President Donald Trump has nominated acting CDC Director Susan Monarez to permanently lead the Centers for Disease Control and Prevention (CDC). If confirmed, she would be the first non-physician to hold the role and the first director who would require a Senate approval under a 2023 law. However, what is even more important is to know what it really means for public health in the US?

Who Is Susan Monarez?

She served as an interim CDC director since January and has a background in microbiology and immunology. She also holds a doctorate from the University of Wisconsin-Madison and has conducted postdoctoral research at the Stanford University School of Medicine. Unlike the previous CDC directors who were physicians, Monarez has built her career in science policy and has worked in the Department of Homeland Security, the White House Office of Science and Technology Policy, and the National Security Council. Before joining the CDC, she was the deputy director at the Advanced Research Projects Agency for Health (ARPA-H) under the Biden administration.

Monarez has been described by Trump as a "dedicated public servant" with a focus on innovation and transparency. However, her tenure, even as an acting director has sparked controversy. Especially in the way the agency has been restructured and handled.

What Health Challenges Do Lie Ahead?

If confirmed, Monarez will face immediate public health crisis, including:

A measles outbreak that has led to two deaths and over 300 cases in West Texas, New Mexico and Oklahoma

Concerns over the spread of bird flu, which has now also been detected in cows and cats

Additionally, the CDC is experiencing significant internal shifts, with the recent departure of eight high-ranking officials. Some of these resignations may be linked to Monarez’s leadership decisions, including layoffs of over 700 employees and the removal of certain health information from CDC webpages, particularly references to LGBTQ+ youth issues.

What A Shift In CDC Leadership Mean?

One of the biggest changes in the CDC's leadership structure is that Monarez's confirmation will require Senate approval. Before this, the CDC director was appointed directly by the president. However, this shift was introduced in 2023 and was backed by Republicans who argue that greater accountability was needed within the agency.

Her nomination follows Trump’s withdrawal of his initial pick, former Rep. Dave Weldon, whose past views on vaccines made him a controversial choice. While Monarez’s stance on vaccines is not entirely clear, her nomination has been met with more approval from public health experts.

Impact on the Health Sector

Monarez’s leadership could signal major changes in public health policy. Under her interim tenure, the CDC temporarily delayed the release of the Morbidity and Mortality Weekly Report and postponed an immunization advisory committee meeting after a White House communications freeze. These actions raise concerns about political influence over CDC decision-making.

Additionally, her collaboration with Health and Human Services Secretary Robert F. Kennedy Jr., known for his mixed messaging on vaccines, could impact national vaccination strategies. While Kennedy has publicly supported vaccines, his past statements have fueled skepticism.

Public health leaders are watching closely. Dr. Georges Benjamin, executive director of the American Public Health Association, has praised Monarez’s scientific background but warned that a prolonged confirmation process could weaken her authority. “When you are not confirmed, you may be less willing to take tough positions,” he noted.

Looking Ahead

If confirmed, Monarez’s tenure at the CDC will be crucial in shaping America’s public health response. Her ability to manage outbreaks, navigate political pressures, and restore public trust in the CDC will determine whether her leadership strengthens or weakens the agency in the years to come.

Semaglutide, a well-known drug for diabetes and weight loss, commonly referred to as Ozempic, has been found to help patients with peripheral artery disease (PAD) walk longer distances. PAD is a circulatory condition where narrowed arteries reduce blood flow to the limbs due to plaque buildup. This condition is particularly common among individuals with diabetes.

A study published in The Lancet demonstrated that administering 1 mg of semaglutide to adults with type 2 diabetes and symptomatic PAD led to a 13% increase in their walking distance compared to those given a placebo. The drug was also associated with an improvement in ankle-brachial indices, a key test that compares blood pressure in the ankle to that in the arm, assessing blood flow in the lower limbs. The results of the STRIDE trial were presented at the American College of Cardiology Annual Meeting on March 29. The research was funded by Novo Nordisk, the manufacturer of Ozempic.

Beyond Blood Sugar Levels

The significance of this study lies in its demonstration of semaglutide's multifaceted protective effects beyond just improving blood sugar levels and aiding weight loss. Previous findings have already established its role in reducing the risk of cardiovascular events, benefiting kidney health, and even helping lower certain addictive behaviors.

Understanding Peripheral Artery Disease (PAD)PAD occurs when arteries narrow, restricting blood flow to the arms and legs. It is one of the most serious complications of diabetes and a leading cause of disability and amputation. More than 230 million people worldwide are affected by PAD, and there are currently no medical treatments available that can prevent or slow down its complications in diabetics.

