CDC director calls for data-based, prevention-focused community health care during a talk at Johns Hopkins

At the latest Health Policy Forum, CDC Director Mandy Cohen discusses how data can help solve problems ranging from opioid overdoses to gun violence

Data will play a critical role in shifting the nation's focus from sick care to prevention and protecting the United States from health threats, said Centers for Disease Control and Prevention Mandy Cohen during the June 26 installment of the Johns Hopkins Health Policy Forum.

Cohen joined Johns Hopkins School of Nursing Dean Sarah Szanton for the quarterly event, held in-person for the first time since its launch during the pandemic at the Hopkins Bloomberg Center in Washington, D.C. During the talk, which was also livestreamed, Cohen and Szanton advocated for a prevention-based system that promotes whole-person care and eliminates inequities.

"You cannot solve problems you do not see," Cohen said. With better data and evidence, health care providers and systems at all levels—local, state, and national—can take a proactive approach to health threats, identify communities that need help, and determine what treatments and measures work or not, she said.

"Look at the CDC evidence and data," she urged health teams. "We can be a partner to help you think through what to spend dollars on and how to do that in a smart way. There are things you should not spend your dollars on as well. Use that evidence." As former secretary of the North Carolina Department of Health and Human Services, Cohen, an internal medicine physician, led the state's response to COVID-19 and garnered accolades for promoting data-driven decisions, equity, and transparent communication. Cohen became the CDC director in July 2023. She identified three current focus areas of the CDC:

Ready our response to health threats ranging from the virus that causes avian flu to extreme heat and gun violence

"To be that response agency for the country and to keep us safe, we need some core capabilities … in a disease agnostic way," Cohen said. "Our HIV data was over here, COVID data over here, malaria over there. How do we think about bring[ing] some of that together, because we are all working with communities and individuals who may be impacted by COVID, flu, and [other conditions]. How do [we] … bring data together to identify concerning trends?"

Bolster mental health services

"Mental health, we know, is always strained during an emergency, whether it's a hurricane or a pandemic," Cohen said. "… We are seeing more substances out in the market that are more potent. [Last year alone,] we lost 100,000 people to overdose [and] 50,000 to suicide. We can do better." Data visibility is key.

Support young families

A prevention-based health system starts with better supports for young families, Cohen told the audience. "How do we create a system that can … think about the upstream causes [of] how my patient ends up here with diabetes or [another] chronic disease? What are the ways in which we could have prevented that?" Cohen asked. "The data tells us what it is that shapes your lifelong health patterns—[and] that actually happens in the first few years of life," she answered.

With these three focus areas come other CDC initiatives, including work related to the social determinants of health, Cohen told the crowd of nearly 100 in-person Johns Hopkins students, faculty, staff, and members of the public, along with close to 200 tuning in remotely. "We know from our data that your zip code determines your lifelong health patterns more than your genetic code," Cohen said, noting a waiver she created to help individuals pay for housing, food, and transportation as part of an innovative Medicaid program in North Carolina. "We have an evaluation to show that not only is it helping folks stay health, but it is saving money."

Szanton brought up a new pilot program in Baltimore, Neighborhood Nursing, a collaboration among community organizations and nursing schools at Johns Hopkins, Morgan State University, Coppin State University, and the University of Maryland. Through the program, nurses and health workers meet with individuals in homes, schools, and neighborhood gathering places like libraries and barber shops to learn about and support their health needs. "We are trying to turn primary care on its head," Szanton said. "In primary care, we often see [only those] who come to us. If you don't feel well, you go, but what about the older adult who's homebound—or homeless?"

Baltimore is a great place, Szanton continued, and it suffers from high rates of opioid overdoses, a reality her team has seen firsthand in its door-to-door work through Neighborhood Nursing. "We very quickly added fentanyl testing strips, Narcan, and are really taking overdose prevention to the streets," she said.

The CDC is committed to helping cities like Baltimore combat overdoses, Cohen said. "We've invested in an overdose data action platform that allows us to [send] dollars right out to communities like Baltimore," Cohen said. The platform provides not only "real-time data on overdoses but also what those substances are in communities that may be more potent and causing more harm to folks, so folks can react more quickly."

Moreover, the platform helps communities figure out what works and what doesn't. The data shows, for instance, that in addition to fentanyl test strips and Narcan, recovery care in emergency rooms is important. "Emergency departments are where the broken parts of our system show up," Cohen said. "But we have best practices from CDC-funded and evaluated projects, where we know what works," she said, prodding people to consult the CDC's information and resources on health topics spanning everything from the impact of droughts on health to preventing high cholesterol.

Cohen's talk was the 12th event in the Health Policy Forum series, which launched in fall 2020 to highlight the university's engagement with key leaders on matters of health policy and health care. The Health Policy Forum series is jointly hosted by the Bloomberg School of Public Health, the Carey Business School, the School of Nursing, and Johns Hopkins Medicine.