Public health system at a turning point

FOR NEARLY 25 YEARS, the first full week of April has been designated as National Public Health Week. This year, it comes at a critical turning point for the future of public health in our country.

Over the last two years we have seen firsthand the critical role our public health system plays in protecting our lives and livelihoods. At the same time, we also witnessed how COVID-19 not only exposed but exacerbated longstanding systemic disparities in heath access, quality, and outcomes among communities of color. These disparities are driven by factors that affect an individual’s physical and mental health, including access to affordable and nutritious food options, safe environments, affordable housing, financial security, and quality, affordable medical care—all factors that a strong public health system can improve.

The social and economic value of public health is often underestimated and misunderstood, despite the numerous studies that find huge cost savings and gains in public health improvements. A systematic review of public health interventions in high-income countries, including the United States, Australia, and the United Kingdom, found that the median return on investment for all public health interventions was 14 to 1. Studies have shown that 80 percent of an individual’s health can be attributed to these socioeconomic factors or socially assigned circumstances. According to a recent analysis by the W.K. Kellogg Foundation and Altarum, health inequities result in approximately $93 billion in excess medical costs and $42 billion in lost productivity each year.

Public health departments across the country have been underfunded for decades. A one-time infusion of federal COVID-19 relief funds is an opportunity to strategically invest in and sustain the public health system. In Massachusetts, state policymakers have allocated $200 million for strengthening the state’s local public health system. This provides a historic opportunity to effect real and lasting change for our Commonwealth’s residents to live longer, healthier, and more prosperous lives.

I am proud to have served on a multi-sector task force assembled by the Bipartisan Policy Center that recommended actions to policymakers and public health leaders to steward the use of this investment to provide long-term strategic benefits to state, territorial, and local public health systems. This task force, comprised of state and local elected officials and local public health and non-profit leaders like myself, sought to tackle the question of how we seize this unprecedented opportunity to modernize and transform public health in our country. Together, we developed a five-year framework, entitled Public Health Forward, that charts the course to healthier communities across America.

Perhaps the most important recommendation is for greater, sustained, and less siloed funding for our public health system. For years, limited and inconsistent funding has been a burden on public health departments. Because of this, it is nearly impossible for departments to build the cross-cutting competencies and skills needed to address challenges and health inequities, such as those in low-income, rural, Tribal Nations, and communities of color. Restrictive funding sources also prevent public health departments from being nimble in their response to emerging problems and curtails their ability to address jurisdiction-specific issues and advance health equity.

Secondly, we must put into place methods to enhance and evaluate the social and economic impact of all public health programs and strategies. As stated in the report, “a robust, modern, interoperable, and secure public health information system is needed to deliver real-time, accurate, and actionable data to help public health officials detect new or growing threats, identify groups that may be at risk, and respond quickly with tailored policy, practice, and program interventions.” Evaluations should be comprehensive in determining the impact on population health and reflect changes to health outcomes, community feedback, and qualitative analysis.

Beyond the pandemic, our country faces tremendous public health challenges. By working together on modernized laws and public policy, multi-sector partnerships, and flexible funding, we can advance health equity and strengthen this foundational cornerstone of our Commonwealth’s future.

Michael Curry is the president and CEO of the Massachusetts League of Community Health Centers and a member of the Bipartisan Policy Center’s Public Health Forward Task Force.