With the COVID-19 pandemic still going on and monkeypox now being considered a public health emergency in the United States, we are officially in the middle of two viral disease crises. Public health experts know what it takes to control disease outbreaks. It is broad identification/testing, treatment and prevention. However, systemic problems with the funding and administration of healthcare in the country have created a public health system that is passive rather than proactive. As a result, our public health system is chronically underfunded, understaffed, and in some areas deprived of legal authority.
Key Federal Public Health Preparedness and Response programs of the U.S. Department of Health and Human Services—including the Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness Cooperation Agreements, Hospital Preparedness Programs, and the Prevention and Public Health Fund—obtain necessary resources. Is not … Adjusted for inflation, the CDC budget, the primary source of funding for state and local health departments, has grown only 11% over the past decade. The Public Health Emergency Preparedness Cooperation Agreement and the Hospital Preparedness Program have seen cumulative budget decreases of 48% and 61%, respectively, taking into account inflation from the early 2000s to 2022. These programs experienced an influx of emergency funding in response to COVID. 19 pandemic, it was still well below its pre-pandemic highs. The Prevention and Public Health Fund was established as part of the Affordable Care Act, but faces constant threats from policy makers to use it to offset the costs of other governmental priorities. . Meanwhile, state and local health sector funding has flattened or declined over the past decade, with the health sector workforce down 23% between 2008 and 2019.
The way the U.S. health sector is funded contributes to labor shortages and is one reason why the 50,000 public health jobs lost in the 2008 Great Recession have not been regained. is. Many departments rely heavily on disease-specific subsidies, creating precarious and time-bound positions. The issue of this type of discretionary funding is multifaceted. Applying for these grants requires time and resources, something most health departments are already lacking. Also, funding is generally limited to single-year use, making it difficult to recruit qualified personnel. Faced with relatively low wages and uncertain funding year after year, more and more public health graduates are turning to the private sector for employment.
As it stands, more than 40% of public health workers could leave their jobs in the next five years, according to the results of the 2021 Public Health Workers Interests and Needs Survey. The public health workforce is underpaid and overworked, but the politicization of the response to the COVID-19 pandemic has brought new issues, including negative public attention, that contribute to worker burnout .
Most public health officials are accustomed to relative anonymity in the course of their work, but these days, some have to contend with armed protesters and threats to themselves and their property, according to a study in , American Journal of Public Health57% of local health departments reported being harassed during the COVID-19 pandemic, leading to the resignation of 256 officials between March 2020 and January 2021.
This outflow of skilled public health workers will slowly erode the skills of government public health agencies, weakening their ability to respond to future emergencies. This is based on current estimates that state and local public health departments provide minimal public health services (such as communicable disease control, chronic disease and injury prevention, assessment and monitoring, policy development and support) — de Beaumont Foundation According to a report in . In the event of a simultaneous public health emergency, as we are currently experiencing, it could provide the “people power” necessary for effective case investigation and contact tracing to prevent illness. More personnel are needed to slow the spread of the virus.
Additionally, many conservative state legislatures have curtailed the powers of public health agencies or authorities to enact policies that protect public health. At least 26 states have passed laws limiting public health authority. These include legislative attempts to undermine the power of public health agencies to close businesses in the name of public safety, mandate masks, require vaccines, or quarantine infected individuals. increase. Political pressure also includes threats to withdraw or redirect public health funding. Collectively, this undermines local, state, and national efforts to deal with the next pandemic.
Unfortunately, public health often falls victim to its own success. No one can see the disasters prevented by preparedness, so it’s easy to underestimate what we can’t see. This affects the boom-bust cycle of public health spending in the face of emergencies.
The public health fund purse strings are controlled by politicians voted into positions of power by voters. U.S. voters view politicians more favorably for providing disaster relief spending, such as coronavirus aid, relief, and the Economic Security Act, compared to reserve funds, survey shows There is an important relationship between increased votes and additional votes. This encourages legislators to continue reactive funding practices.
Monkeypox shows that the next pandemic can occur before the previous one is adequately controlled. It is therefore imperative to improve the public health system in this country and prepare for yet another pandemic that could strike at any moment.
A more proactive approach to funding public health in this country involves not only increasing spending but also changing how these funds are allocated. One option is for governments to increase the proportion of public health spending that is mandatory rather than discretionary. This reduces year-to-year funding variability that negatively impacts state and local health departments.
A second option is for governments to replace siled or classified funding and instead provide more general funding that allows public health agencies the flexibility to spend according to priorities and emerging community needs. is to provide
A third option is government funding based on measures of community need, such as the ‘local deprivation index’. Doing so is more equitable than awarding funds through competitive grant programs, and at the expense of people in poorer and underserved communities to provide resources for successful grant applications. And rewarding institutions for their skills may widen the gap even further. No single policy can improve public health in this country, but these are some that can.
