October 20, 2021

Why the US public health system is worse off than before Covid-19

Daily Briefing

    Public health departments across the country are struggling with staff burnout, limited funding, and new restrictions on their authority—shortfalls that could make the country even less prepared for the next pandemic than it was for Covid-19, according to the New York Times.

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    More than 30 states limit public health powers

    According to the Times, legislators across the country have approved more than 100 new laws limiting local and state health powers, and hundreds of more pieces of similar legislation—across all 50 states—are under consideration.

    For example, in Kansas, the state legislature passed a series of laws that limited Covid-19 contact tracing; transferred the authority for health decisions to elected leaders; and allowed anyone "aggrieved" by a health order, such as a mask mandate, to sue the agencies that imposed it, the Times reports.

    "It was a huge slap in the face to all of us who are doing the public health work," Jennifer McKenney, the top public health officer for Wilson County, Kansas, said.

    Currently, at least 32 states have enacted new laws preventing public health officials from enacting health orders, the Times reports. In 13 of these states, public health officials are barred from enacting vaccine mandates, and in 23 states, public health officials can no longer place restrictions on businesses, schools, or churches. Many of these new laws also limit public health departments' ability to conduct contact tracing or penalize individuals for violating health orders.

    In addition, some of the new laws are so broad that they could make it harder for public health officials to carry out long-standing health orders, including flu vaccination campaigns or quarantine protocols for the measles, the Times reports.

    "We have learned all the wrong lessons from the pandemic," said Adriane Casalotti, chief of public and government affairs for the National Association of County and City Health Officials, which represents nearly 3,000 local health departments in the United States. "We are attacking and removing authority from the people who are trying to protect us."

    'Who wants to work there?'

    In addition to these new restrictive laws, public health departments have struggled with staff burnout, public animosity, and unpredictable funding over the course of the pandemic—which is likely to leave a long-lasting impact on their ability to function going forward, the Times reports.

    According to a Times survey of 300 county health departments across the country, many health departments have lost experienced staff during the pandemic, in part due to threats and abuse from the public, and are struggling to find replacements. In fact, more than 500 top public health officials have left their positions in the past 19 months, the Times reports.

    Kathy Emmons, executive director of the Cheyenne-Laramie County Health Department in Wyoming, said her department has seen an almost 80% turnover rate during the pandemic. "They didn't join our department to Covid-test 10 hours a day or give vaccinations 10 hours a day," Emmons said. "We were asking people to completely change their work priorities."

    In addition, more than 220 health departments said they temporarily or permanently abandoned other public health activities to respond to the pandemic, the Times reports—significantly impacting many people's health. For example, drug overdoses have spiked during the pandemic, and some areas have seen increased rates of STIs and lead poisoning.

    Many health departments also told the Times they were worried about their levels of funding, which had largely been decreasing or flat before the pandemic. Although billions of dollars in funding have been invested in public health during the pandemic, many officials said most of the money has gone towards hiring temporary workers or urgent testing and vaccination needs instead of permanent staff and long-term infrastructure.

    In May, the Biden administration announced an additional $7.4 billion in Covid-19 stimulus funds to train and recruit public health workers, the Times reports, but that funding is not likely to be permanent. According to many local health officials, they expect the proposed funding to run out within the next two to three years—much like how funding that came in after the 9/11 attacks petered out as political priorities changed.

    "Everybody looks at public health now and says, 'Who wants to work there?'" said Sue Rhodes, the health department administrator in Marshall County, Kan. "Who wants to work in that chaotic mess?" (Baker/Ivory, New York Times, 10/18; Gonzalez, Axios, 10/18)

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