A Conversation with Dr. Julie Gerberding, the 2013 BUSPH Commencement Speaker.
As director of the Centers for Disease Control and Prevention, Dr. Julie Gerberding oversaw an agency that parsed a seemingly endless supply of data into critically useful information for advancing public health.
Effective monitoring of disease outbreaks — coupled with breakthroughs in medications — have saved countless lives but Gerberding, the 2013 BUSPH Commencement speaker, hopes graduates help change a complex health care system that she believes is more focused on fixing disease than preventing it.
“It’s really up to the leaders in the public health community to help drive our nation toward a true health system, not just one that can apply the latest technology and tools for treating disease once it has occurred,” Gerberding said.
In her current role as president of the vaccines division of Merck, one of the world’s largest pharmaceutical companies, Gerberding manages researchers leveraging technology to improve the health of millions. She has been an evangelist for prevention since her early training in internal medicine and infectious disease control. She taught on the faculty at the University of San Francisco before joining the CDC in 1998 as director of the Division of Healthcare Quality Promotion at the National Center for Infectious Diseases (NCID).
Stopping illnesses before they begin was a core component of her work at NCID, where she led teams developing patient safety initiatives and other programs to prevent infections, antimicrobial resistance, and medical errors in healthcare settings. When Gerberding was promoted to head the CDC from 2002 to early 2009, she helped the massive agency shift its focus toward chronic diseases, home and workplace injuries, and obesity – all common, all preventable.
Looking ahead, what are some of the themes that our recent BUSPH graduates will be facing?
“They’re going to be facing a world where continuous evolution is the norm. Nothing will be static, everything will be changing. Change is the first thing, connectivity is the second.
“Another emerging theme is the idea that cross-disciplinary, horizontal networks will really drive planning and decision-making. No one is going to be able to work in a silo and we’re going to have to draw upon expertise from multiple disciplines to solve the complex problems that we’re facing. No monotonic solutions will be likely to drive the kind of change we’re going to need going forward.
Will those types of partnerships be applicable both internationally and domestically?
“Yes, it’s cross-discipline, but it’s also cross-sector — and in particular the model there will be the private-public partnership.
What advice do you have for graduates who, like yourself, came into public health with a varied background? How can they apply that background for the good of the field itself, and for their own personal growth?
“Public health is a set of capabilities and the more opportunities you have to put tools in your toolbox, the more likely you are to be able to use them for constructive purposes as you go forward.
“So, if you start out in an academic environment in the health professions and you learn clinical care, that’s an important set of capabilities and tools. If you work in a research lab, that’s another set of empowering tools because it teaches you the discipline and methodology of science, but also the terminology and culture of science. If you’re specializing in a particular area, or getting an academic degree in a particular discipline within public health, that definitely adds to your toolbox. Practicing your trade, whether in government or in a city or county health department, or in a non-governmental organization, are also ways of contributing and building your own capabilities and tools.
“Over time you can build up a set of skills that will make you adaptable to whatever environment you choose to serve in.”
Throughout your own history, you have done many different things in different fields, but what’s been most helpful to you? Was there anything that you didn’t expect you would need?
“The most important thing to me of anything is that I’m a physician first. In my mind, I’m always at the bedside — whether I’m actually treating a patient at San Francisco General Hospital, or speaking to a group of people in a press conference who are nervous and worried about the most recent health crisis, or counseling people in a business environment who are trying to launch a vaccine or deal with frightened parents.
“In all of those cases, the metaphor I try to keep in my mind is the humility of being privileged to be a member of the medical profession. At the end of the day, that’s the skill set that combines empathy and humanitarianism with science and medicine. That really provides the best perspective to deal with complex health issues.
“So at my core, I’m a doctor first.”
Does going back and seeing patients in a hands-on, hospital environment give you the opportunity for an early look at some emerging public health issues?
“Most public hospitals in inner city or rural areas tend to be harsh indicators of the state of health in the United States. At San Francisco General Hospital, I used to track what proportion of the patients’ medical conditions were problems that we at CDC were supposed to be preventing. We were tracking the number of people with complex infections, or with head trauma from not wearing seat belts or helmets. How many seniors who fell and broke their hips could have been prevented if their homes had been equipped with the simplest injury protection measures? What proportion of patients with cervical cancer should have been screened and vaccinated? What proportion of patients with hepatitis B infections should have been given clean needles, or vaccinated against hepatitis B at birth?
“So when you go through the common medical conditions – not even talking about the obesity-related conditions that cause cardiovascular disease, kidney disease and diabetes, not to mention cancer – the vast majority of conditions that cause hospitalizations are preventable. It’s a harsh indicator that we have a great deal more to do before we really have a health system as opposed to a disease-care system. It’s really up to the leaders in the public health community to help drive our nation toward a health system, not just one that can apply the latest technology and tools for treating disease once it has occurred.”