In summary

We cannot wait for the next pandemic or public health crisis to emerge; we still face a host of other public health issues.

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By David Souleles, Special to CalMatters

David Souleles is the director of the COVID-19 Response Team at the University of California, Irvine, and director of the Master in Public Health Program and Practice at UC Irvine.

As a public health practitioner with 35-plus years of experience working in public health in California, it is my duty to bring attention to the urgent need for a significant investment in our public health workforce and infrastructure.  

Public health has historically struggled with three key issues: being understaffed, underfunded and misunderstood. The pandemic has claimed nearly a million American lives – a devastating, but preventable loss had public health agencies been better equipped with the appropriate resources, staff and infrastructure. 

When COVID-19 eventually becomes endemic, we are still left with a host of other public health issues including more than 480,000 tobacco-related deaths; rising rates of chronic conditions; an all-time high of sexually transmitted infections; and disparities in maternal and child health issues and birth outcomes. At the root of all public health problems are long-standing issues of equity and access.

The Great Public Health Exodus

Since 2008, the National Association of County and City Health Officials reports that local and state health departments have lost nearly a quarter of their workforce, and another 25% plan to leave the profession within a year. 

An analysis by Kaiser Health News and the Associated Press found that more than 180 state and local public health officials have resigned, retired or been fired since April 1, 2020, in what experts are calling the largest exodus of public health workers from the field in our country’s history. The report states nearly 40 million people reside in a community that lost its local public health leader during the pandemic. Overwhelmed, exhausted and facing increased personal threats and political pressure, public health leaders have been driven out at unprecedented rates – just when we need them the most.

Investing in public health to improve and maintain community health

Investing in a vibrant and capable workforce is one step in a multifaceted approach to rebuilding public health agencies. The other is to invest in the systems and technologies that make up the public health infrastructure. Serious investments in disease reporting technologies, public health laboratories, public communications systems and health department facilities are needed to allow public health professionals to be effective. 

Public health is preventative health, and measures like ensuring proper sanitation, clean air and drinking water and immunizations against infectious disease have essentially doubled human life expectancy over the past 200 years.

Research shows that investing in public health comes with high returns and impactful results. According to the World Health Organization, population-level approaches are estimated to cost five times less than individual interventions, and in general, investments in public health come with a fourfold return on every dollar invested.

The power of health policy 

I applaud Gov. Gavin Newsom’s proposed 2022-23 budget that earmarks $300 million for state and local public health agencies to build up capacity and transform California’s public health system. 

This investment would strengthen staffing, data collection and expand local partnerships with health care delivery systems and community-based organizations. It would also help improve statewide public health infrastructure with investments in resources for emergency preparedness and enhancing communication, public education and combating misinformation.

This is the action we need. And this can also help other states craft their own roadmap to build public health capacity. This proposal happened because public health experts were at the table with policymakers. This is proof that we need to continue building relationships with government officials and continue working through our professional associations. We need to talk about the science and counter anti-science narratives. We need to talk to our networks and communities to build trust and support. We need to vote. And we need to find a way to speak with one voice to be better advocates for public health. 

We cannot wait for the next pandemic or public health crisis to emerge to make our investments in the future. By now, that lesson should be learned.

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