Yale School of Public Health students got an inside look at how decisions are made at the top of the public health pyramid on September 30th, when Dr. Karen Hacker, MD, MPH, BA ’77, director of the CDC’s National Center for Chronic Disease Prevention and Promotion, visited the school as part of Dean Megan L. Ranney’s Leaders in Public Health speaker series.
During an hour-long discussion with Ranney, Hacker shared insights on how she manages a massive federal health organization that has a $1.4 billion budget, more than 1,000 employees, and awards more than $800 million in grants annually. Ranney launched the speaker series a year ago to showcase real-world leaders in public health and to provide students and others an opportunity to learn about different career trajectories, how important public health decisions are made, and what lies ahead for the future of public health.
Hacker oversees a broad portfolio at the CDC that includes maternal health, school health, obesity prevention, smoking policies, and a wide range of chronic illnesses from heart disease and diabetes to lupus and Alzheimer’s disease. Her center is also responsible for managing the CDC’s Chronic Disease and Data Surveillance program as well as the Youth Risk Behavior Surveillance System, the largest public health surveillance system in the U.S., monitoring multiple health-related behaviors among high school students.
Hacker said one of her biggest challenges is balancing the needs and priorities of nine “very independent” divisions under her center’s jurisdiction and securing funding for 42 separate line items in her budget. The National Center for Chronic Disease Prevention and Promotion is funded entirely by Congress, Hacker said, and appropriations are often influenced by special interest groups and the current political climate.
“In most cases, we really want to push money out so that states, and sometimes communities, have resources to focus on chronic disease,” Hacker said. “We are pretty much the largest funder of any chronic disease programs at the state level and in some cases, we are the only funder.”
We are pretty much the largest funder of chronic disease programs at the state level.
Dr. Karen Hacker, MD, MPH, BA '77
The National Center for Chronic Disease Prevention and Promotion also conducts a lot of epidemiology research, Hacker said, and it relies on universities to evaluate programs and interventions in instances when the center’s staff can’t do it themselves. Ranney emphasized the importance of that relationship.
Ranney said the important work being done by academic researchers like those at the Yale School of Public Health can highlight emerging issues and emerging solutions. Importantly, Ranney said, researchers must try to get their results before Dr. Hacker and her staff and, equally importantly, the Congressional representatives and senators who are making appropriation decisions.
“One of the things I’ve learned from [Dr. Hacker] is what a difference … advocacy, representation, and storytelling and then backing up those stories with data makes in terms of the ability to create those funding streams that support work on the national level, but also the state and local level,” Ranney said.
Hacker and Ranney talked about several other issues during their discussion including the importance of clear communication in conveying the value of chronic disease prevention and public health to others, the chronic underfunding of public health, and a recent push to have clinical care systems get more involved in addressing social determinants of health.
Hacker has a long history of public health practice at the local level. Prior to her position at the CDC, Hacker served as the Director of the Allegheny County Health Department in Pennsylvania for six years. She also held a variety of leadership roles at the Cambridge Health Alliance in Massachusetts, including her role as the Senior Medical Director for Public and Community Health.
Hacker has published extensively and is an expert in community-based participatory research (CBPR). She served as the Director of the CBPR program of the Harvard Clinical and Translational Science Award Initiative and wrote Community-Based Participatory Action Research, a widely used academic text.