Public health is at a crossroads

We can't go back to the way it was pre-COVID

This article was originally published in Harvard Public Health.

NOW ENTERING the fourth year of a historic pandemic, the US public health system is at a crossroads.

COVID-19 has exposed major weaknesses in our defenses against infectious diseases. Pre-pandemic, the US was thought to be the country best prepared to manage an infectious disease outbreak; most experts never imagined that over 1 million Americans would die.

It is still possible to build a positive legacy from the fires of COVID-19. To do that, we must rethink the mission of local health departments and provide them with the resources to prevent disease and promote health through direct, individual outreach to vulnerable citizens.

Does your local health department help you get treatment for COVID-19 and other diseases when your symptoms are getting scary? Does it help you figure out how to keep the power on, and get groceries when you can’t make it to the market?

Public health departments could and should do all of that and more.

Local health departments like the one I advise, Montachusett Public Health Network in central Massachusetts, added new staff and skills while responding to COVID-19 and mpox. We need to continue helping vulnerable patients access the medical, social, and financial assistance they desperately need. Doing so will save lives, build trust in our government institutions, and prepare for future outbreaks.

This is the future of public health I want to see.

The US public health system is a lot larger than people realize. The media spotlight is naturally trained at the top, the Centers for Disease Control and Prevention. But the CDC’s role is to provide guidance to the state health departments, each controlled by their respective governors. Under the state departments of health are approximately 2,800 local health departments, which are the first line of defense against outbreaks and pandemics. Large counties and cities may have populations in the millions, but 61 percent of local health departments serve populations of less than 50,000.

When the pandemic first exploded, local health departments were quickly overwhelmed by the sheer number of patients. But since then, health departments have been reorganizing themselves to provide the many services—COVID-19 education, testing, vaccination, and referral for treatment—that are needed by the communities they serve.