The state of public health is something that the COVID-19 pandemic put at the forefront of people’s minds in potentially new ways.
After decades of medical advancement, that much of the world seemed caught off guard from the novel coronavirus has seemingly given every outbreak since – like bird flu and measles – a new sense of urgency. And alongside it, a rise in medical skepticism and misinformation.
Now, new book is putting forward a strategy built around a simple formula that aims to reexamine our approach to both public and individual health, and hopefully save lives in the process.
Dr. Tom Frieden is the former director of the Centers of Disease Control and Prevention and the author of “The Formula for Better Health: How to Save Millions of Lives – Including Your Own,” out today.
Frieden joined Texas Standard for an extended discussion. Listen to the interview above or read the transcript below.
This transcript has been edited lightly for clarity:
Texas Standard: You structure your book around a simple three-part formula you came up with on how we as a society could better save lives. Can you give us a summary of those three parts?
Tom Frieden: There’s an approach, a formula, that has been proven to save millions of lives. It can save millions more, including your own, and it is see, believe, create.
See the invisible. Believe that what may seem unchangeable actually can be fixed. And then work systematically to create a healthier future for ourselves, our families, our communities.
Each three of those elements is hard but possible. And there are rigorously proven ways to do it that I’ve learned in 40 years of fighting everything from tuberculosis in India to Ebola in West Africa to multi-drug resistant tuberculosis in New York City.
Dr. Tom Frieden is the former director of the CDC. Raul Alonzo / Texas Standard
“See, believe, create.” Sounds so simple. Of course, we’re not done with those three steps.
The thing about it is, is you think about that first step, the seeing. And going back to COVID-19 days, it wasn’t as if people couldn’t see that. I can remember it being part of the larger conversation, social conversation, most certainly. And yet, I think there was a sense of doubt that we would be affected by this. It seemed to be happening, what, half a world away when those first reports started coming in.
So there’s the belief part. How do you make that jump? Especially when someone’s gonna have to be the first to say, “hey, we gotta take this seriously.”
Let me step backwards to the “see” part of it. Because what “see” has to do with is see invisible trends, see why we don’t pay attention to the threats that might kill us and see the rigorous fact-based pathway to progress. And we didn’t get that right in COVID.
So first off, we didn’t see what was going to happen in time. It hit us like a ton of bricks.
Why not? This is a repeated thing.
It is. And it comes back to something I talk about in the book. It’s something called the Cassandra curse.
Cassandra was a mythological priestess from ancient Greece. She was blessed with foresight. She could see the future, but she was cursed. Nobody believed her predictions and therefore didn’t change their behavior. And therefore, the tragedies that she could foresee happened.
And that’s kind of like what we in public health have been like. And that’s what we as individuals are like too much if we keep smoking when we know it might kill us or we do other things that may harm us.
The reason the Cassandra curse exists, the reason we have to see why we don’t do those things is that we don’t perceive ourselves or the world or the future as accurately as we could. And if we improve that perception, we can take much better action.
There’s something that’s been called the ostrich effect or the normal bias – that we assume the world is just gonna continue the way it does all the time. But in fact, it’s already changed a lot and it can change more.
But it’s interesting you should mention smoking because I can remember going back to reading about the Surgeon General’s report. I guess it was in 1964 or something, right? And it took years for that to develop a kind of central mass where people were thinking – not that I’m going to be the exception – but I could be on that list of people who get the diagnosis of cancer.
There are proven ways to fight the leading killers of our time, as there are for tobacco. And this is part of the “create” part of formula – to do what works, not what sounds good or feels good necessarily.
But in tobacco control, as an example, taxation. Big difference. The more you tax tobacco, the fewer people smoke. Smoke-free places, hard hitting ads… You do the things that work.
When I was health commissioner in New York City, we made tobacco control our number one priority. When we started, 22% of adults smoked and about the same proportion of kids smoked. Today, it’s less than half that number for adults.
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Absolutely, but we’ve had a sort of a changing of thinking around this. And that was a huge project unto itself. And I can’t help but think that one of the greatest obstacles that we face is getting to that point where you can create, where you have the political will. And it seems like it kind of comes down to that.
