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It’s Time to Build a Strong, Well Resourced Public Health Infrastructure

To protect our nation’s health, safety and security, it is vital we hold public health prevention and preparedness as a high priority—as high as our nation’s military defense.

  • April 14th 2021

By Judy Monroe, MD, CEO and president, CDC Foundation

To protect our nation’s health, safety and security, it is vital we hold public health prevention and preparedness as a high priority—as high as our nation’s military defense. The COVID-19 pandemic represents the world’s most dangerous health threat in over a century, and it has exposed significant deficiencies in our local, state and national public health systems, deficiencies brought about from years of underspending and unpredictable funding.

Even before the coronavirus pandemic, the Trust for America's Health (TFAH) estimated public health efforts were about $4.5 billion underfunded annually. Further, public health budgets have either declined or remained flat over the last decade. According to Kaiser Health News and the Associated Press, spending for state public health departments has dropped by 16 percent per capita and spending for local health departments has fallen by 18 percent. And very troubling, at least 38,000 state and local public health jobs have disappeared since the 2008 recession. The effects are that we are short-handed in resources, technology and critically skilled staff to do the job. 

Though our public health leaders have warned of a worldwide pandemic for years, we have operated in a reactionary status when it comes to funding for our local, state and federal public health organizations. And, our public health infrastructure has been subject to continuous ebbs and flows in funding depending on the crisis of the moment, from the September 11 terrorist attacks to H1N1 to Ebola. While current funding may increase to support efforts to fight the COVID-19 pandemic, support will likely dip once again when the pandemic is stabilized, unless we take action.

The current pandemic in stark terms has shown us that preparedness is paramount. But, as a nation, will we increase and provide reliable funding for public health so that we will be better prepared for the next inevitable pandemic? To me, this is the essential question of the moment.

Having run a state public health department and served as a leader at the Centers for Disease Control and Prevention, I can tell you that it is difficult to spend large sums of funding in the heat of the moment to put out a figurative fire. It is much more efficient to have predictable funding that can be invested over time and then strengthened in an emergency.

TFAH’s report highlights the policy actions we must take to strengthen our public health infrastructure, from modernizing our surveillance and data systems that are antiquated and often too slow in emergencies to investing in the public health workforce and chronic disease prevention. These critical steps are just the tip of the iceberg, but crucial nonetheless in our ability to move the needle towards a sound infrastructure. 

But even with appropriate levels of funding and staff, the federal government for all of its strengths cannot take on this role alone. Our experience tells us we need dedicated partnerships and funding from different sectors—including philanthropy, businesses and individuals. Bottom line is we need a coordinated effort from the start to face a public health emergency, and we need a coordinated effort to end it.

The Johns Hopkins Bloomberg School of Public Health and de Beaumont Foundation recently partnered to create “Seven Ways Businesses Can Align with Public Health for Bold Action and Innovation.” The report offers concrete steps businesses can take to strengthen their partnerships and improve the health of their employees, communities, and the nation, positioning businesses to be influential during a public health emergency. With this guidance, businesses can bolster their role in preparedness and help to reach communities on levels the government is unable to.

I am certain no one wants to experience a pandemic of this scale again in their lifetime. The loss of lives, the economic devastation and the mental health toll that occurred in 2020 and continues today is not something we want to face again. Therefore, we need to make the right investment in our public health infrastructure to fight off, minimize or even prevent that next pandemic.

We all can agree that this will be money well spent. Investment in our public health infrastructure today translates into a safer, healthier and more successful future for our nation.

To learn more, tune in to Aspen Ideas: Health (April 27-29) for a conversation presented by the CDC Foundation between Judy Monroe, the organization’s CEO and president, and Rochelle Walensky, Director of the Centers for Disease Control and Prevention (CDC).


The views and opinions of the author are their own and do not necessarily reflect those of The Aspen Institute.

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