Experts emphasize that PAD is a persistent and highly debilitating disease for which no current therapies exist. Patients suffering from PAD often experience severe limitations in their ability to function and walk without pain. As the condition progresses, some individuals may require interventions such as revascularization surgery, which aims to restore blood supply to the legs. In extreme cases, limb amputation may become necessary.

Semaglutide As A Potential Solution

Medical professionals point out that functional impairment in individuals with PAD is often overlooked in its early stages despite the severe disability it causes. The findings of the STRIDE trial are particularly promising as they indicate that semaglutide’s benefits on maximum walking distance were noticeable at 26 weeks and continued to improve up to 52 weeks without reaching a plateau. This suggests that semaglutide could be a viable long-term therapy option for PAD patients.

Experts further highlight that amputation is one of the most feared complications of diabetes and is significantly more common in diabetic individuals than in those without the condition. The findings of this study offer a ray of hope in addressing this pressing issue.

Following the trial’s promising results, Novo Nordisk has submitted a label extension application for Ozempic to the US Food and Drug Administration (FDA). If approved, this could mark a major breakthrough in the treatment of PAD, potentially offering a new medical option for millions affected by the disease.

As per the Australian Bureau of Statistics (ABS) National Health Measures Survey, 1 in 15 Australian adults is living with diabetes. The ABS also included the details on the number of Australians who showed signs of kidney disease, vitamin D deficiencies and other potential chronic illnesses.

The survey also noted a total 6.6% of Australians over the age of 18 have diabetes. There is also an increase of 1.5% when compared to a decade ago.

What Is Diabetes?

Diabetes is a long-term condition that happens when there is too much sugar in your bloodstream. This is because your body is unable to process it correctly. When someone is diabetes-free, the pancreas produce a hormone called insulin that helps move sugar into the cells of the body. However, with someone with diabetes, the pancreas either does not make enough insulin or the body does not use it well. This leads to sugar build up in the blood.

Increasing Prevalence of Diabetes

Diabetes has become a significant health challenge in Australia, with the number of diagnosed individuals rising to 1.3 million between 2000 and 2021. Data from the Australian Institute of Health and Welfare (AIHW) shows that men are more likely to have diabetes than women. Additionally, adults living in socioeconomically disadvantaged areas are at a higher risk of developing the condition. These figures highlight the growing burden of diabetes on individuals and healthcare systems nationwide.

Apart from diagnosed cases, an estimated 500,000 Australians may be living with undiagnosed type 2 diabetes. The National Health Measures Survey also found that 2.7% of adults are at high risk of developing diabetes. The prevalence of undiagnosed cases suggests a need for increased awareness, screening, and early intervention to prevent complications.

What Could Be The Risk Factors?

Several health risk factors contribute to diabetes, including a high body mass index (BMI), large waist circumference, smoking, and high blood pressure. Individuals with diabetes are more likely to exhibit multiple risk factors compared to those without the condition. However, data also shows that 88.9% of people with diabetes are non-smokers, and 70.5% maintain normal blood pressure levels. These findings align with the management goals set by the Royal Australian College of General Practitioners.

How Can Diabetes Be Managed?

Lifestyle and dietary changes can significantly reduce the risk of developing type 2 diabetes. Research indicates that up to 58% of cases can be delayed or prevented through healthier choices. However, approximately 42% of cases are linked to genetic factors, making prevention challenging for some individuals. Reducing the stigma around diabetes is essential to encourage at-risk individuals to seek medical advice and support without fear of judgment.

Cholesterol and Vitamin D Deficiency Trends

The AIHW health survey also examined cholesterol levels and vitamin D deficiencies among Australians. Around 30.2% of adults have high cholesterol, with women more likely to be affected than men. Additionally, 17.8% of adults have cholesterol levels close to abnormal.

High-density lipoprotein (HDL), often referred to as "good cholesterol," plays a crucial role in transporting cholesterol to the liver for breakdown. However, 14.9% of Australians have an abnormally low HDL level, increasing their risk of heart disease and stroke.

Seasonal Variations in Vitamin D Levels

Vitamin D deficiency is another widespread health concern, affecting 20.6% of adults. Seasonal variations impact deficiency rates, with 26.1% of adults experiencing low vitamin D levels in winter, compared to 15.5% in summer. Vitamin D is essential for calcium absorption, bone health, and muscle function, and severe deficiencies can lead to brittle bones and other health issues.

Pain is the body’s way of signaling that something is wrong. In most cases, pain fades once the underlying issue heals. However, for millions of people, pain becomes a constant companion, lasting for months or even years. This condition, known as chronic pain, not only affects physical health but also has a profound impact on emotional well-being.

