Fighting Frieden
Nice smile, not-so-nice approach to fighting AIDS, diabetes and other diseases
Many New York City community health advocates are dismayed by talk that Department of Health and Mental Hygiene Commissioner Dr. Thomas Frieden’s name has been floated as a possible director of the CDC Centers for Disease Control and Prevention. Advocates criticize Frieden for implementing coercive measures to deal with public health while ignoring the need for increased access to community health providers.
“Appointing Commissioner Frieden to the top post at the CDC would be a devastating blow to combating HIV/AIDS in the U.S. as well as other chronic illnesses that require complex public health solutions and involvement from local communities. Throughout his tenure as New York City Health Commissioner, Frieden has simultaneously employed an authoritarian, my-way-or-the-highway approach and an unabashed secretiveness undignified of a public servant. He has excluded AIDS groups wherever possible from having input into life-and-death AIDS funding, testing and care policymaking decisions,” said Housing Works President and CEO Charles King.
The New York Times City Room blog wrote Wednesday about Housing Works’ opposition to Frieden.
While some were afraid to speak out for fear that their organizations would lose city funding, the view that Frieden is wrong for the CDC job is widespread among community health advocates.
“Tom Frieden seems to be way more interested in tracking, monitoring and surveillance than implementing effective services, and it’s not clear what he’s tracking, monitoring and surveilling,” said Judy Wessler, director of the Commission on the Public’s Health System, which advocates for children’s health.
Wessler said she had originally been optimistic about Frieden’s appointment in 2002, since he has a strong public health background and his work controlling tuberculosis was universally respected. But Wessler and other community advocates were quickly disappointed by Frieden’s focus on monitoring and surveillance, without taking into account civil rights protections, often to the detriment of community health. Wessler cites the fact that the DOH closed community dental health clinics despite the fact that 55 percent of children on Medicaid haven’t seen a dentist.
While Frieden was widely praised for instituting universal HIV testing in the Bronx last year, Health People Executive Director Chris Norwood noted on the New York Times website, “While widespread HIV testing is crucial, unfortunately, DOH has gutted the Bronx’s HIV support services. It now sends some 60% of the more than $100 million a year the city gets in federal AIDS support money to Manhattan organizations.”
This wasn’t the first time Frieden ignored input from people in the Bronx regarding HIV/AIDS. In response to a letter from Bronx advocates in 2004 about the borough’s exclusion from the New York City Commission on HIV/AIDS, Frieden wrote that the commission “was created as a high-level deliberative body” and “not meant to include members from every specific sub-population or borough.”
He doesn’t listen
After taking office Frieden disbanded monthly meetings of advocates to discuss issues in their communities. “The emergency rental assistance fund came out of the housing work group because people around the table knew that it was a tremendously needed program,” said Gina Quattrochi, who had been a member of the AIDS housing work group before its demise. “What came out of those processes really addressed the needs of the community, and Dr. Frieden hasn’t always demonstrated his willingness to listen.”
This unwillingness to listen became clear when Frieden sought to persuade New York State legislators to make sweeping changes to the state’s HIV-testing policies, including the elimination of written consent and pre- and post-test counseling. He also attempted to divert AIDS funding away from community-based AIDS organizations toward large hospitals and ignored the need for basic services, such as housing, that allow low-income people to remain medically adherent. Frieden’s effort showed his indifference to both the profound stigma attached to AIDS and his ignorance of the critical role supportive services provided by community-based organizations play in the health of people living with the disease.
Frieden also sought—and received—sweeping access to medical records of people living with diabetes while giving insufficient consideration to the damage that the revelation of personal health information could pose for individuals.
In response to Frieden’s diabetes surveillance measure implemented in 2005, people with diabetes expressed concerns—ignored by Frieden—that access to their medical records would further stigmatize them. As one patient said at a public hearing, “As a diabetic I am not a threat to the City’s public health, nor do I wish to be treated as one.”
Yet Frieden didn’t listen, and routine medical examinations for all diabetics are now sent to the DOH, along with all of their contact information. When Frieden doesn’t like the results of the tests, diabetics’ doctors receive notes from the DOH. At the same time, Frieden ignored the fact that diabetes sticks are not covered by Medicaid and failed to address other systemic reasons why people with diabetes are not receiving proper treatment.
New York State legislators wisely rejected Frieden’s misguided efforts to reform HIV testing and expand Health Department control over HIV information—diabetics weren’t as lucky—but as head of the CDC Frieden would not be readily beholden to a legislative body to formulate key aspects of the nation’s public health policy.
Not over till it’s over
Right now, Frieden’s appointment is purely speculative. Dr. Richard Besser is currently serving as interim director after Julie Gerberding’s ouster, and Health and Human Services Secretary Tom Daschle will likely replace him when he is officially confirmed. But New York City public health advocates want to make sure that Frieden’s heavy-handed public health strategy isn’t inflicted on the country.
“Would I like to see him leave the New York City Health Department? Yes. Would I like to see him go to the CDC? No. He could go to some other state, I guess,” Wessler said.
To join a coalition of advocates in opposing a Frieden CDC appointment, contact terri smith-caronia at smith-caronia@housingworks.org
Posted on January 31, 2009 at 3:22 am
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