In spite of everything, we retain an innocent trust in government. When Publisher's Clearinghouse says that your million dollar prize will be delivered by an employee of the United States government, they mean "the check is in the mail." We put out our garbage cans at night with the same certainty as children hanging Christmas stockings. We drive 65 in a 55 mph zone because we assume the roads will be maintained. Never mind that Alberto Gonzalez of torture memo fame is Attorney General; when we read that a person is under investigation by the FBI, there's still a feeling that there's a good reason for the investigation.
Government may have a gear loose at the very top, but we believe the nuts and bolts will be solid. We're slow learners.
The Centers for Communicable Disease Control and Prevention (CDC) is part of the Department of Health and Human Services, but only a small part. It is headquartered in Atlanta, not Washington, and its activities go beyond the obvious communicable diseases, the bacterial and viral conditions, to include workplace hazards, disabilities and environmental health threats. The director, Dr. Julie Gerberding, joined the CDC in 1998 as head of its healthcare quality program. She hold degrees in medicine and public health. Forbes magazine ranks her as the 23rd most important women in the world, one slot below Margaret Whitman, CEO of eBay. The CDC does essential work on a budget that's surprisingly reasonable by Washington standards.
But in the past two years, the CDC has been hit by what the Atlanta Journal-Constitution described as a "brain drain." Although the absolute numbers of people who chose to retire from the CDC has not been large, just 46, this is far higher than the average in past years, and includes some of the most skilled and experienced senior staff. Dr. Jose Cordero, director since 2001 of the National Center on Birth Defects and Developmental Disabilities, resigned in August. Dr. James Marks, director since 1995 of the National Center for Chronic Disease Prevention and Health Promotion, who had been with the CDC since 1980; Dr. James Hughes, director since 1992 of the National Center for Infectious Diseases; Dr. Sue Binder, director since 2000 of the National Center for Injury Prevention and Control; and so on. The people leaving have been unwilling to speak to the press, or have spoken glowingly of the wonderful opportunities they were offered elsewhere. Others have declined to discuss their career choices.
But the 2006 budget for the CDC was cut by $500 million, and priorities shifted away from the traditional role of the CDC toward "bioterrorism preparedness." The largest increase in the CDC budget was a $203 million allocation for the Strategic National Stockpile (SNS), a program designed to "ensure a sufficient supply of countermeasures and ensure bioterrorism preparedness." The National Association of County and City Health Officials (NACCHO) basically describes the SNS system as loads of antibiotics and other medical supplies that can be delivered to the site of an emergency. The budget cuts, in part, come from programs designed to deal with chronic diseases and lifestyle problems that have led to epidemics of obesity and obesity-related conditions.
"It is estimated that cardiovascular diseases will cost our country more than $394 billion in healthcare costs and lost productivity this year," said William Colledge, Chairman of the Board of Directors of the American Heart Association, in a statement. "To reduce that figure, and more importantly, to save and improve lives, we have to prevent these diseases first. Cutting CDC's funding won't make prevention easier."
The resignations and retirements at the CDC have been quiet and slow. The Atlanta Journal-Constitution, which reported the story, had no anonymous source at which to point fingers. There are no reports of open political corruption or cronyism. But apparently there is an increased emphasis on having staff members, who are officers in the Public Health Service, wear the outfit more often (the uniform looks like a Navy uniform). There is more concern about passing physical-fitness tests. There has been a major restructuring and development of large numbers of new programs, which would be fine if there were also new funding or if the old programs were no longer needed.
The CDC had been one of the best examples of what government can and should do, and its senior staff was something special. Now, it has not so much exploded as eroded. It seems typical of the current administration. Even when they don't have glaring failures, the kind that make national headlines, they find ways to leave the nation just a little bit worse than the way they received it.
Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.
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