When you think of COVID-19, I’m skipping around a bit here, but at the same time, thinking about how this applies to all of these health problems… In COVID- 19, there was not that depth of agreement, certainly, and as the COVID-19 restrictions went on, it seemed like there was greater disagreement over what the threat really was.
How do you get that sort of political will? How do generate the political will you have so many people who are in disagreement over what is posed by this health crisis?
You start with seeing. So COVID is a deadly disease, especially if you’re older or have a serious health problem. For younger people, it can be pretty mild or completely no symptoms at all.
What about the vaccine? Well, the vaccine reduces your risk of serious illness. What about mandates? Not a good idea, right? The COVID vaccine protects you. It doesn’t do much to prevent you from spreading it to others.
So we shouldn’t have been mandating people to get the vaccine.
You think that was a mistake?
I do.
There are a lot of people who feel very strongly that, no, if not for the mandates, there would not be the vaccination.
If you take other things, there are a lot of things about COVID that are controversial.
Masks got, I think, unnecessarily controversial. The data on masks is pretty clear. They’re not perfect, but they’ve reduced the risk that you’re gonna give me COVID if we’re indoors together, including before you have any symptoms, because about half of the spread of COVID is when you feel totally fine.
Now, I’m not saying everyone should wear masks or be forced to, but there are certain times. If our hospitals are getting overwhelmed, would you rather close all your businesses or wear a mask when you’re indoors?
There are other times when it doesn’t make any sense. Wearing a mask out of doors really doesn’t make much sense.
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Let’s fast forward here. Let’s imagine that there’s going to be, and you don’t have to imagine too hard. I mean, there is going to another public health crisis that we have not yet articulated in that, again, public conversation.
Let’s image a hypothetical here. We’ve heard about some virus half a world away that could create some potential problems in the U.S. How do you begin to see what the issue is going be? And move on from seeing to believe.
Well, first, my organization, Resolve to Save Lives – I have to say neither I nor my organization take a penny from the pharmaceutical industry. Don’t now, never have, never will.
What is your organization?
It’s called Resolve to Save Lives and we partner with communities and countries around the world to tackle the world’s deadliest threats with solutions that can be scaled up.
One of the things we do is we partner countries so they will find a virus like that faster and stop it sooner. Because the first thing we can do is to see sooner, to find these things and stop them where they first emerge before they come to our shores. That’s the first thing to say: That a lot of the threats don’t have to happen if we stop them when and where they emerge.
Second, we need to quickly understand that threat. How serious is it? How does it spread? How do you prevent it? And we have to be very clear about communication.
In the early days, we may need to say over and over again, “there’s a lot we don’t know.” We’re going to share with you whatever we know, when we know it, we’re going make clear that this is based on what we know now and things may change over time. That’s how real facts work. They don’t work with certainty.
If you think about science, science doesn’t lead to certainty. Science leads to humility. The more someone really understands the topic and I mean…
The more questions you’re asking.
… I’ve studied it for five or 10 years or more, the more I recognize what I don’t know and what I’m pretty certain.
So with that kind of authenticity, you’re hoping that you can come up with a structure.
Absolutely. And we need to do things like make sure healthcare workers are safe, because they’re often the canary in the mine shaft. They die or get sick or infected, and that’s not okay. We need them to be healthy to protect us.
So we have to protect the healthcare workers. We have to quickly figure out what is really happening. We have quickly figure what works to prevent spread. And then we have work with communities to decide how to that.
Part of that belief and moving into actions, though, seems to be that we have to have trust in the institutions that are there. And I see you looking up and rolling your eyes like, “yeah, boy, oh boy.”
That does seem to be a big problem. And especially now, there seems to be a lot of concern about where we are with the public health system in the United States.
It’s a huge problem. I think part of the problem is that we don’t live in the same reality anymore. Used to be said, you’re entitled to your own opinion, but not your own facts. Now people are believing their own facts.
There really are facts and they’re important. We’re never gonna find out that cigarettes are good for you. We’re not gonna find that a higher cholesterol keeps you healthier. We’re never gonna find more sugar is good or that more salt is good.
