A Person Who Aims At Nothing Is Sure To Hit It

The Centers for Disease Control and Prevention (CDC) is one of those entities you hear about on the news occasionally but also one that few people really know much about.  Rarely do we hear about the CDC except when flu season gets going or when some new infectious disease hits our shores. Yet the CDC has a broad federal mandate and a $6.6 Billion/year budget to make a difference in public health and their stated mission is “to collaborate to create the expertise, information, and tools that people and communities need to protect their health – through health promotion, prevention of disease, injury and disability, and preparedness for new health threats.”  That’s a pretty broad mission, particularly given the broad constituency the CDC serves: Americans of every shape, size, age and ethnicity.  The CDC’s original mission when it was founded in  1946 was singularly to eliminate malaria in the U.S. going after the mosquito population (thus paving the way for Obama’s safe passage through Iowa backyard barbecues 64 years later).

Back in June 2009, President Obama appointed Thomas R. Frieden, M.D., M.P.H., as Director of the Centers for Disease Control and Prevention (CDC).  Frieden achieved fame in his role as New York City’s Health Commissioner when he succeeded in achieving a ban on smoking in public bars and restaurants and for going on a mission against obesity and diabetes by forcing restaurants to eliminate trans-fats and requiring chain restaurants to post calorie counts on their menus.  His results were pretty impressive:  350,000 fewer NY smokers and the elimination of trans-fats in more than 90% of all NY restaurants.    Plus, a new definition of a New York minute:  the time it takes you to run screaming out of the TGI Fridays in Times Square when you realize that one order of their Loaded Bacon and Cheddar Potato Skins has 1100 calories and 3000 mg of sodium.

So like any good New Yorker, Frieden has ruffled a few feathers since he came to the CDC.  Most recently, he achieved this by declaring that the agency can’t do everything and that, instead, it should focus on “winnable battles” as he calls them.   Frieden has chosen to focus his team’s efforts on six specific public health problems, which are:  smoking, AIDS, obesity/nutrition, teen pregnancy, auto injuries and hospital-acquired infections.  The immediate result of this prioritization and narrowing of focus was the ire of a myriad of public and private people organizations that have dedicated their being to health issues that didn’t make the cut.

In business, one of the most valued attributes of a leader is his or her ability to focus.  Focus helps one effectively deploy resources and enables workers to set priorities and channel efforts towards essential goals so they can be achieved.  The best managers are often said to be those who can keep their eye on the prize and forsake all else in its path.  Warren Buffett, the capo di tutti capi of businessmen, once said, “You only have to do a very few things right in your life so long as you don’t do too many things wrong. “

But when you work for the government, focus can be perceived as the enemy.  Politicians often find themselves in a position where they are trying to please all of the people all of the time.  In my humble opinion, this is a key reason they are often so ineffective.  As the title of this post says, “A person who aims at nothing is sure to hit it.” (Quote by Anonymous).

Among the complainants about CDC Director Freiden’s chosen priorities are employees at the CDC itself.  There is a CDC employee blog where the minions post their opinions and thoughts, mostly anonymously (and for good reason).  Here are a few examples of CDC staffers’ blog posts about the Winnable Battles campaign:

• It gives the impression that TF thinks of himself as the general and CDC staff as his personal army. Unfortunately there are lots of things that CDC does that need to get done that aren’t part of the “battles.” And the state health departments aren’t necessarily going to do what the CDC director wants and he has no real control over them. I don’t think he has a very good concept of how a federal agency works.

• It’s a coward that focuses on “winnable battles”.

New Yorkers may be perceived as a tough crowd, but these Washington D.C. folks are brutal, unleashing a veritable social network that echoes with “Hey Freiden, are you tawking to me?!”

The hardest thing to learn in life is which bridge to cross and which to burn.  ~David Russell

But let’s be realistic, so many health problems, so little time.  If the CDC and its companion agencies don’t focus their efforts, they can’t possibly get anything done.    At least Frieden has focused on issues that have knowable solutions and not on finding a unicorn on the Capitol Mall.

Refreshingly,  several of these 6 winnable battles line up nicely with the priorities of employers seeking to address the out of control healthcare costs that are eating up their corporate earnings.  Not a 100% overlap, but not bad.  Points of commonality include efforts to reduce hospitalization due to illness and error; activities to eliminate the costs related to smoking and smoking-related illness ($97 billion from loss of productivity due to premature death and $96 billion in smoking-related health care costs); and, actions to positively impact the $147 billion in annual costs related to obesity, which affects nearly 25% of our population.  Employers have sunk a fortune into wellness and disease management programs that target these same issues and it is fortuitous that the government has its resources targeted to support these efforts.  This is one instance where Obama’s team is demonstrating an affinity towards the interests of the business community, which many believe is not their typical stance.

I like that the CDC has also targeted a key patient safety issue among their goals by taking on hospital-acquired infections.  With over 1.7 million such infections afflicting patients each year and clear evidence that such infections can be virtually eliminated by adopting best practices at the hospital bedside, this is a serious win-win opportunity that could potentially save 100,000 lives annually while saving the U.S. healthcare system up to $8 billion per year.

I think it is also interesting that vehicle related injuries made the cut.  As the parent of an about-to-drive teenager, this is welcome news.  Auto accidents are the leading cause of death for people ages 1-34 and nearly 5 million people are injured each year in these incidents.  $230 billion is spent as a result of auto accidents.  This may not be the typical problem taken on by the CDC, which has historically focused primarily on infectious diseases, but it’s a good one to have on the list.    No doubt that Freiden’s years in New York trying to avoid being killed by a taxi have given him a unique perspective on this issue.  I am hoping that the CDC’s offered solution is not simply to issue those little hanging evergreen tree deodorizers to every U.S. driver. What do those things really do anyway?  Could it be possible that New York cabs would smell worse if they weren’t present?  Fuggetaboutit!

I understand that there are people and interest groups that focus on equally serious health issues that are disappointed by the “Winnable Battles” prioritization at the CDC.  I also understand that it is the nature of government to try to throw everyone a bone so you get to keep your job (there is an entire TV station dedicated to watching this trait in action:  C-Span).  However, in my mind it is a welcome change to see public officials step out and take a stand by admitting that they cannot do it all and by being responsible enough to make good choices.

I will close with a great quote from former U.K. Prime Minister Tony Blair:  It is not an arrogant government that chooses priorities, it’s an irresponsible government that fails to choose.