Investing in Public Health
“People only hear about
their local health department
when there is a problem.”
The word “health” instantly brings images to mind of getting your temperature checked, visiting your doctor’s office, maybe the last meal you ate, or a New Year’s resolution to start getting more exercise. There are also millions of other possibilities to consider when exploring the topic. We are aware that we make choices that impact our health, just as genetic or family health issues affect our overall wellness. Health encompasses the most personal, private decisions that we, as individuals, make every day. In a nation of over 328 million people, it can be overwhelming to consider the unbelievable number of choices Americans make that affect our healthcare system. Yet, managing the health of all people and their communities is the main role of public health professionals.
Quietly existing in the background
In “normal” times, public health works to prevent health problems from happening by creating awareness, education, or actively involving health care providers and community members to provide health services. “Public health is a quiet secret that exists in the background. People only hear about their local health department when there is a problem,” says Dr. Oscar Alleyne. Dr. Alleyne is an epidemiologist and graduate of UAlbany’s School of Public Health. He currently serves as the Chief of Programs and Services for The National Association of County and City Health Officials (NACCHO). In his role, Dr. Alleyne assists local health departments throughout the country with the resources and tools they need to keep their communities healthy at all times. “Local health departments are at the ground level, focusing on the ten essential public health services. What is fascinating is how this diverse team comprised of social workers, health professionals, nurses, physicians, local government officials, public employees, and community members all work together as the backbone in maintaining a strong public health system.”
Essential Public Health Services (source CDC.gov)
The 10 Essential Public Health Services provide a framework for public health to protect and promote the health of all people in all communities.
Dr. Alleyne describes public health as a team sport. Collaboration and cooperation are the two methods pubic health uses to save millions of lives at a time and improve our life expectancy by twenty-five years. Early in his career, he was an epidemiologist at the Rockland County Health Department. During these years, he was part of a local team that responded to Anthrax, Lyme disease, and fast-food industry service issues. “We would meet with other regional health departments to share experience and knowledge. We then worked with health departments in other areas of the country to create a network to share best practices, information, and ideas to support each other in addressing the health and safety of our nation’s communities.” This experience set Dr. Alleyne on the path to advocate for a strong network, operating on the latest technology, to provide instant access to health officials during manmade threats or natural disasters.
Public health during COVID
At the outset of the pandemic, local health departments and local health officials became the source of information and direction on the guidelines established to keep our communities safe. There are nearly 3,000 local health departments in the United States; many lack resources or funding to operate fully. The CARES Act was a $2 trillion coronavirus response bill passed by Congress in March. The aid package was emergency relief funding to help citizens, small businesses, corporations, hospitals and public health, local and state governments, and education. For example, $100 billion was for hospitals responding to the pandemic. $4.3 billion went to the CDC programs and response efforts. Almost $340 billion was designated for local and state governments; more than half was reported toward specific COVID projects, with the remaining $150 billion as direct aid to state and local governments requiring emergency funding to operate. Dr. Alleyne advocates for counties who “have not seen federal dollars.”
On a basic level, local health departments are charged with slowing the spread of COVID-19 by testing, tracking, and tracing area infection rates. During this process, the data collected is then shared on a state level, incorporated into the national health system. This work is where Dr. Alleyne shared his favorite analogy. “I often joke that the healthcare infrastructure investments, like health information technology, did not reach public health departments. Public health is sitting on the information superhighway with a bus pass because they were not eligible for these investments. We have antiquated systems to process information. We still have health departments that are still delivering their reports by fax.”
After months of speculation, a safe, effective COVID vaccine from Pfizer/BioNTech is now available in the United Kingdom. The UK reportedly ordered 40 million doses, enough to vaccinate 20 million people. UK health officials are implementing a vaccine rollout plan, similar to what US officials have stated, targeted at administering doses to frontline healthcare workers and the elderly. The US Food and Drug Administration approved emergency use authorization for Pfizer and BioNTech’s vaccine this week, after an all-day meeting that formalized distribution logistics and the national vaccination plan. Shots will not be available for administration until the CDC officially recommends the vaccine to the American public. The CDC’s Advisory Committee on Immunization Practices has scheduled emergency meetings for this weekend. As our nation’s leaders formulate a strategy for vaccinating Americans, the planning process must include the role of public health.
Local health departments will need to work with community health care providers to deliver COVID vaccines and communicate the effectiveness and importance of vaccination. Public trust has wained this year due to conflicting messages and misinformation shared through social discourse. In their Recommendations for the Biden-Harris Transition and the 117th Congress, NACCHO recognized that public health must abstain from promoting any political agendas. “Even perceived political interference with public health guidance and mixed messages at the federal level greatly impact the ability of our members to protect their communities.” Dr. Alleyne addressed that a safe, effective COVID vaccine is the beginning of a long-term timeline in improving public health. “The next phase is critical; what can we expect in the future? That is the overall impact on mental and physical health, as well as the elements of the economy and society. How are we going to reset to return to a sense of normalcy? We will need adequate resources to create significant and long-lasting progress in behavioral health and social concerns. We are not in for a sprint but a very long marathon!”