Thomas R Frieden's research while affiliated with Gracie Square Hospital, New York, NY and other places
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Publications (262)
Millions of avoidable deaths arising from the COVID-19 pandemic emphasise the need for epidemic-ready primary health care aligned with public health to identify and stop outbreaks, maintain essential services during disruptions, strengthen population resilience, and ensure health worker and patient safety. The improvement in health security from ep...
Objective:
Implement a user-centred digital health information system to facilitate rapidly and substantially increasing the number of patients treated for hypertension in low/middle-income countries.
Methods:
User-centred design of Simple, an offline-first app for mobile devices to record patient clinical visits and a web-based dashboard to mon...
This Viewpoint discusses 3 areas in need of progress regarding societal approaches to pandemics and other health threats: a renaissance in public health; robustness of primary health care; and resilience of individuals and communities, with higher levels of trust in government and society.
Hypertension is the leading single preventable risk factor for death worldwide, and most of the disease burden attributed to hypertension weighs on low-and middle-income countries. Effective large-scale public health hypertension control programs are needed to control hypertension globally. National programs can follow six important steps to launch...
In 2011, the US Department of Health and Human Services launched the Million Hearts initiative, led by the Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services (CMS) with participation from a wide range of federal agencies, state governments, clinical consortia, community and professional organizations, and...
The COVID-19 pandemic is the most disruptive global health threat in a century. We analyzed publicly available data on preparedness capacity, COVID-19 incidence and mortality, governance, and testing. Although other analyses have suggested that preparedness assessments do not correlate with effective pandemic response, we found that testing rates c...
Despite a history of public health progress and the most expensive health care system in the world, the United States failed in its initial response to COVID-19. Much of this failure resulted from a presidential administration that sidelined, undermined, and maligned public health. But the roots of failure are deeper. Recovering from the pandemic a...
In response to the Covid-19 pandemic, many low- and middle-income countries (LMICs) expanded access to telemedicine to maintain essential health services. Although there has been attention to the accelerated growth of telemedicine in the United States and other high-income countries, the telemedicine revolution may have an even greater benefit in L...
![Figure 1. Primary Sources of Sodium from the United States [8], China...](publication/343828446/figure/fig1/AS:954577377574914@1604600390119/Primary-Sources-of-Sodium-from-the-United-States-8-China-9-and-Costa-Rica-10_Q320.jpg)
High sodium intake is estimated to cause approximately 3 million deaths per year worldwide. The estimated average sodium intake of 3.95 g/day far exceeds the recommended intake. Population sodium reduction should be a global priority, while simultaneously ensuring universal salt iodization. This article identifies high priority strategies that addr...
Because SARS-CoV-2 spreads easily and healthcare workers are at increased risk of both acquiring and transmitting infection, all healthcare facilities must rapidly and rigorously implement the full hierarchy of established infection controls: source control (removal or mitigation of infection sources), engineering and environmental controls, admini...
Non-communicable diseases (NCDs) are the world’s leading causes of death and disability, with cardiovascular disease (CVD) accounting for half of NCD deaths. An ambitious global target established by the United Nations Sustainable Development Goals – indicator 3.4.1 – aims to reduce the risk of premature death among people aged 30–69 years from CVD...
To the Editor Hripcsak et al¹ compared cardiovascular and safety outcomes of chlorthalidone and hydrochlorothiazide in the treatment of patients with hypertension. Chlorthalidone is recommended over hydrochlorothiazide because it has a longer duration of effect (24 vs 6-12 hours) and has been more extensively documented as effective in randomized c...
High blood pressure (BP) is the single leading preventable cardiovascular disease (CVD) risk factor across the world. In order to decrease the global burden of CVD, broad hypertension screening programs that facilitate early hypertension diagnosis and treatment are essential. Accurate BP devices are a key element of hypertension control programs. W...
It appears inevitable that severe acute respiratory syndrome coronavirus 2 will continue to spread. Although we still have limited information on the epidemiology of this virus, there have been multiple reports of superspreading events (SSEs), which are associated with both explosive growth early in an outbreak and sustained transmission in later s...
High blood pressure is the world’s leading cause of death, but despite treatment for hypertension being safe, effective, and low cost, most people with hypertension worldwide do not have it controlled. This article summarizes lessons learned in the first 2 years of the Resolve to Save Lives (RTSL) hypertension management program, operated in coordi...
