Building a strong public health capacity across the United States


For the first time in the history of the U.S. response to public health emergencies, Congress and the Biden administration have the opportunity to break the cycle of partying and starvation in public health funding. In addition to pumping out the billions of dollars needed by public health agencies across the country to respond to the immediate emergency of the COVID-19 pandemic, there is hope that instead of giving up interest for public health in a post-emergency period, we will see serious investments that will rebuild our public health system, so that we are better positioned to meet the challenges of the next pandemic, as well as the continuing challenges we face, including with regard to health equity.

This is reflected in the $ 7.66 billion in the American Rescue Plan Act dedicated to the public health workforce, of which approximately $ 3 billion will be spent on longer-term investments. And this is reflected in the share of House Energy and Commerce of Rebuild Better Act allocate $ 7 billion in money without year for the personnel and the infrastructures of public health and Sen. Patty murrayPatricia (Patty) Lynn Murray The Texas abortion law creates a headache for the GOP in 2022.‘s (D-Wash.) Law on public health infrastructure to save lives.

Recognizing that we have underinvested in public health is the first step. But we must also recognize that “to rebuild better” in terms of public health is to rebuild differently. Even when health services have been relatively well funded, the response to the pandemic has been inadequate and underlying inequalities in communities across the country have resulted in the tragic and disparate impact of the pandemic. This means that we cannot simply rebuild the existing public health infrastructure. We need to think differently not only about how public health is funded, but also how it is structured at all levels – federal, state and local.

We can find the way forward if we are guided by certain principles. First, we need to address the huge variation in capacity in state and local health services across the country. Where you live shouldn’t determine how well the government protects you from pandemics or other health threats. Second, public health must regain the trust of its residents by forging stronger partnerships with organizations and community representatives to set priorities, based on reliable data provided by public health to help shape restructuring and direction. of a modernized public health agency. Finally, and most importantly, this reconstruction effort must be guided by a focus on equity. This is the primary mission of public health: to ensure that all members of the communities we serve can lead the healthiest lives possible.

How to move from these principles to the practical reality of public health agencies which can translate them into practice? There is now a broad consensus in public health that all communities should be served by a public health system with certain fundamental abilities ranging from robust assessment and monitoring to emergency preparedness and response and community partnerships. These are now incorporated into the revised accreditation standards being developed by the Public Health Accreditation Board (PHAB), and the Energy and Trade Bill and Murray Bill tie this new funding to accreditation.

Going in this direction will not be done by chance. As these new funds flow in, the federal government needs to be more assertive in its expectations of state and local public health agencies. We have learned, painfully, how endangered the entire nation is when we have health services spread across the country that lack these basic capabilities. Federal officials must hold grant recipients accountable for achieving measurable standards. This can be achieved through a four step process:

1) States (and their localities) should provide a detailed assessment of their current capacity to implement their core capacities and strategies to address gaps, whether by creating new systems, hiring new workers or sharing services between jurisdictions. This has already been done in some states, such as Ohio.

The federal government should fund this assessment, and it should be a condition of additional infrastructure and labor funding.

2) The federal government must ensure that funding reaches all public health agencies – tribal, state and local. The traditional federal focus on states works in places with centralized public health systems. Most of the country has a decentralized system; money must follow need.

3) The federal government should secure multi-year funding so that states and communities have confidence that the hiring of new staff will be sustainable. This is already implicit in the American Rescue Plan Act and the pending reconciliation bill, but Congress and federal agencies must support these investments.

4) Independent accountability should be built into this funding. With sufficient federal funding, state and local health departments are expected to obtain accreditation from the Public Health Accreditation Board within a certain time frame, with technical assistance provided to help achieve this goal.

The United States will always have a decentralized public health system. But that doesn’t mean that the federal government, as the largest funder of public health in the United States, shouldn’t be maximizing its investment in ensuring that all Americans are equally protected from threats to human health. public health.

Jeffrey Levi, PhD, is Professor of Health Policy and Management at George Washington University.


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