Thoughts On Public Health, Economics And Advocacy During The COVID-19 Pandemic

I am not alone in my feelings of powerlessness as our world deals with the COVID-19 pandemic. I am a follower of epidemics going back to my college days. My college roommate is a plague/tuberculosis specialist and is currently the Director of the Division of Infectious Diseases with the New York State Department of Health at the Wadsworth Center in Albany, New York. As a result, I knew of the forecasted pandemic. 

Over my last 20 years of involvement with podiatric public health and attendance at the annual meetings of the American Public Health Association, the emerging diseases were always featured in the programming. Preparedness was the consistent message across all of these topics. I have also witnessed a downward trend in the funding of public health activities on all levels, leading to increased disparities and what is accurately labeled a “piecemeal” system. As I am writing this, the truth continues to emerge of how unprepared the world is and how the system responsible for the greater good is badly underfunded. 

All of us are affected by COVID-19 and know that a new normal will emerge. For me, the “new normal” equates to a life-sustaining society labeled in the 1990s as the “Great Turning.” This term came to signify the transition from an unraveling, industrial growth-consumable society to an integrated, sustainable earth-based solidarity. 

Along with my interest in epidemics, I devour economic theory books and recently came across Doughnut Economics: Seven Ways to Think Like a 21^st-Century Economist by Kate Raworth.¹ Raworth discusses the need for transitioning away from outdated economic tenets rooted in 1950s textbooks that message century-old premises of unlimited growth to one where every person can lead a life with dignity, opportunity and community.  

Medicine continues to advance and grow. Many of us who started a few decades ago witnessed the corporatization of health care in which the principles of depersonalized mass production (highly effective in retail business models) were applied to health care systems. This depersonalized approach replaced the sacrosanct doctor-patient relationship with that of a commodity and consumer. I have long felt that health-care providers in general are slow adapters and this has led to non-clinical “others” leading health care decision-making, often without necessary input from the grassroots physicians and patients. These “others” often do not have patient care as their first concern nor future sustainability concerns in mind. With our current emergency and the relaxation of corporate control, we are seeing glimpses where patient care and providers are the priorities. This may be an opportunity to revolve back to a model in which patient care is first based on medical team decision-making and not on the interests of corporate insurance carriers.  

It is also my observation during my professional tenure that physicians are not proportionally represented in the advocacy world although the COVID-19 emergency may “radicalize” many more. We definitely do have standouts and many will “go to bat” for their patients, but these numbers are shrinking. My college focus was in political science. Having grown up during the 1960s and 1970s in the post-Vietnam/Watergate era, my peers spent their time on advocacy. We logged miles and time at antinuclear, women’s rights and environmental gatherings with a few concerts thrown in the mix.  

My advocacy interest has led me to participate professionally in the American Podiatric Medical Association Political Action Committee (APMAPAC) since I started practice in podiatry. I am currently on the APMAPAC board and have noted the aforementioned trend continues in podiatry. A decreasing number of DPMs support professional advocacy efforts. COVID-19 is life-changing to our practices and I believe a shift will occur in medicine. Everyone impacted needs to have a voice in deciding where we are going. This is uncharted territory and I believe that returning to what was the norm will not be sustainable. 

Here are some final thoughts adapted from Joanna Macy: Being present to fear, to gratitude, to all that is – this is the practice of mutual belonging. As living members of the living body of Earth, we are grounded in that kind of belonging. We will find more ways to remember, celebrate and affirm this deep knowing: we belong to each other, we belong to Earth. Even when faced with cataclysmic changes, nothing can ever separate us from her. We are already home. 

Dr. Simon is a Past President and Executive Director of the New Mexico Podiatric Medical Association and is a Board Member of the APMAPAC. She is also a Member of the APMA Public Health Committee and the American Association for Women Podiatrists. Dr. Simon is in practice in Albuquerque, N.M.

Reference

1. Raworth K. Doughnut Economics: Seven Ways to Think Like a 21^st-Century Economist. White River Junction, VT: Chelsea Green Publishing;2017.