Background:
Preventable noncommunicable diseases, mostly cardiovascular diseases, are responsible for 38 million deaths annually. A few well-documented interventions have the potential to prevent many of these deaths, but a large proportion of the population in need does not have access to these interventions. We quantified the global mortality im...
Ebola is back. The disease that killed more than 11,000 people in West Africa just a few years ago has returned, striking the Democratic Republic of the Congo (DRC). Last week, intervention with a new vaccine was initiated to help contain the outbreak, adding another tool to a response that is exponentially better than it was 4 years ago. But we ar...
In Reply We agree with Dr Dietz that there has been a reduction in childhood obesity among 2- to 5-year-old children. At the launch of the Winnable Battles initiative, the target selected for childhood obesity was a decrease in obesity among 2- to 19-year-old children and adolescents. Obesity among 2- to 19-year-old children and adolescents increas...
Five years ago, the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, and partners launched a public–private initiative to prevent 1 million heart attacks and strokes by 2017.1 Although final results will not be known for several years, data suggest that the initiative made substantial progress and will achie...
In 2010, the US Centers for Disease Control and Prevention (CDC) identified 6 focus areas termed Winnable Battles, in which concerted effort could lead to substantial health improvement in a short time.¹ Teams selected a limited set of strategies that could enable rapid progress, established ambitious targets, aligned efforts within the CDC, and wo...
The Centers for Disease Control and Prevention (CDC) transformed its approach to preparing for and responding to public health emergencies following the anthrax attacks of 2001. The Office of Public Health Preparedness and Response, an organizational home for emergency response at CDC, was established, and 4 programs were created or greatly expande...
In Reply Drs McCarron and Alderman misrepresent the conclusions of NAM, the UK experience, and the TOHP II study. In 2010, the NAM indicated that reducing sodium added to processed and prepared foods is safe and effective and will provide consumers with greater choice about how much sodium to consume.¹ The 2013 NAM report states, “Although the revi...
Large sample size cannot overcome these design flaws. Among other limitations, several of these studies used a single spot urine sample to assess usual sodium intake; this is an inaccurate measure of sodium intake because it ignores day-to-day variability in sodium intake, diurnal variation in sodium excretion, and the effects of medications. A sin...
Hypertension is a common and major risk factor for the leading U.S. killer, cardiovascular disease.(1)-(5) Reducing excess dietary sodium can lower blood pressure, with a greater response among persons with hypertension.(6)-(9) Nine of 10 Americans consume excess dietary sodium, defined as more than 2300 mg per day.(10),(11) Many leading medical an...
Public health, like politics, is the art of the possible. To maximize effectiveness, public health officers in any jurisdiction should (1) get good data and ensure timely and effective dissemination; (2) prioritize and tackle more difficult initiatives first; (3) find, fight, and win winnable battles in areas where progress is possible but not ensu...
Deaths from prescription-opioid overdose have increased dramatically in the United States, quadrupling in the past 15 years. Efforts to improve pain management resulted in quadrupled rates of opioid prescribing, which propelled a tightly correlated epidemic of addiction, overdose, and death from prescription opioids that is now further evolving to...
A decade ago, we called for applying public health principles to the human immunodeficiency virus (HIV) epidemic in the United States.(1) Over the past decade, U.S. health departments, community organizations, and health care providers have expanded HIV screening and targeted testing, and as a result a greater proportion of HIV-infected people are...
The field of public health aims to improve the health of as many people as possible as rapidly as possible. Since 1900, the average life span in the United States has increased by more than 30 years; 25 years of this gain have been attributed to public health advances.(1,2) Globally, life expectancy doubled during the 20th century,(3) largely as a...
Since Ebola virus disease was identified in West Africa on March 23, 2014, the Centers for Disease Control and Prevention (CDC) has undertaken the most intensive response in the agency's history; >3,000 staff have been involved, including >1,200 deployed to West Africa for >50,000 person workdays. Efforts have included supporting incident managemen...
The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. Out of this human calamity has come renewed attention to global health security--its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities,...
This Viewpoint discusses the importance of innovation and persistence in tuburculosis control programs.
Despite being nearly 100% curable, tuberculosis remains a major public health problem, representing the second leading cause of death from infectious diseases globally, with drug-resistant tuberculosis increasingly common. In 2012, an estimated...
Since Ebola virus was first identified in 1976, no previous Ebola outbreak has been as large or persistent as the current epidemic, and none has spread beyond East and Central Africa.(1) To date, more than 1000 people, including numerous health care workers, have been killed by Ebola virus disease (EVD) in 2014, and the number of cases in the curre...
