TEN TRANSFORMATIVE TRENDS 2021
build expertise in the workforce. And when we starve it as it moves away from the front pages of the newspaper, we’re not realizing our investment. There are innovations going on right now that can and should be maintained in the future, because it will end up benefiting us in our day-to-day public health work. But if there is another crisis, we want to be better off than we were when COVID hit, instead of starting from scratch or starting at a deficit.”
emphasis has been on traditional public health methods. We need to put more emphasis on modern methods like data science and informatics, so that individu- als who graduate now and in the future in public health will have some under- standing about information systems and how to use them, and what kind of requirements they should be asking for when they’re in agencies, because if the users are largely uninformed of how to use systems, then they’re going to be
willing to come from the community that we could train up to do this work, who would supervise them?” The budget reconciliation bill work-
ing its way through Congress currently includes $7.6 billion for awards to state, local, and territorial public health depart- ments for staff to serve as case investi- gators, contact tracers, social support specialists, community health workers, public health nurses, disease interven- tion specialists, epidemiologists, program
“I’m still waiting for my return on that $27 billion loan I gave healthcare. 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. We now see what happens when you defund public health.” —Brian Castrucci
Workforce issues Local health departments lost 20 percent of their jobs nationwide after the 2008 recession, and although they added 3 percent of that lost workforce back between 2016 and 2019, the increases have not kept up with demand. In addition, local agency funding is unpredictable from year to year, Casalotti notes, “and oftentimes, it’s really siloed and tied to particular diseases or programs. You might be able to continue to have a dia- betes educator because you keep getting that grant, but when there were workforce cuts, you lost a lot of your utility players or cross-cutting positions that weren’t attached to one disease.” A good example is public informa-
tion officers, she explains. COVID has highlighted how important that role is. If you can’t communicate, you’re not going to get everyone on board, and then you’re going to continue to have unmitigated spread. “Another challenge has been is that we’ve lost a lot of our registered nurses,” Casalotti says, “and those are the individuals who can work across programs. When you’re dealing with something like this pandemic, you need that clinical expertise in your health department.” Over the last 10 years, we have seen
the retirement of people who’ve been in public health service for a long time, Dixon adds. “Also, the curriculum for public health hasn’t really evolved. The
content with faxes and manual data entry and typical methods that we’ve used in the past.” “We’ve lost 60,000 jobs since 2008,”
Castrucci says. So when we needed to stand up an army of disease intervention specialists, we didn’t have the ones who were experienced to begin with, because we cut them a long time ago. It’s not just the epidemiologists, it is an entire public
managers, laboratory personnel, and informaticians.
“It’s not just the epidemiologists, it is an entire public health infrastructure that needs to be able to flexed up. When you flex, you have to flex on a foundation that’s strong. And we cut beyond the muscle into the bone.” —Brian Castrucci
health infrastructure that needs to be able to flexed up,” he notes. “When you flex, you have to flex on a foundation that’s strong. And we cut beyond the muscle into the bone. Even if we had 2,000 dis- ease intervention specialists who were
Back to the status quo? There is a danger we will go back to stan- dard operating procedure after the public health emergency ends. “I worry about that a lot,” Dixon says, “because we’ve seen that pattern happen before: 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, he says. “I think there’s a real danger of doing that again this time around. That’s why we need to make some commitments, both politically and financially and, in our workforce, so that we are prepared for the next pandemic.” Castrucci is a bit pessimistic that things
will change. “I think that the second the first shot went into somebody’s arm, the likelihood of us funding public health started to drop,” he says. “Because once we get past it, once we’ve demonstrated that science can save us, are we going to invest in the idea that something bad could happen again?” He said many sec- tors of the economy are going to be turn- ing to Congress for help. “Do we really think public health is going to be at the front of that line? We don’t electioneer. We don’t lobby. So how is that money coming down? And I’m not talking about scraps. I’m not talking about just $50 million. I’m talking about a thoughtful investment.” HI
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