‘We All Need to Be the Chief Health Strategist’.
On the fourth day of National Public Health Week, and the day that total coronavirus cases in New York surpassed the number of cases in any other country, the School of Public Health gathered veteran public health leaders for the Coronavirus Seminar Series event, “Building the Public Health System of the Future.”
The online event, held on Zoom, featured Georges Benjamin, executive director of the American Public Health Association; Mary Bassett, former commissioner of health for New York City and director of the FXB Center for Health and Human Rights at Harvard University; John Auerbach, former commissioner of public health for Massachusetts and former executive director of Boston Public Health Commission, and current president and CEO of Trust for America’s Health; and Sandro Galea, SPH dean and Robert A. Knox Professor, who moderated a panel discussion with the speakers.
The panelists explored the most glaring public health challenges exposed by the “once-in-a-lifetime” coronavirus pandemic, and shared their thoughts on the most critical improvements necessary for the US public health system to withstand a future crisis of this magnitude.
“We’ve always said that public health remains invisible, and that when our best work is done, nothing happens—until something big happens,” said Benjamin. He said that public health professionals are broadly grappling with not one, but three, epidemics: COVID-19, an “infodemic”—or, misinformation and disinformation—and an epidemic of fear, which leads to misstatements and poor risk communication.
“I remember a time when public health wasn’t so political,” said Benjamin. “But now everything we do is highly political, and unfortunately, in many cases, becomes very partisan.” A 24-hour news cycle, “significant mismanagement by policymakers,” and the intentional or unintentional dissemination of false or outdated information by national leaders have led to severe public mistrust of the federal government, he said. Furthermore, the COVID-19 response revealed fractures within the public health system, such as the failure to produce accurate and widespread testing, understaffed public health departments, slow data systems, and an underinsured and uninsured population.
To rebuild a sustainable public health system, “we all need to be the chief health strategist,” Benjamin said. “We have a statutory responsibility to do that by creating partnerships across sectors, building data systems that can deliver essential public health services, and securing adequate and sustainable funding, accountability, and leadership.”
Bassett drew comparisons to New York City’s response to the Ebola, Zika, and Legionnaires disease outbreaks during her tenure as commissioner of health from 2014-2018.
When the city’s public health department learned of the first Ebola patient, the department made a concerted effort to keep the media and the public informed, which Bassett said was key to controlling the situation and easing public fear.
“We provided detailed information about everything that we knew about the patient, from the name of the bowling alley they attended, to what subway lines they took, to where they walked in the city,” said Bassett. “People prefer bad news to conflicting or confusing news. This was our effort to assure the public that they were being given the facts and nothing was being hidden.”
When the city experienced a Legionnaires outbreak the following year in an impoverished South Bronx community—the largest outbreak at the time since the disease had originated in the 1970s—officials experimented with new ways of communicating pertinent information to residents through digital town halls with local elected leaders. And when Zika emerged in 2017, the NYC public health department looked beyond the mainstream media and relayed critical health information to ethnic media, churches, community groups, and corner stores.
Bassett stressed the need for government leaders to provide accurate and complete COVID-19 information to the public, as well as the need for ongoing communications strategies developed through an equity lens, as current state and national data show that African Americans are disproportionately affected by the virus.
Plenty of studies have shown that “if we used the framework of ‘poverty kills people,’ or ‘racism kills people,’ then we would identify many deaths associated with racial discrimination and income inequality,” Bassett said. “I hope that during this period, as we see how much we’re paying for these inequalities, we’ll have a chance to reassess” and “make the case that it is outrageous that we have a growing number of uninsured people in the midst of a pandemic.”
Auerbach zeroed in on the lack, or misplacement, of funding for local, state, and national public health resources.
“Public health is often funded by narrow categorical line items” that serve policymakers’ interests, but don’t always align with the issues at hand, he said. Funding for the Centers for Disease Control & Prevention, which he said is the main source of state and local public health funding, has decreased by more than 30 percent since 2006.
“It’s no surprise that we’re not as prepared as we could have been for COVID-19,” Auerbach said. “We have aspirational goals of improving public health, but decreasing resources and increasing emergencies.
“We can’t build effective public health strategies by underfunding it, waiting for an emergency, and then flooding it with short-term money,” he said.
Auerbach said Trust for America’s Health, his nonprofit health policy, research, and advocacy organization, is supporting a $150 billion proposal to the federal COVID-19 Response Plan that would fund major changes in public health infrastructure. A stronger public health system will also require accurate data collection, effective contact tracing, and continued research on the underlying causes of poor health.
“We have an emergency now, so we have to focus our attention on that, but we shouldn’t do it with blinders on,” Auerbach said. “We should still be thinking about how to make changes that will continue beyond COVID-19, and that will [enable] us to become the chief health strategists of public health 3.0.”