Newsletter - Rebuilding Our Public Health System
Making the Healthy Choice to Preserve Our Nation’s Future
This newsletter introduces three essays on America’s public health system. The US once led the world in most health ratings, due in part to its once stellar public health system. Today, after years of watching its public health system decline, the US lags behind most industrialized nations for key health markers (e.g., mortality). Unless it recommits to upgrading its public health system, the US will be ill-prepared to survive the next pandemic.
Big Story
Since early 2020, the world has faced a life-and-death struggle—the Covid-19 pandemic. If Covid-19 was a trial run, it is clear that our public health system is too weak to protect us from the next pandemic.
The US public health system is a victim of its own success. After building one of the world’s best public health systems, the US turned to other priorities. After the Covid-19 pandemic forced public health officials to impose tough public health mandates, our indifference turned to resentment. Public rage. Bizarre legislation emasculating public health agencies. Staff trauma and departures. The pandemic has wreaked havoc on our lives, but also left our public health system reeling.
Big Question
When public health measures prevent illness or save lives, people don’t fully appreciate their value. Should we continue to allow our collective blind spot to drive our policies and weaken our defenses?
The contrasts could not be clearer. Our health care system, which treats individual health, is the most expensive in the world. Our public health system, which prevents community illness, receives far fewer resources. Despite its many achievements—safer living conditions and longer life spans—our public health system is profoundly undervalued and underfunded. A cultural revolt against common sense public health measures is underway and spreading fast.
As we approach the Covid-19 pandemic’s third year, many questions remain. Should we continue to spend more on treatment than prevention? Can we protect the nation’s health with a public health system so fragmented and diminished? With a public health infrastructure so poorly financed? Will we even have enough resources to perform basic public health functions? Should we act or doze? Solve the problem or die with it?
Big Idea
Preserving public health and defeating pandemics are patriotic endeavors. To win the war against illness and disease, we must fight as one people to rebuild our public health system.
Defeating an enemy—foreign attack, domestic disaster or lethal virus— requires a unified effort. We cannot extinguish a fire, for instance, if we waste precious moments debating which firehose to use. To prepare for the pandemics to come, we must put public interest first—over individual impulse, private gain and partisan passions. We must stop fighting each other and use the Covid-19 crisis to overhaul our public health system.
How? Align the public health and health care systems. Alter the way public health is financed. Reorganize the system (including 911 call centers) around larger regions. Expand public health services to reduce health care costs. Modernize the public health data infrastructure. Mount unified public health campaigns.
Promising Initiatives
Rhode Island – centralized structure with state Health Department and no local health agencies; effective surveillance, public education and community outreach systems; aligned public health and primary care; high childhood immunization rates via partnerships with healthcare providers and schools (Immunize for Life)
Hawaii – centralized structure; state launched Living Well Hawaii project with other entities (e.g., Primary Care Association and local agencies) to align public health and primary care resources and improve health outcomes for adults with mental illness; state’s health outcomes better than national health outcomes
Denmark – universal health care, national registry and electronic health records systems, unique personal identifiers, hybrid structure with central regulation, regional coordination (five regions) and local delivery (98 municipalities) and strong investments in community-based primary care and social services
Sweden – universal healthcare; hybrid structure with central regulation and regional delivery through 21 regional councils, national health and social care standards; significant investment in community-based primary care and social services; 6th healthiest country per Bloomberg Global Health Index
California – public health workers in Imperial County, in partnership with local groups, used state Environmental Health Tracking Program to gather urine and water samples and assess environmental health hazards (e.g., perchlorate-contaminated water and soil)
Bipartisan Policy Center – in 2017, the Bipartisan Policy Center launched the Future of Health Care Initiative
Other Views
Bridging Health and Health Care, Bipartisan Policy Center (9-30-21)
Staffing Up, Workforce Levels Needed to Provide Basic Public Health Services for All Americans, de Beaumont Foundation (10-21)
State of Obesity 2021: Better Policies for a Healthier America, Trust for America’s Health (9-21)
The State of America’s Local Health Departments, National Association of County and City Health Officials (2019)
Partnering with Metropolitan Planning Organizations to Advance Healthy Communities, American Public Health Association (2017)
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