TEN TRANSFORMATIVE TRENDS 2021 Will COVID-19 Lead to Adequate Investment
in Public Health Infrastructure? Innovations developed during the pandemic could end up benefiting day-to-day public health work By David Raths
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eglected. Archaic. Siloed. Those are just some of the adjectives regularly used to describe federal, state and
local public health data systems. The pan- demic has made the fragmented nature of our response and the underinvestment in public health painfully obvious. That means we have an opportunity to re-eval- uate our priorities and re-invigorate our infrastructure before the next pandemic. But will we find the political will and long-term vision to make the investment? Several public health experts and orga-
nizations point to information systems and work force issues as key to revitalization. Brian Dixon, Ph.D., director of public
health informatics and an associate pro- fessor at the Indiana University Richard M. Fairbanks School of Public Health as well as the Regenstrief Institute’s Center for Biomedical Informatics, says there is a lot that the Biden administration could invest in.
highlighted that those systems are not connected to the healthcare delivery system,” Dixon explains. “A lot of what has happened during the pandemic was bootstrapping for exporting data electronically for public health. During a pandemic, it’s crazy that we are doing a lot of faxing in 2021, when we have the capability to submit data electronically.” The investments, he adds, would be in
those kind of standard information flows, standardized processes and systems that can interconnect public health internally, and then connect them to healthcare sys- tems. (Prior to the pandemic, the annual federal budget for public health data infrastructure was only $50 million.) One concern is that there tends to be
huge investment in public health and emergency preparedness in the wake of an actual emergency but then it gets ignored or defunded when things return to normal. On the other hand, during
“After the emergent threat is gone, we forget about public health, we forget about the need for planning, and we just assume it’s going to be there when we need it. I think there’s a real danger of doing that again this time around.” —Brian Dixon, Ph.D.
health infrastructure that incorporates all of our HITECH Act investment in electronic medical record (EMR) systems. “I don’t know about you, but I’m still wait- ing for my return on that $27 billion loan I gave healthcare,” he says. “We spend $750 billion a year on defense. When was the last time a foreign nation took 450,000 American lives on American soil? What we have to understand as a nation is that our security, our safety, and our economic prosperity are going to be dependent on having a robust public health system,” he stresses. “We now see what happens when you defund public health. We’ve seen what happens when you have too many holes in the fence, and we’re vulnerable.” Getting past the boom-and-bust cycle
In terms of information systems, public
health is today where healthcare provid- ers were in the 1990s and early 2000s, he says. “Most public health workers have a computer on their desk with Internet access, and they use information systems, but they’re mostly fragmented systems. There’s an HIV system and an STD sys- tem and a tuberculosis system, but these things weren’t connected. The pandemic
an emergency is not the best time to be implementing new systems or hiring staff. “You can’t hire the firefighters while the house burns,” says Brian Castrucci,
Dr.PH, president and chief executive officer of the de Beaumont Foundation, a philanthropic organization focused on public health practice. Castrucci contends that the country needs a comprehensive national public
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of investment is critical, public health officials agree. We are investing a lot of money in COVID response for good reason. It is resource-intensive, time- intensive, and person-intensive. Adriane Casalotti, M.P.H., M.S.W., chief of govern- ment and public affairs for the National Association of County and City Health Officials (NACCHO), says we need to apply those levels of resources all the time. “Building up data systems to track vaccines is critical, but we work every day to try to find kids who are lost to follow- up for the vaccines that they need, based on their age, and we lose adults in the system who are not getting the vaccines that are recommended for their age and health status,” she adds. “These systems are critical. When we invest in them, we
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