With Public Health at Crossroads, Time is Now for Strategic Development

Much like the summer equinox, public health in the U.S. now is at a major crossroads. COVID-19 has shown both the essential nature of our public health response, as well as major deficits in our public health infrastructure.

State and county public health programs played a major role in defining local closings and openings of schools and businesses during the epidemic. They also set up and managed public vaccination sites and operated related websites to schedule appointments. And they prepared public service announcements on topics ranging from use of masks, hand washing, and social distance to mitigating the negative effects of quarantining on personal mental health and substance use.

At the same time, many state and county public health directors and staff members resigned from their positions during the epidemic due to overwork, stress and even threats. It also became very clear that the capacity of the public health response was not equal to the magnitude of the problem being confronted. For example, system capacity clearly was inadequate to reach in a timely way all the seniors in the community who needed assistance to sign up and receive vaccinations.

The several COVID-19 relief packages have provided almost $360 billion in support of state and county operations. However, it is unclear what proportion of these funds will be allocated to public health. Further, the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (March 2020) provided CDC with $730 million, awarded subsequently to 65 jurisdictions to improve the public health response to COVID-19. A year later (May 2021), the American Rescue Plan provided $2 billion to CDC for the same 65 jurisdictions to improve the public health workforce. This latter act also provided more than $7.6 billion to HRSA to train and place public health workers to address the COVID-19 pandemic.

So, where does public health stand at the time of the summer equinox? It seems clear that the pandemic has demonstrated the essential nature of public health capacity and response to both the Congress and to the Biden-Harris administration. At the same time, what seems less clear is whether we actually have a national strategy including all key dimensions of public health, including behavioral health. A key nagging question: Are we prepared for the next pandemic?

The American Public Health Association (APHA) can play a key role in developing and advocating for a national strategy. This is an urgent agenda as the organization approaches its 150th anniversary. The window to do this likely is time limited. Currently, both the Biden-Harris administration and Congress would be very supportive.

Shortly after the 9/11 terror attack, APHA played an essential role with Congress in the award of $2 billion to fund an emergency response officer in each county. Thus, APHA can take bold steps.

I urge you to support the development and implementation of a national public health strategy as an urgent issue. The behavioral health field must support this effort.

Ron Manderscheid, PhD, is president and CEO of NACBHDD and NARMH.