Current studies emphasize the strong link between chronic pain and mental illness such as anxiety and depression. Individuals suffering from long-term pain tend to be stuck in a vicious cycle of fear, stress, and emotional distress. But how does chronic pain actually lead to deteriorating mental health, and how can the cycle be stopped?

For over 45 million Americans, chronic pain is a way of life. Although physical pain is the most visible symptom, its impact reaches far beyond the physical body. Chronic pain is frequently accompanied by psychological distress, as many victims experience anxiety and depression caused by their illness.

As per Dr. Ravi Kesari, a general medicine specialist, "Chronic pain and mental illness tend to exacerbate each other. Patients have disturbed sleep patterns, increased mental tension, and depression-like symptoms. This forms a vicious circle in which pain causes emotional distress, which further increases the perception of pain."

This cycle is especially seen in conditions like:

Fibromyalgia – A syndrome of widespread pain, fatigue, and cognitive difficulty.

Irritable Bowel Syndrome (IBS) – A bowel condition frequently associated with stress and tension.

Lower Back Pain – Prolonged pain in the lower back, often accompanied by decreased mobility and depression.

Migraine and Nerve Pain – Prolonged headaches and nerve pain that interfere with daily functioning.

Research indicates that two-thirds of IBS sufferers experience anxiety symptoms, and 65% of patients with depression exhibit chronic pain symptoms. This commonality indicates that mental illness not only heightens sensitivity to pain but also complicates recovery.

How Stress of Chronic Pain Can Rewires Your Brain?

When a person hurts, the body releases stress chemicals such as cortisol and adrenaline to assist in the regulation of pain. Such hormones are helpful during short-term occurrences, but once pain persists over time, continued exposure to stress hormones alters brain chemistry.

"Chronic pain leads to chronic stress, and that changes the neurochemicals in the brain that control mood, thought processes, and behavior," explains Dr. Kesari. "That's why people with chronic pain tend to be irritable, angry, or drained of emotions."

Chronic exposure to stress hormones can cause:

Heightened anxiety and fear reactions, making people excessively careful about everyday activities.

Depression, as serotonin and dopamine levels decrease—two neurotransmitters that produce happiness and motivation.

Cognitive impairment, including problems concentrating, remembering, or deciding.

Pain, Anxiety, and the Fear of Movement

Another very frequent mental impact of chronic pain is kinesiophobia, or fear of movement. Individuals with chronic pain tend to avoid movement for fear of making their pain worse. This avoidance behavior can cause stiffness in the muscles, loss of mobility, and increased pain over time.

For example, a person with chronic back pain might try to avoid exercising, which would further weaken muscles and worsen their condition. This pattern of avoidance and worsened pain begets a spiraling sense of helplessness that further fuels anxiety and mood shifts.

"Anxiety is an understandable reaction to chronic pain," says Dr. Kesari. "People become concerned about what pain will mean for their lives, so tasks that are minor—such as shopping for groceries or socializing—become overwhelming."

Daily Struggles and Self-Esteem Loss

Chronic pain does not only impact mood; it is able to significantly modify the way an individual perceives himself. Most of those who have chronic pain struggle with simple activities such as exiting bed, dressing up, or personal hygiene. Failing to do so by oneself may cause the individual to feel inadequate, frustrated, and socially withdrawn.

As Dr. Kesari describes, "Patients tend to feel ill at ease in social situations because they view their condition as a restriction. This adds to low self-esteem and exacerbates mental illness such as depression."

Considering the complex connection between chronic pain and mental well-being, both physical and emotional welfare must be treated.

Dr. Kesari stresses, "Healthcare providers need to take a whole-body approach to treating chronic pain. That involves coupling conventional pain management with mental health care to break the cycle between pain and emotional distress."

Some strategies that have been found to be effective are:

Cognitive Behavioral Therapy (CBT) – A type of psychotherapy that enables people to deal with negative thought processes and respond to pain.

Physical Therapy & Movement-Based Practices – Gentle exercise, like tai chi or yoga, decreases pain and alleviates fear of movement.

Medication Management – Painkillers can be beneficial, but only as part of a combination of holistic therapies to prevent dependency.

Stress-Reduction Techniques – Techniques such as meditation, deep breathing, and mindfulness assist in balancing stress hormones.

Social Support & Therapy Groups – Sharing experiences with others who live with chronic pain has been shown to combat the sense of isolation and offer emotional support.

Chronic pain is not merely a physical condition—it has a powerful impact on mental health, causing anxiety, depression, and extreme lifestyle constraints. But knowledge of the interlinkage of pain and emotional health can encourage proactive measures toward improved general well-being.

Dr Ravi Kesari is MBBS, MD- General Medicine at Apollo Spectra Hospital, Bangalore in India