The rate of death from overdoses of prescription opioids in the United States more than quadrupled between 1999 and 2010 (see graph), far exceeding the combined death toll from cocaine and heroin overdoses.(1) In 2010 alone, prescription opioids were involved in 16,651 overdose deaths, whereas heroin was implicated in 3036. Some 82% of the deaths d...
The 1964 surgeon general’s report on the health harms of smoking “hit the country like a bombshell.”1 More than 40% of US adults smoked, and smoking was accepted and considered normal behavior. Today, the US adult smoking rate is around 18%2 and about half of Americans are protected from secondhand smoke in workplaces.3
Public health programs succeed and survive if organizations and coalitions address 6 key areas.
(1) Innovation to develop the evidence base for action; (2) a technical package of a limited number of high-priority, evidence-based interventions that together will have a major impact; (3) effective performance management, especially through rigorous,...
Improved treatment of hypertension is among the most important—and quite possibly also the single most neglected—area of clinical medicine. Only half of Americans with hypertension have blood pressure less than 140/90 mm Hg, and more than 13%—an estimated 9 million people—have a systolic blood pressure of 160 mm Hg or higher and/or diastolic pressu...
sodium interventions. The IOM committee determined that sodium intake impacts health outcomes through pathways in addition to the blood pressure pathway. The report included recommendations to strengthen research to understand the extent of the effect of sodium on blood pressure and then to events and mortality and for more studies addressing mecha...
What is the appropriate role of governmental public health action? Law and public opinion recognize protection of health and safety as a core government function, but public health actions are sometimes characterized as inappropriately intrusive. Such criticism has a long history, but today we accept many public health measures that were once consi...
Human health has improved more in our lifetimes than it did in the preceding thousand years. Since 1970, the number of infants who die has decreased by more than half worldwide, and maternal mortality has fallen dramatically in virtually every region of the world. Facing today's enormous global health challenges, we often lose sight of such advance...
Stroke remains a leading cause of disability and death for people of all races and ethnicities. Nearly 800 000 Americans experience a stroke each year—1 every 40 seconds—and ≈135 000 die.1 Approximately 600 000 of these are first or new strokes, and those who survive are at increased risk of a future stroke.1 In 2010, strokes cost the United States...
In 1949, Alexander Langmuir became the first chief epidemiologist at the Communicable Disease Center (CDC) in Atlanta, Georgia.
Among his many contributions to the agency and to public health, 2 of the most important—the Epidemic Intelligence Service
(EIS) and his particular brand of epidemic-assistance investigation (the Epi-Aid)—are highlighted i...
Each year, more than 2 million Americans have a heart attack or stroke, and more than 800,000 of them die; cardiovascular disease is the leading cause of death in the United States and the largest cause of lower life expectancy among blacks. Related medical costs and productivity losses approach $450 billion annually, and inflation-adjusted direct...
It has been a year since the earthquake of January 12, 2010, devastated the poorest country in the Western Hemisphere. Piles of rubble remaining throughout the Haitian capital and a devastating cholera epidemic provide stark reminders of the challenges that arise in the absence of the infrastructure and institutions that most of us take for granted...
Since 1946, CDC has monitored and responded to challenges in the nation's health, with particular focus on reducing gaps between the least and most vulnerable U.S. residents in illness, injury, risk behaviors, use of preventive health services, exposure to environmental hazards, and premature death. We continue that commitment to socioeconomic just...
In 2002, the New York City Department of Health and Mental Hygiene (DOHMH) launched an aggressive, comprehensive tobacco control program comprised of five components: taxation, legal action, cessation services, public education and evaluation. Smoking cessation has been delivered through two main approaches: the promotion of cessation behaviors, an...
An important role of public health agencies is to define the unacceptable. This concept has particular relevance for healthcare-associated infections. Evidence indicates that, with focused efforts, these once-formidable infections can be greatly reduced in number, leading to a new normal for healthcare-associated infections as rare, unacceptable ev...
An important role of public health agencies is to define the unacceptable. This concept has particular relevance for healthcare‐associated infections. Evidence indicates that, with focused efforts, these once‐formidable infections can be greatly reduced in number, leading to a 'new normal' for healthcare‐associated infections as rare, unacceptable...
