We have two health systems in this country. One – our health care system – is anchored in medical treatment delivered one patient at a time. The other – our
public health system
– promotes health and prevents disease in our neighborhoods, communities, and nation. Both health care and public health are crucial to overall health, yet these two systems have followed sharply different trajectories over the past 50 years. Health care has thrived. It’s almost one-fifth of the economy despite its severe shortcomings in quality, cost, and access. Public health has struggled overall. Even with moments of shining success, the underlying infrastructure has been under-resourced and under-appreciated for years.
The pandemic came along, and like a national stress test, it revealed our anemic public health system and put its weaknesses in stark relief – decades of disinvestment, inadequate staffing, outmoded equipment, copy machines masquerading as information systems, and a disjointed patchwork of financing and organizations.
I have been involved in public health throughout my career. My academic training was in public health. I worked on responding to toxic waste threats in Memphis
and was involved in the aftermath of a closed U.S. Public Health Service Hospital in Seattle
(yes, public health used to have its own hospitals). I was in San Francisco when the city developed a unique community-based system of care for patients with a new infectious disease, HIV. I was fortunate to join outstanding colleagues at Robert Wood Johnson Foundation on several public health issues – most notably reducing tobacco use. And I was a board member of a local public health agency in New Jersey. So, it is painful to see public health underperform at a time when it is most needed.