The first 10 days on the job were pretty much what Dr. Julie Gerberding expected. On Day 11, however, the world changed.
Gerberding had been working at the National Center for Infectious Diseases, an agency of Centers for Disease Control and Prevention, when she was asked to fill in as acting deputy director while a search progressed for a permanent replacement.
That was Sept. 1, 2001. With quiet understatement, Gerberding explains what happened less than two weeks later.
"I was not expecting to be involved in terrorism," she says. "When I came to CDC, I came here on a five-year plan to serve my country and to do everything I could to try to protect patients. I was very interested in patient safety and anamicrobial resistance and infections associated with health care. It was only somewhat a surprising coincidence that I started the role as the deputy (director) of the center on Sept. 1, and 10 days later we were in the middle of terrorist attacks."
But unexpected doesn't mean unprepared. Gerberding's expertise and experience helped her lead the NCIS through a uniquely difficult time.
"I found myself, very quickly, bringing my infectious disease knowledge base to play in an environment where my previous experience working in an emergency room served me very well," she says. "It was an environment that required rapid assessment of changing events and adaptive decision-making so that we could make a decision, get more information and then move forward. I think that characterized pretty much the whole CDC operation during those difficult months of the fall and winter of the post-9/11 season."
Gerberding placed her stamp on the NCIS, and in July 2002 was named the director of Centers for Disease Control and Prevention and administrator of the Agency for Toxic Substances and Diseases Registry. Her original five-year plan suddenly underwent a dramatic rewrite.
"The clock on the five-year plan has definitely been reset since 9/11," Gerberding says. "I was coming here prepared to serve in a particular role, and after I was appointed to be the CDC director, that role has definitely changed. So now, I'm looking to the future with a completely different outlook."
Part of that outlook includes how Gerberding manages CDC, an agency of the Department of Health and Human Services with more than 10,000 people -- 5,600 in the Atlanta area -- deployed worldwide.
"CDC's primary responsibility is protecting the health of Americans," she says. "We do that through preparedness for terrorism, infectious diseases or environmental threats. But we also do that through health promotion and prevention of disease, injury and disability."
CDC has the lead responsibility for protecting health and giving people the tools, information and support they need to make healthy choices. To ensure that's done in the most effective manner, Gerberding is spearheading a massive transformation project. When she's finished, CDC will look drastically different than it does today.
Currently, CDC employs workers across the country, including 47 state health departments, and around the world (about 120 are assigned overseas in 45 countries). Also included under Gerberding's direction are 12 centers, institutes and offices.
"It's very important to recognize we are a strong agency, and we are also a deep agency," she says. "We have a work force of more than 10,000 people, and so we have enormous treasures of knowledge and capability focus across our agency."
A more effective organization
Gerberding says the strategic process is designed to "identify priority areas where we feel not only can we make a difference, but also that we are the logical agency to take on the responsibility and the accountability for leading that particular activity. That strategic process is one that has identified for us what are the goals for health across the lifespan of people in this country."
One area in which Gerberding hopes CDC will engage new partners is its drive to improve the health and safety of the nation.
"While CDC's traditional customer has been the public health system, the business sector is really our most important new set of partners and stakeholders because of the important health problems (facing the country) and the fact that most adults work, and employers and employees really have to engage in health protection in the workplace, both because of the value of having a healthy work force but also in the way that it affects the corporate bottom line," she says.
CDC, she says, has been involved with a national business group on health to analyze how her organization can better provide evidence and tools to support health promotion and protection programs in the workplace.
"This year, we took our extramural research dollars and targeted them specifically to identify the evidence base to help employers have the science behind the decisions they are making about wellness and health protection programs in the workplace," Gerberding says. "We are really reaching out in an aggressive way to business as, hopefully, a useful source of information and evidence around best practices."
CDC's transformation project is aptly named the Futures Initiative, and Gerberding views it as an opportunity to strengthen an already healthy and vibrant organization as it moves forward.
"The concept of the Futures Initiative was really to go outside of CDC and spend a long time, almost a year, getting input not just from our usual partners and customers but people we think we ought to be working with more effectively to leverage our investments more strategically," she says. "We've learned a great deal, and that's helped us formulate some very specific strategic imperatives."
One of those initiatives is to draw upon the outside world, such as the business community and other groups that have not been part of CDC's traditional information base, and bring those perspectives into CDC's planning process.
"I spend a lot of my time brokering meaningful input and networking with new partners and stakeholders in what we do," she says. "For example, if I am going to a public health meeting to present a CDC perspective, I very typically will try to meet with the local health agency while I'm there so I can ask them three questions: What is CDC doing well for you? What are we not doing as well as you would like? And what specifically can we do to help you do your job better?"
Gerberding makes it quite clear that the transformation is not about reworking a dysfunctional organization.
"There's not something broken here that we're in desperate need to fix," she says. "We are really operating from an agency that's just evolved a very capable set of actions in response to some pretty major league outbreaks, like SARS. It was exactly at that point that we realized this is the new normal, and we really do need to ensure that the entire agency can function efficiently and effectively with whatever new challenges are in front of us."
And in this atmosphere of change, Gerberding says she is able to thrive as a leader.
"In a sense," she says, "we're really modernizing many of our activities and capabilities to stay ahead of the curve."
Sticking to the basics
While Gerberding's CDC may be changing its approach to doing business, she has no intentions of abandoning the organization's core functions -- one of which is to work with the Congress on developing a health policy for the country.
"We are part of the administration, the executive branch of government," she says. "In that role, we have responsibility for assessing the health of our nation. We monitor health status, we measure diversity and inequities in the way health is distributed. We certainly take every opportunity to inform the executive branch, Congress and people -- our key customers and partners -- about problems, because the first step toward a solution is really recognition and awareness."
One thing CDC is trying to make people aware of is that the most serious health threats facing Americans today are tobacco and obesity.
"It is very difficult to point to a health factor because it depends in part on who you are, where you are and how old you are, but across all of the life stages, the two most important risks for health are tobacco and obesity," Gerberding says. "Those two health threats affect every age group and certainly are problems that we have not yet solved.
"We've made some limited progress on the tobacco front, and we have some successes to celebrate, but we have a long way to go before we have conquered that health threat," she says. "And obesity is moving toward the front of the classroom, so to speak, with considerable speed in most parts of the country and in most age groups. These are very, very serious threats. We definitely, as a nation, have to come to grips with both of these problems. We cannot afford, for the sake of our children's lives but also for the sake of our economy, to continue is this direction."
It would be easy for Gerberding to get lost in the details of running such a large government agency, but the doctor makes sure she doesn't stray too far from her roots or from the reason she got involved in the first place.
"I'm an internist as well as an infectious disease expert," she says. 'Internal medicine is actually a very holistic approach to health, which recognizes the whole compendium of health threats, whether they are through chronic diseases or injury or disabilities or infectious diseases or environmental threats."
For Gerberding, this has special meaning.
"What I bring to CDC is the fact that I'm a doctor," she says. "I spend a great deal of my time bridging the gap between the health care delivery system and the public health system because I feel very strongly that there should be no dividing line between public health and the health care delivery system.
"I do go back to San Francisco General Hospital for a couple of weeks every year and take care of patients just to remind me of all of the health consequences of the diseases that we here at CDC are trying to prevent," Gerberding says. "What I bring to my role here is not my technical knowledge of any particular category of disease but rather my philosophy that we all want the same thing, and there really is no difference between the health of a community and the health of the individuals in that community."
HOW TO REACH: The Centers for Disease Control and Prevention, 800-311-3435 or www.cdc.gov