working on. The mark of any good conference is always your ability to learn more than you could ever hope to contribute, and I’m sure that will be true for me at this conference as well. But I look forward to it, and I’m sure I will be able to learn a lot.

Matthew:  That’s great. We look forward to seeing you there. This is Matthew Holt . I’ve just been talking with Dr. Julie Gerberding. She’s the director of the Centers for Disease Control, and she’ll be participating in the World Healthcare Congress coming up on Sunday, Monday, on Tuesday. Dr. Gerberding, thank you very much for your time.

Julie:  Thank you very much.