Unethical uses of humans as research subjects represent appalling chapters in the history of medicine.1 To ensure that effective protections against such abuses continue to evolve and improve, it is essential to continue to learn from historical examples. Sadly, a new example has recently come to light.While conducting research on the Tuskegee stud...
Healthcare reform plans refer to improved quality, but there is little quantification of potential health benefits of quality care.
This paper aims to estimate the health benefits by greater use of clinical preventive services.
Two mathematical models were developed to estimate the number of deaths potentially prevented per year by increasing use o...
In Pennsylvania on February 16, 2006, a New York City resident collapsed with rigors and was hospitalized. On February 21, the Centers for Disease Control and Prevention and the New York City Department of Health and Mental Hygiene were notified that Bacillus anthracis had been identified in the patient's blood. Although the patient's history of wo...
Learning lessons from previous pandemics is not merely an academic exercise. Our experiences from 1918 and other 20th-century pandemics helped us prepare for and respond to the 2009 H1N1 pandemic. In addition to better understanding these earlier pandemics, we must continue to learn and apply lessons from our experience with the current H1N1 pandem...
Childhood obesity is epidemic in the United States, and is expected to increase the rates of many chronic diseases. Increasing physical activity and improving nutrition are keys to obesity prevention and control. But changing individual behavior is difficult. A comprehensive, coordinated strategy is needed. Policy interventions that make healthy di...
A 5-tier pyramid best describes the impact of different types of public health interventions and provides a framework to improve health. At the base of this pyramid, indicating interventions with the greatest potential impact, are efforts to address socioeconomic determinants of health. In ascending order are interventions that change the context t...
In 2006, New York City's Health Department amended the city Health Code to require the posting of calorie counts by chain restaurants on menus, menu boards, and item tags. This was one element of the city's response to rising obesity rates. Drafting the rule involved many decisions that affected its impact and its legal viability. The restaurant in...
Context:
In December 2005, in characterizing diabetes as an epidemic, the New York City Board of Health mandated the laboratory reporting of hemoglobin A1C laboratory test results. This mandate established the United States' first population-based registry to track the level of blood sugar control in people with diabetes. But mandatory A1C reporti...
Decades after key modifiable risk factors were identified, cardiovascular disease remains the leading cause of preventable death, and only one quarter of persons with high cholesterol levels have attained recommended levels of control. Cholesterol control efforts have focused on consumer education and medical treatment. A powerful, complementary ap...
Tuberculosis (TB) control in many ways exemplifies evidence-based public health practice, rigorously implemented, with appropriate emphasis on the central importance of political support for success. With more than 30 million patients treated in the past decade, TB control has important implications for managing both communicable and non-communicab...
Sandeep P. Kishore, Karen R. Siegel, Aria Ahmad, Amina A. Aitsi-Selmi, Mohammed K. Ali, Phillip Baker, Sanjay Basu, Asaf Bitton, Gerald S. Bloomfield, Gene Bukhman, Eleanor Emery, Andrea B. Feigl, Karen Grepin, Mark D. Huffman, Kiti Kajana, Shweta Khandelwal, Kavitha Kolappa, Chenhui Liu, Naaznin Lokhandwala, Vishal Marwah, Modi Mwatsama, Nicole No...
We describe smoking prevalence and secondhand smoke (SHS) exposure among adult nonsmokers in New York City (NYC) across key demographic strata and compare exposure estimates with those found nationally.
We used serum cotinine data from the 2004 NYC Health and Nutrition Examination Survey (n = 1,767 adults aged 20 years or older) and the 2003-2004 N...
Tuberculosis (TB) control in many ways exemplifies evidence-based public health practice, rigorously implemented, with appropriate emphasis on the central importance of political support for success. With more than 30 million patients treated in the past decade, TB control has important implications for managing both communicable and non-communicab...
Effective public health interventions can save hundreds of millions of lives in developing countries, as well as create broad social and economic benefits. Unfortunately, public health approaches and solutions applied in developed countries are often assumed to be inappropriate or unattainable in developing countries. This has sometimes forestalled...
To determine the prevalence of diabetes and impaired fasting glucose (IFG) and to assess clinical management indicators among adults with diabetes in a representative sample of New York City adults.
In 2004, New York City implemented the first community-level Health and Nutrition Examination Survey (NYC HANES), modeled after the National Health and...
