The year 2020 should not be forgotten in our desire to forget the isolation and deaths of COVID-19. On one hand, it showed how easily America could descend into political chaos. On the other hand, it demonstrated to the country, in very stark ways, what public health is all about.
Presidents of both parties have, over almost half a century, focused on guaranteeing universal access to health care (i.e., treatment), assuring affordability of that care through insurance, and controlling the costs of care through regulations and innovation. In other words, finding ways to efficiently and effectively care for those who are sick.
Such efforts, however, are only part of the story — as the pandemic has so dramatically shown.
They are reactive, not preventative. They focus on the treatment of individuals once infected, not protecting populations from getting sick in the first place. They address an infectious disease once it has spread to become a pandemic; they don’t anticipate and prepare for the outbreak.
It is these public health efforts that have been in decline as the others have been in ascendance.
The field of public health promotes and protects the health of people and the communities in which they live, learn, work and play. Public health research provides the basis for laws and regulations promoting wellness in the workplace and at home. Public health researchers document how the quality of housing, employment, education and the environment affect our health and helps us to understand the source of disparities in health across different regions and populations.
Public health departments monitor the health of the community to identify health threats and their sources, educate communities on healthy behaviors and administer vaccinations.
The public health workforce that supported West Virginians for decades — public health nurses, epidemiologists, sanitarians, health educators, contact tracers, communication officers, environmental monitors and others — has been decimated by state leadership from both parties over the past two decades.
Data from the Association of State and Territorial Health Officials documented a 27% reduction in public health spending in West Virginia from 2010 to 2018. From 2007 to 2019, full-time jobs in the state health department dropped 29% and, in 2020, the commissioner of the Department of Health and Human Resource’s Bureau for Public Health reported that 20% to 25% of those remaining positions were vacant when the pandemic hit — 30% in epidemiology.
Public health efforts are underfunded and resource starved.
Without an adequate number of public health workers, we have resorted to making additional demands on medical staff and nonhealth workers to do the job. Doctors and nurses and other medical professionals already overburdened by the “sick-care” services required by the pandemic on top of their usual caseloads are also called on to perform services outside their routine, e.g., vaccinations. National Guard troops are asked to run programs to distribute vaccines. And governors and athletic coaches are tweaking science-informed maps framing our state’s response to the pandemic.
The current pandemic might be the worst we have experienced in generations, but it will not be the last. The illnesses that rob us of our good health are not going away.
We must rebuild, support and fund public health. While we laud our first responders and other essential workers, we must remember that they are still only a reactive force, a response to a situation.
While we buy bobbleheads of Dr. Anthony Fauci, we must realize he is only one of thousands upon thousands of unknown and unrecognized public health professionals across the country in need of support.
Yes, take 2020. Please. But recognize the role of public health in formulating public policy to assure the failures in our preparation and response to a health crisis like COVID-19 never happen again.