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June 23, 2022

How America needs to rethink public health, according to the Commonwealth Fund

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    The Commonwealth Fund Commission on a National Public Health System on Tuesday released a report detailing the shortcomings of the United States' current approach to public health—and called for the creation of a new "national public health system."

    Covid-19 tested national health systems—and they responded largely as designed

    Shortcomings of the American public health system

    In the report, the nonpartisan panel highlighted the shortcomings of the United States' response to public health challenges, including the Covid-19 pandemic. Since the start of the pandemic, over 1 million Americans have died from Covid-19.  In addition, the panel noted that the United States is failing to shield millions of Americans from growing health challenges, including overdoses, diabetes, and maternal mortality.

    In particular, the panel found that there are several deficiencies within the American public health system, including how:

    • Public health efforts are not set up for success. While there are dozens of federal health agencies and almost 3,000 state, local, tribal, and territorial health departments, there is no single entity at HHS tasked with leading and coordinating the country's health efforts.
    • Public health funding is insufficient and unreliable. Years of underfunding has resulted in a weak public health infrastructure with major shortcomings, including outdated data systems, a strained workforce, and run-down laboratories.
    • There are minimal expectations for health agencies. Funding is not tied to basic standards for the abilities of health departments.
    • The health care system is not taking advantage of opportunities to support health improvement. It is difficult to transition collaboration between public health agencies during an emergency into sustainable efforts to address everyday health challenges.
    • The public health enterprise is experiencing a "crisis in trust." According to the report, this crisis is related to individuals' experiences with racism and discrimination, ideological opposition, and misinformation.

    "The consequences of these deficiencies reach far beyond the current pandemic and undermine the nation's ability to respond to ongoing and pressing health challenges," the report authors write. "The pandemic exacerbated a national mental health crisis, especially among millions of children and young adults who have been knocked off their life trajectories." 

    "The COVID-19 crisis shone a very harsh spotlight on many of the longstanding gaps in public health and its ability to respond to both day-to-day concerns and to a crisis such as COVID-19," said Margaret "Peggy" Hamburg, former FDA commissioner. "It really reminded us that public health may not lack for effort and commitment, but it does lack for structure, resources, and coordination ... We really need to build a strong, robust, sustainable system of public health, a system led at the national level that will promote and protect health day in, day out, but also better prepare us to respond to emergencies."

    Panel calls for a national public health system

    To better address both current and future public health challenges, the panel recommended the creation of a new national public health system.

    One of the panel's key recommendations is the creation of a role within HHS that will oversee and coordinate the national public health system. The role would focus on strengthening "the nation's public health infrastructure, including data systems, workforce, laboratories, and procurement, and to bring together state, local, tribal, and territorial health departments to promote coordination."  

    In addition, the authors called for increased cooperation between HHS and other federal agencies.

    "The healthcare system should work closely with public health agencies, sharing data and workforce and planning together to address a wide range of challenges," Hamburg said. "This collaboration can lead to progress against many pressing ongoing health challenges, including chronic diseases like diabetes, obesity, heart disease, addiction, and overdose."

    According to former CDC Director and commission member Julie Gerberding, "[o]ne of the biggest frustrations [she faced as CDC director] was the coordination of all of these efforts across multiple agencies within HHS, but also across cabinets."

    For instance, with the Covid-19 pandemic, "it is a 'whole of government' challenge to manage a complex health issue. It's not just HHS or CDC -- it involves [the] Transportation Department, the Education Department, the Commerce Department, the Treasury [Department], and on and on. So, we have to find mechanisms that allow us to do a much better job of coordination," she said.

    To make the panel's recommended changes, they proposed "that approximately $8 billion in new investments be dedicated to improving information technology (IT) and public health infrastructure each year -- an amount that pales in comparison to the trillions of dollars lost as a result of the inadequate public health response to the pandemic."

    "We did not intend this to be another layer of bureaucracy, another layer of delay in getting things done, but in fact, a mechanism to really ensure that we're thinking broadly about public health," Hamburg noted. (Stolberg, New York Times, 6/21; Melillo, The Hill, 6/21; Frieden, MedPage Today, 6/21; Hamburg et al., "Meeting America's Public Health Challenge," 6/21)

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