We can work together. Because if we improve health for people, for communities, all of us are better off. Businesses are more productive. Healthcare costs are lower. People are happier. Kids are healthier. So there’s a lot of common ground in health.
Do you believe that, I mean, as you’re no doubt aware, currently we have the health secretary, Robert F. Kennedy, who is launching this Make America Healthy Again. There are a lot of people in the U.S. who believe that that’s the right direction, that in some way separates us from some of the institutional problems that have existed in healthcare, many of them legitimate.
At the same time, there are a lot of people who feel that we are moving in a wrong direction and that in some way this is promoting and accepting a lot of fake science.
Where do you see things heading right now? Are we headed in the right direction, headed in wrong direction? Winning, losing, what are your concerns?
I think a lot of the concerns are absolutely spot on. Yes, we’ve got way too much preventable disease in this country. Yes, we have a healthcare system that emphasizes high-tech, high-cost, invasive procedures.
The diagnosis is not bad. The treatment is a problem. Watch what people do, not what people say.
And I can tell you, as a doctor, as an internal medicine specialist, as someone who’s worked in public health and looked at the data from the research that I did for the book over the last 10 years, that there are six things that every person can do to live a longer, healthier life and they don’t have to cost money and I’m not selling anything. And if you’re not focusing on these six things, then you’re really kind of distracting people with things that aren’t nearly as important.
You’re gonna hit me with those six things?
I am.
First, may surprise you because you think it’s obvious, but it’s blood pressure. Blood pressure kills 600,000 Americans every year. We get it right only half the time to even a modest level of control. You want it ideally less than 120, that first number, or definitely less than 140. We’ve still got tens of millions of Americans.
And let me put it to you this way. With high blood pressure, every second of every day, your heart is slamming that into your brain, to kidneys, the heart vessels, and doing damage that’s going to make you die younger, have a stroke or a heart attack or kidney failure or dementia. And it’s easily treatable with generic, safe, low-cost medications. You do have to take them every day and there’s some things we can do to try to prevent it, but most people are gonna need treatment. So the first is blood pressure.
The second is your cholesterol or lipids. And frankly, they’re too high. A lot of people will benefit from a drug like a statin. Now they’re generic, they’re low-cost, they’re safe, they are effective, they’re really underused.
The third is physical activity. Minimum dose: Four days a week, 30 minutes of a brisk walk. You do that especially outdoors and you actually are getting a true wonder drug.
Physical activity improves everything you’d wanna improve. It improves your mood, your sleep. It reduces your risk of cancer. It reduces the risk of a heart attack, stroke or arthritis even if you don’t lose an ounce of weight. So find something you love to do and do it at least four days a week, at least 30 minutes. If you can do more, great, but that’s the minimum dose of this miracle drug.
And then sleep. Sleep is underrated as an important thing. At least seven hours, seven to nine hours of sleep every night. Really important. Cleans out the toxins in your brain, improves your mood, reduces your blood pressure
Avoid toxins. Tobacco, alcohol… There are other toxins in our environment, we can get to that.
And finally, healthy nutrition, which is the toughest thing. But there are a few things. It’s so confusing to people – “eat this, not that.” I try to make clear what’s gonna be most effective is not dieting, but finding healthy food you love and eating more of it.
And one of the things that makes a big difference is eating foods that are high in potassium. We have, most of us, a potassium deficiency. If we consume enough potassium – things like not just bananas that everyone thinks of as high-potassium, but sweet potatoes, salmon, spinach, avocados, yogurt, pistachios, tomatoes, mushrooms – all of these are high potassium. And within reason, the more of them you eat, the better.
The same is true for healthy food. Nuts, fish, fruit, vegetables, olive oil – these are all healthy foods. Find ones you love and eat more of them. Hopefully not deep fried, but more of em.
If there’s any one thing that you would say that you hope your readers walk away with from this book, what would you say it would be?
You can do a lot to control your own health for yourself, for your kids. You can also get involved in your community to make it a healthier community, because most of the illness and death we see today, most of that could be prevented with simple measures that cost little or nothing that we have access to.
