Marty Levine
November 29, 2022
Warnings about an impending “Tripledemic” are everywhere. As described by the New York Times, three serious diseases, the “Flu, R.S.V. and Covid…” will be simultaneously spreading, creating serious risk to the health of children, older people (like me) and those with underlying health issues. And so I was scratching my head last week when I caught this CNN Health headline telling me that with this serious health threat before us “Thousands of public health experts are losing their jobs at a critical time.”
Underneath that headline is the disturbing story of a nation that seems better at sticking its head in the sand than it is at protecting its people and learning from its mistakes.
In 2021, with the national death toll from COVID-19 moving toward 1 million, Dr Susan Bailey, past president of the American Medical Association assessed the sorry state of the nation’s public health infrastructure that had left us so vulnerable to a virulent disease.
“Nearly 40,000 jobs at state and local public health agencies have been eliminated since the 2008 recession, according to an Associated Press-Kaiser Health News analysis published last summer. And funding steadily reduced over that period is now at further risk of reduction from the pandemic-related economic downturn, which has thrown governmental budgets deep into the red.
“At the same time, federal funding for emergency preparedness and response programs administered by the Centers for Disease Control and Prevention has been slashed by 50% over the past decade, according to Trust for America’s Health (TFAH), the nonpartisan health policy research organization. That same TFAH study highlighted other concerning trends as well, such as a general decline in funding for the Strategic National Stockpile as well as the Hospital Preparedness Program. That program is the sole source of federal funding for emergency response by regional health care systems, and had its budget slashed from $515 million in 2004 to $275.5 million in 2020.”
When the government responded to the health crisis and allocated emergency funding, it did include some funds that could be used to rebuild the public health infrastructure. But it was temporary, not permanent funding. It responded to an immediate crisis while ignoring the underlying systemic weakness that made COVID more impactful than it might have been in a better prepared nation.
And that temporary funding did not come close to allowing our leaders to create the public health organizations that we need.
According to a recently completed study published in the Journal of Public Health Policy and Practice “The US state and local governmental public health workforce needs at least 80 000 additional FTEs…in a post–COVID-19 landscape…Transitioning a COVID-related surge in staffing to a permanent workforce requires substantial and sustained investment from federal and state governments to deliver even the bare minimum of public health services.”
A Kaiser Health News article brought the meaning of these statistics home. “In Chicago, {emergency funded employees} made up about as much as a tenth of the city’s public health workforce, said Dr. Allison Arwady, commissioner of the city’s public health department. Although she got 26 of those 66 employees extended into December, she said it’ll hurt to lose the rest. They’ve contributed to everything from public health nursing to communicating the latest guidance about the pandemic to Chicagoans….’ The lack of a steady source of money from year to year is jeopardizing health department programs,’ Chicago’s Arwady said. She estimates the city will lose 86% of its current grant funding in two years, putting wastewater tracking, some of her department’s IT staff, and community-based outreach on the possible chopping block…’We’re not going to be able to do half a dozen things that the city of Chicago clearly expects we should be able to do. Forget Can I bring vaccine to your house? It’s Can I even stand up, like, a vaccine clinic in your neighborhood?’ she said. ‘It’s that level of how far backwards I’m afraid we’re going to slide.’”
I guess I should not be surprised by this willful ignorance at the expense of the nation’s population. There are few, if any, examples of our investing in the structures of government that are needed for what we know and what may surprise us. We’ve underfunded public education even though we are aware of the need for more investment. We have underfunded the pipes that bring water into our homes (remember Flint, Michigan?) We are seeing how ill-prepared we are for a changing environment as storms ravage communities and the Mississippi River runs dry. We allow our unhoused population to grow rather than build enough affordable housing.
For reasons I struggle to comprehend, we prefer as a nation to view everything from an individual perspective making each of us responsible for our lives even when the problems, we face are not solvable on an individual basis. Poverty, homelessness, education, employment, and health are viewed as failures of the person rather than failures of our nation. We refuse to see the need for collective actions, for solutions that are built on a city, state or national basis, solutions which we are all asked to pay our fair share for and make the necessary personal sacrifice.
And we do this even when the cost is small and the sacrifice minimal (remember wearing a face mask or getting a vaccine?).
And that’s what makes this story of the failure to build a public health infrastructure so scary. We are not talking about a budget-busting amount of money. The 4,000 public health personnel whose jobs are ending were funded as part of a $289 million allocation. That’s only a bit more than $72 THOUSAND per employee. At that rate, funding the entire 80,000 Public Health worker shortfall would require about $6 billion or about or about 1% of the Defense Department’s 2023 budget request.
And that allocation for new public health employees was not a budget line in the budget of the Centers for Disease Control, the federal agency responsible for responding to a health crisis, but to an independent but to the organization “created by Congress to mobilize philanthropic and private-sector resources to support the Centers for Disease Control and Prevention’s critical health protection work…” As if we can or should fulfill our collective responsibility to each other only if wealthy individuals or businesses deign to contribute rather than pay their fair share through our tax system!
The story of our public health system is the canary in the mineshaft that should alert us and spur us to support Congress, the President, as well as our state and local leaders, to take on the challenges we face realistically and lead us to solutions that will work for everyone. But I fear they will not because we will not demand that they do so. Too many of us will be focused on keeping what we have and protecting our personal comfort. As COVID has proven if we are only willing to see what is right before our eyes. Systemic and widespread challenges cannot be solved by individual actions. We continue to ignore this at our own peril.
