The public health system in the United States needs an immediate “transformation,” two of the nation’s leading health experts write in a new appeal for change driven by the COVID-19 pandemic, climate change, and the politicization of public health.
The essay is the lead article in “Reimagining Public Health,” a new special issue of Health Affairs, one of the nation’s foremost health policy journals. The authors are Ross C. Brownson, the Steven H. and Susan U. Lipstein Distinguished Professor at the Brown School and founder of the Prevention Research Center; and Jonathan Samet, a professor and the former dean of the Colorado School of Public Health.
“No matter what label we attach to this effort, the past several years have made one thing clear: Transformation of the US public health system is needed, and needed now,” the authors conclude in their essay, “Reimagining Public Health: Mapping a Path Forward.” Brownson and Samet were co-authors four years ago of a missive in the American Journal of Public Health that called for public health change as the nation grappled with the pandemic. The current version builds on their thinking and provides more specifics, said Brownson, who hosted a podcast on the subject.
“COVID demonstrated not only the value of public health, but also how it has been politicized, and the need for focused change,” he said. He and Samet talked with nine public health leaders about their ideas on the path forward. Brownson said they were encouraged by the positive views of those leaders, even in states where criticism of public health has been substantial. “One of the things we found inspiring was how optimistic they are,” he said. “That gave us reassurance this thing can be done with focused effort, political will, leadership, and funding incentives.”
In their essay, Brownson and Samet note that the decentralized public health system in the U.S. is administrated and distributed across approximately 3,000 state and local health departments, encompassing governmental public health; community-based organizations; the health care sector; and the education, training, and research of academic public health and medical enterprises. While that far-flung group offers opportunities for using local data in policy and practice, it also can result in an uneven allocation of resources and decision-making.
Public-health experts had been calling for a revamping of the American system even before COVID, but the pandemic “laid bare the deficiencies of the existing public health system and heightened the politicization of public health along partisan lines to an unworkable level in some jurisdictions,” the authors wrote, and highlighted the need for global collaboration.
The essay makes recommendations in seven areas of focus to guide public health transformation:
- Accountability: Provide as much transparency as possible in government actions, and share decisionmaking, budgeting and communication with community members.
- Politicization and polarization: Identify areas where there is consensus/common ground, make better use of local data and messengers, and establish legal protections from violence against public health workers.
- Climate change: Make climate change a core priority, develop ways to track its effects, and advocate for policies to address the root causes.
- Equity: Make health equity a core value of public health agencies, build skills among staff, fully engage the public and policymakers and address health and social needs in marginalized populations.
- Data sciences: Support the harmonization of data sets and repositories, enhance capacity, engage communities and develop real-time surveillance system to detect and monitor threats to public health.
- Workforce: Develop training in new areas, including resilience, communication, systems thinking and entrepreneurship.
- Communication: Identify distinct audiences, create messages that are positive and show benefits, translate evidence into easily understood stories, and identify “superspreaders” of misinformation.