Page 8 - Driving Public Health in the Fast Lane

Expert Testimonial
Anne Schuchat,
MD (RADM, USPHS, RET)
Principal Deputy Director
CDC
Driving Public Health in the Fast Lane
Data are truly the engine of public health. Without appropriate
data, we don’t know how to chart the course ahead, how to
know if we are headed in the right direction, or when and
where we may have made a wrong turn. As data grow bigger, we need
better systems and strategies to manage the flow of information and
ensure access to the most timely content. There are so many fast-moving,
complex public health challenges that require real-time or even predictive
data for public health to fully comprehend and address them. So where are
we now? Are we still puttering along the data superhighway in our Model
T Ford, or are we speeding along in the latest electric car? Spoiler alert:
we are likely closer to the former than the latter. What that means for the
system’s ability to address these complex challenges is that we are woefully
behind. Yesterday’s data systems must evolve to meet future public health
challenges.
The opioid epidemic is one example where the factors driving the epidemic
are changing over time. So far there have been three waves: The first wave
of the epidemic began in 1999, caused by a rise in prescription drug use due
to overprescribing by physicians who were under the misguided belief of
no harm. The second wave of the epidemic came from increases in heroin
use beginning in 2010. The third wave, a rise in synthetic opioids including
illicitly manufactured fentanyl, began in 2013 and has increased rapidly.
Without access to reliable data, we have been slow in recognizing changes
and were also not able to get ahead of these shifts as quickly. It also means
we may not see the next threats to our health coming until they are closer
than we think. We know that 30 million American adults have diabetes but
another 84 million have prediabetes, which can lead to development of
the disease. Nine out of 10 adults don’t know they have prediabetes. This
is a major public health problem – what else is there in our blind spots?
Old diseases are making a comeback and challenging our public health
data systems to keep up. Measles was declared eliminated from the United
States in 2000, yet in 2019 we saw 880 cases in the first five months of the
year. Tracking this resurgence was more difficult than it would have been if
our systems were ready.
Don’t despair—the news isn’t all bad and there are opportunities to
strengthen and improve our data systems. We need a few things to do this:
Deep, growing data sets that drive new analytics; the ability to predict,
model, and address diseases based on data quality and currency; and
modernizing the public health data platform, adding data resources that
are well-governed, fast, and flexible. We may not be ready for self-driving
cars in our public health data world yet, but there are an awful lot of ‘driver-
assist’ features that public health really needs to make standard options in
the immediate future.
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