What the CDC Has All Wrong

The CDC is a venerated and iconic institution of public health that was founded as the Communicable Disease Center in 1946. Like its predecessors, the Office of National Defense Malaria Control Activities, and the Office of Malaria Control in War Areas, its original mission was to stem the tide of malaria that was endemic in the southern United States at that time.

In 1957, the CDC expanded beyond mosquito abatement and malaria control to include sexually transmitted diseases. Subsequently, it included tuberculosis control in 1960 and then in 1963, its immunization program was established. In 1967, it became the National Communicable Disease Center, and the Center for Disease Control—CDC—on June 24, 1970. Ultimately, on October 27, 1992, its name was appended to include the words “and prevention” but it retained the initials CDC because of name recognition.

Currently, the CDC encompasses a wide array of public health facilities concerned with conditions ranging from infectious and chronic diseases to disabilities and bioterrorism preparedness. But it is still mostly referred to as the Centers for Disease Control. And therein lies the problem. Because those crucial appended words that Congress attached to the CDC in 1992 — “and prevention“ — should be its central focus not an asterisk or footnote of its overarching mission.

Thus, as the title of this post suggests, the CDC has it all wrong with respect to its name and the implied prioritization of its primary purpose and goals. Namely, its focus on disease control rather than a full-throttle effort to prevent diseases. A criticism that can be leveled at our entire medical health delivery system, not only the CDC. That is, it would be much better if our medical establishment and federal health institutions endeavored to prevent diseases with the same fervor and resources it deploys on controlling them.

Behavioral Healthcare Saves Billions of Dollars in Medical Costs

Indeed, data from the CMS (Centers for Medicare and Medicaid Services) estimated that national healthcare spending exceeded $4 trillion in 2020 and is projected to exceed $6 trillion by 2028. That would account for almost 20% of our entire GDP. Yet, according to the most recent statistics, expenditure on mental and behavioral health services was less than $250 billion in 2020 or roughly 6% of the total health expenditure for that year (excluding direct costs of substance abuse treatment that adds another $600 billion to the annual tab.) And therein lies the second rub, because it has been well established that each dollar spent on behavioral and mental health care saves several times as much on standard medical healthcare costs. For instance, a 2014 Milliman Inc. study calculated that if behavioral health services were fully integrated with physical treatment, the American healthcare system could save almost $50 billion annually. An amount that has no doubt skyrocketed since then.

This is because clinical psychologists and other mental health providers can often prevent unnecessary hospital visits because of combating anxieties, depression, substance use problems, and stress manifestations before they rise to a level that requires direct medical care. What’s more, mental health clinicians who work with medical patients (e.g. people with diabetes, high blood pressure, heart disease, obesity, etc.) often enhance their compliance with treatment thus resulting in greatly reduced avoidable complications and unnecessary healthcare costs.

The DOD Is Funded 500 Times More Than the CDC

Moreover, in my view, it is shocking and deeply distressing that the annual budget for the CDC is approximately $1.3 billion while the annual budget for the Department of Defense is almost $700 billion––538 times the amount of money spent on our government’s frontline effort to prevent and control disease.

A highly disturbing irony because it is estimated that about 650,000 American armed service personnel have died in war during the entire history of the United States. Yet every year, more than 200,000 people die from infectious diseases. And the number of lives claimed by COVID-19 in only the past year has already matched the total number of military lives lost in all the wars this country has waged and participated in during the last 200 years. What’s more, approximately 1.5 million Americans die each year from heart disease, cancer, stroke, and diabetes. Still, the DOD receives more than 500 times the funding the CDC gets.

Obviously, we need to have strong military and defensive capabilities to protect our country from foreign threats. But as COVID-19 has demonstrated, the most significant danger to our nation and way of life is not foreign hostiles. Rather, it is infectious diseases and internal threats (e.g., corrupt and inept politicians and domestic terrorists). Still, it is better to prevent war than to wage it.

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So this post is not an indictment of the CDC. In fact, now that it is no longer shackled and muzzled by anti-science politicians, it is doing an outstanding job trying to combat the devastation of the current pandemic. It is simply a suggestion that its name be changed to the Centers for Disease Prevention and Control—the CDP. This will emphasize the importance of preventative medicine and behavioral health care rather than attempts at curative medicine. Because it is well known that an ounce of prevention is worth a pound of cure… or control.

Remember: Think well, Act well, Feel well, Be well!

Copyright 2021 Clifford N. Lazarus, Ph.D.

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