Ex -director of the CDC: the last words that my father gave me – and what they taught me to save lives
On September 11, 2001, I was deeply in rural India, five years after an assignment to help control tuberculosis. In the hall of a small hotel, I looked on a vacillating television like the second round of the World Trade Center had fallen. I was born in New York, I was trained as a doctor there and managed his tuberculosis program. Looking at my hometown under attack, I knew it was time to come back. Three months later, the rubble, the mayor elected Mike Bloomberg called for asking me to become a health commissioner.
Before I start, I visited my father in his nursing home. He was a cardiologist. Calm, kind and a man of a few words. Parkinson’s disease had silenced him almost completely. I sat down at his bedside, holding his hand, and I told him about my new role. “Dad,” I say, “I want to be the best health commissioner.”
He looked at me and gently pronounced the last words he would speak to me: “How would you know?”
It was a devastating question. How do you know that if you are doing a good job in public health? Being the best does not mean giving the best speech, pushing through the most daring politics, or even working the longest hours. This means saving the most lives. But how could we measure this? At the time, tobacco killed more in New Yorkers than anything else. However, we did not even know how many people smoked. Nobody counted.
This changed when my colleague Dr. Farzad Mostashari launched a simple but powerful investigation. We started calling 10,000 New Yorkers each year, asking if they smoked cigarettes. Sober results: 22% of adults have smoked, without progress in a decade. If nothing changes, tobacco would kill 400,000 New Yorkers and deactivate one million others with heart attacks, strokes, lung disease and cancer. Now we could clearly see the crisis. The next step was to act.
The increase in tobacco tax was the most effective way to reduce smoking. It was a deadly political fight, but with the management of mayor Bloomberg, the tax increased by $ 1.42 per pack. The survey of the following year showed a major drop in smoking. Shortly after, we adopted a law making all the restaurants and bars without smoke. After that, the survey of the following year showed another drop.
I thought we had cracked it. But the following year, the survey showed something alarming: progress had blocked. It was terrifying. We could fail at our absolute priority.
The data forced us to rethink. We tried to note the tax again, but the state legislature refused. Then came a risky option: spending $ 10 million, money that could finance clinics and staff wages, on anti-Tobacco ads. I was not convinced. But the data gave us the courage to play.
The survey of the following year revealed the results: the announcements worked. Smoking has dropped again, especially in the communities that we had the most targeted. Our bet has borne fruit in fewer smokers, longer lives and healthy future.
This is how I could answer my father’s question. Monitoring – Systematically measure what matters – visible invisible progress. Without that, we would have tripped blindly, not knowing if we save lives or gaspillons from time and money. With that, we knew it. Public health is generally not making one of the newspapers. A life saved by dramatic medical care is celebrated as a miracle, but millions saved by prevention are often invisible. Monitoring highlights these anonymous lives, proving that prevention works.
Today, smoking is at low records. Less than 4% of American high school students smoke, the lowest rate ever measured. I continued this work in recent years, when President Obama appointed the director of Centers for Disease Control and Prevention (CDC), where I served for eight years. Most people who have smoked in the past have already resigned. Progress is real and measurable. The last words my father gave me, How would you know, Stay my director. They remind me that good intentions are not enough. We need proof that our actions lead to real results.
This same approach, which I reveal in my next book, The formula for better health: how to save millions of lives, including yours It is to see what is really going on, to believe in the possibility of progress and to work systematically to create a better future. This is relevant not only for public health but also for personal health and for any organization trying to make a difference. For your own health, you could ask yourself a version of the same question: How do I know if what I do work? The drugs you take control your blood pressure? Do you get a physical activity with which you can stick to for years? Do your efforts lead to a longer and healthier life? My father’s question pushed me to see progress and failure, clearly. This is a question that can guide us all towards longer and healthier lives and our organizations to faster progress.
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