Citations
... The primary goal of a digital information system for large-scale hypertension programs is ultimately to support clinicians and program managers by providing data feedback loops to improve quality of care.33 In the Bangladesh Hypertension Control Initiative, blood pressure control increased from 20% before to 39% 6 months after Simple app implementation.19 In India, the non-communicable disease management application of the Ayushman Bharat Comprehensive Primary Healthcare software incorporates user-centric design to enable efficient hypertension and diabetes management. ...
... HEARTS in the Americas has advanced across the region due to the leadership of the Ministries of Health, the growing support of professional organizations and civil society, and the generosity of partners and donors (14)(15)(16). Likewise, the HEARTS' successful implementation strategy, the innovative and practical solutions to Frontiers in Cardiovascular Medicine catalyze health system changes, and the application of a set of guiding principles, all co-created by the participating countries and PAHO, have been relevant (6,(17)(18)(19). Indeed, countries actively participated in the improvement process because HEARTS in the Americas is a community of practice with a shared vision and common goals. ...
... Hypertension (HTN) continues to be the second main risk factor of death cases from cardio-and cerebrovascular accidents as well as end-organs damage globally [1]. It is estimated in the United States (US) that one in every three persons suffers from HTN [2]. The recent redefinition of HTN is blood pressure (BP) levels ≥ 130/80 mm Hg or having HTN medicines. ...
![[object Object]](https://i1.rgstatic.net/ii/profile.image/1148728530485259-1650889632731_Q64/Andrew-Moran-14.jpg)
... RTSL is a global non-profit organisation that supports countries in their efforts to reduce morbidity and mortality from hypertension. 17 The study was also administered among the LINKS community, 18 a global community for cardiovascular health comprising 1061 individuals from 94 countries. Members belong to over 600 organisations, including ministries of health, academic institutions, non-governmental organisations (NGOs)/civil society organisations, RTSL's partner organisations such as WHO and NCD Alliance, private practices and government hospitals. ...
... To implement this approach, countries would need to strengthen national and subnational capacities to detect and respond to disease outbreaks quickly. Frieden et al. propose an effective and practical seven-one-seven metric, which suggests that countries should aim to, first, detect a suspected infectious disease outbreak within seven days, second, notify public health authorities within one day to initiate an investigation, and third, complete an initial response within seven days [11]. The seven-oneseven approach can help countries establish agile and accountable systems and use the timeliness metric and real-world events to monitor response during a health crisis and course correct as needed [12]. ...
... Such an event has become a hot topic that has been debated between global health researchers and international lawyersregarding a new treaty's format, content, effectiveness and usefulness, and states' motivations and compliance (e.g. Frieden & Buissonnière 2021, Fukuda-Parr et al. 2021, Nikogosian 2021. The common ground between them, though implicitly, is solidarity on a global scale. ...
... In addition to this inexperience, the inability of organizations to respond and manage a large-scale crisis such as the COVID-19 pandemic often aggravated all kinds of problems caused by a pandemic disease [10]. Additionally, the widespread and multiple outbreaks of this virus have undoubtedly highlighted great negligence in the management of biological crises, and beyond the containment of the current crisis, the possibility of frequent and more dangerous outbreaks of similar diseases in the future is very worrying [11]. The WHO [12] stated in a report that despite the significant efforts made in the fight have adequate planning for short-term crisis management and are even less prepared for ongoing crises. ...
... Early detection data can aid in policy-making to reduce stroke risk factors. 9,10 However, locally published data on stroke risk factors is still rarely reported. This complicates regulation and policymaking as well as community empowerment efforts to reduce modifiable stroke risk factors. ...
![[object Object]](https://i1.rgstatic.net/ii/profile.image/496983221563393-1495501441871_Q64/Kathryn-Foti.jpg)
... This global initiative for cholera control will require harnessing lessons learnt from previous cholera responses and, importantly, utilising context-specific evidence to revise the country's National Strategic Plan of Action on Cholera Control. Understanding the country's capacity to implement multi-stranded cholera interventions, particularly in healthcare facilities (HCFs), is critical to these endeavours [8]. However, our literature review and interactions with the NCDC-led cholera TWG at both state and national levels indicate a paucity of evidence on HCF resource availability to implement the multi-stranded cholera interventions in Nigeria. ...
... Las estrategias actuales de prevención y control están fracasando. Se necesita urgentemente un enfoque más eficaz, integral y sostenible para reducir la carga de las ECV y contribuir en el aumento de la resiliencia de los sistemas de salud y en la defensa contra la actual pandemia de la enfermedad por el coronavirus del 2019 (COVID-19) y futuras pandemias (3). ...