Planning Group Can Drive Strategic Directions for Public Health

From the early days of the COVID-19 pandemic until today, the services, infrastructure, and staff of our public health system have been stress tested every single day. We have heard about heroic feats by our public health workers, and we have learned about new tools to promote successful campaigns and interventions. However, this experience also has taught us that our public health system will require both innovation and enhancement if we are to meet future challenges rapidly and successfully.

The public health field has remained mostly silent at the national level during the current pandemic. As a result, the challenges being faced by the field neither are well-known to our political leaders in Washington nor to the American public. Clearly, this must change going forward.

To move this important agenda in a timely manner, the public health field will need to convene a planning group charged with developing a set of strategic directions that can be shared with and explained to the appropriate committees of the Congress and the Biden-Harris administration. This submission will need to be accompanied by strong national advocacy from all quarters of the field. The goal will be federal legislation that begins to build a 21st century public health system.

In this piece, I would like to offer several potential strategic directions that this planning group might consider. I do this to foster discussion about potential future directions and to accelerate the planning process.

Leadership Enhancement: At the present time, federal public health functions are distributed across several agencies with different mandates, budget authorities, and programs. Because these functions are not coordinated, they do not create the conditions to foster an integrated national public health system. Hence, a need exists to create a superordinate federal office to coordinate these functions. This could be an Office of National Public Health Policy and Programs in the Executive Office of the President at the White House.

Service Enhancement: The foundational units of our American public health system are county/city public health departments, state public health departments, and state public health associations. Discussions with representatives from each of these units suggest that they lack essential staff and resources for program development and implementation, and for policy development and execution, particularly in a crisis period like the COVID-19 pandemic. Hence, a need exists for the creation of permanent federal programs (e.g., the public health analog to the federally qualified health centers) to fund necessary capacity in these public health entities. Today, we spend less than 3-5% of our national health budget on public health. COVID-19 has shown us that this level of funding is dramatically inadequate.

Workforce Enhancement: The public health workforce actually has declined more than 40% in the past two decades. Hence, programs will be required to train new public health personnel in our universities and then place them into the public health workforce. The National Health Service Corps mandated to train health service personnel and operated by the federal Health Resources and Services Administration represents a good analog program. In this program, educational expenses are forgiven in return for a 3-5 year commitment working in public or not-for-profit healthcare programs in high-need geographical areas. What is required for public health is funding and development of a federally operated National Public Health Service Corps with similar characteristics.

For the public health workforce already in place, additional training is required to modernize skills in information technology, surveillance, communication, conflict resolution, problem abatement in a population-wide crisis, and program assessment, among others. This could be accomplished through federal funding of continuation education training programs undertaken virtually at the work site.

Technology Enhancement: In many places, the COVID-19 pandemic has been addressed with yesterday’s technology, data collection procedures, and tools. The net effects of this are to slow response time, foster chaos, and reduce program effectiveness. A thorough assessment of successes and failures should be undertaken, and a new field of public health technology conceptualized. (See my recent blog on this subject.) To do this, we need to charter and fund a new Office of Public Health Technology in the US Department of Health and Human Services.

Surveillance and Data Enhancement: Better digital surveillance protocols based in social media could have reduced or eliminated many of the surprises that occurred during the COVID-19 pandemic, and, with predictive analytics, could have projected subsequent events. Similarly, better quality and more timely data on COVID positive and negative rates, contact tracing, hospitalization flows, bed availability, deaths, recovery rates, and rates of behavioral health and non-COVID illnesses, could have led to more effective county/city responses to the pandemic. The lessons we continue to learn about this pandemic should serve as input for new funding and program development in modern surveillance and data collection methods at the key federal agencies—the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration.

Moving Forward: As the above description indicates, the development of a 21st century public health system will be a complex undertaking. Clearly, federal leadership and financial resources will be essential to bring this about. This only can happen if the public health field develops the vision, strategic directions, and the advocacy to bring the problem to Congress and the Biden-Harris administration. Please join us on this important journey.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.