As a surgery resident, I see the long shadow of poor public health every day — whether it’s a diabetic foot infection that’s gone too long without care or a hypertensive crisis that never should’ve happened. That’s why the proposed restructuring of the CDC and other federal health agencies is not just administrative news to me — it’s personal.

The argument for reform often leans on efficiency: Reduce bureaucracy, streamline oversight, save taxpayer money. But we need to ask a deeper question: What are we optimizing for?

Because when it comes to chronic disease prevention — arguably one of the CDC’s most important responsibilities — the U.S. is already far behind. We spend more on health care than any other country, yet rank 32nd in life expectancy among developed nations (OECD data). If this restructuring is meant to help us do better, where is the evidence?

There may very well be benefits to reform. Maybe it will unlock faster responses in emergencies or allow better coordination across agencies. But if these changes are being drafted without meaningful input from health care professionals — the very people who live and work within the downstream effects of these policies — we risk making things worse, not better.

Even more concerning is the absence of public consultation. These changes affect every American. Shouldn’t the public have a say? When a country’s national health infrastructure is being reshaped, it shouldn’t happen quietly behind closed doors. A national referendum, or at the very least a transparent, inclusive dialogue, is not just reasonable — it’s necessary.

It’s one thing to talk about efficiency on a spreadsheet. It’s another to amputate a limb because a patient’s diabetes wasn’t caught in time.

Public health infrastructure isn’t glamorous. It doesn’t make headlines until it fails. But those of us on the ground know its value — and we know that once you dismantle it, it’s hard to rebuild.

So let’s have the conversation. But let’s do it transparently. Let’s consult clinicians, epidemiologists, community health leaders, and yes — the public. Let’s center this reform not just on cost savings, but on saving lives.

Because that’s the real bottom line.

Tarek Khrisat is a surgery resident.