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Public Health Officials Offer Grim Testimony Saying The Public Health
System And Workforce Are In A Seriously Compromised State And
Crumbling
System Facing A
Long Litany Of Old And New Realities Which Further Threaten Its
Ability To Protect The Public’s Health
The Select
Subcommittee on the Coronavirus Crisis met on September 29, 2021 and
members of Congress heard a disturbing litany of old and new realities
being faced by the US public health system and the public health
workforce. These realities add up to a “wake up” call that the public
health system is seriously ailing.
Entitled a Hearing On
“Upgrading Public Health Infrastructure: The Need To Protect, Rebuild,
And Strengthen State And Local Public Health Departments”, members of
Congress heard from four public health officials in leadership
positions
in various parts of
the system and with knowledge about frontline workers and the
challenges they face.
Two witnesses,
Mysheika Roberts, Health Commissioner of Columbus Public Health
and Jennifer Bacani McKenney, Wilson County Kansas Health
Officer provided some of the most disturbing examples of the negative
consequences of the COVID pandemic at the local level.
Local Public Health
Dr Roberts told the
committee “This is not easy work. I sit here before you today as an
exhausted, overwhelmed and overworked public health official. I am not
alone…my staff is burnt out, overworked, and underpaid.”
She described the
situation she faces by stating “Here in Ohio, we have had our share of
harassment and intimidation targeting public health officials. Our
previous director of the state department of health was subject to
threats and anti-Semitic slurs at her home. Her designated replacement
never assumed the job after her contact information become known and
she was subject to harassment. In January of this year, the state
Department of Health’s assistant medical director had shots fired at
her home. We are not immune.”
She added, “the bottom
line is, the largest public health crisis in over 100 years has
created an unprecedented challenge for those of us working in public
health and we need the support of lawmakers and leaders now more than
ever. Unfortunately however, lawmakers in many states are actively
working against public health and our authority to protect the health
and safety of the communities we serve.”
Rural Public Health
The situation appears
to be even more dire in rural communities as described by Dr McKenney.
She told the committee “Every public health or health care
professional I’ve spoken with is discouraged and exhausted. They’re
working impossibly long hours to care for patients who are mostly
unvaccinated, and they’re reaching a breaking point…some have been
fired for promoting interventions we know will save lives.”
She added, “Some of
the rural citizens we are working so hard to protect distrust
government as well as public health institutions and the science of
public health. Even though the virus is the enemy, their anger and
frustration are often directed toward public health officials like
me.”
She continued, ”
Nearly 100% of the public health officials I have talked with across
Kansas have seen their county commissioners make decisions based on
political beliefs and anecdotal stories rather than on the scientific
facts. Right now, most COVID decisions are being made by individuals
without any medical or public health training or experience.”
State Public Health
Joseph Kanter,
State Health Officer and Medical Director of the Louisiana Department
of Health, focused his testimony on workforce and funding issues. He
stated “Let us be frank: stress fractures in our human public health
infrastructure have been visible for years. In many departments across
the country these fractures have become gaping holes.” And he noted
that while the burden of COVID on health care workers has been well
publicized, the public health workforce has also worked “long hours
and weekends under incredibly stressful circumstances.”
Dr Kanter called the
current methods of funding public health “no way to do business” and
he urged “long term, sustainable, predictable funding via a public
health infrastructure fund.” He closed his testimony by calling for a
joint congressional inquiry or commission similar to the one after
9/11 to examine the deficiencies in the health and public health
systems which led to the COVID crisis.
Research Findings and
Recommendations
Beth Resnick,
a senior scientist at Johns Hopkins Bloomberg School of Public Health
worked previously for the National Association of County and City
Health Officials (NAACHO) and has done research on the public health
infrastructure and workforce. Dr Resnick’s March 2020 to January 2021
study of media reports and a survey of public health officials
identified at least 1,500 incidents of harassment and violence against
public health workers. Further, she reported that state legislatures
in over 20 states have passed and all 50 states have considered at
least one law to undermine public health authority. She used a telling
analogy to describe these actions, stating “Imagine if a legislature
passed a law prohibiting the fire department from using hoses.
Clearly, this does not make any sense.
Yet, no hoses to put
out fires is the same as taking emergency authority away from health
departments aiming to stop the spread of deadly diseases.”
Reminding members of
Congress that over 700,000 Americans have lost their lives to COVID,
Resnick quoted the late congressman Elijah Cummings saying “We are
better than this.”
Resnick offered six
recommendations to stop harassment and violence against the public
health workforce, protect the statutory authority of public health,
and rebuild the public health system. She defined a robust public
health system as having strong, well-trained, and stable leadership
who work closely with elected officials and the community, having
essential statutory authority, adequate staffing, modern technology,
and timely, accurate, and complete data that can be shared across all
levels of government.
Summary
In summary, the
challenges enumerated at the hearing included the following:
♦
chronic underfunding,
♦
chronic understaffing
because over 40,000 state and local public health jobs were
eliminated in the last decade, which is 15-20% of the total workforce.
♦
large leadership losses with more than 300 state and local leaders
resigning, retiring, or being fired since the pandemic began
♦
limited disease monitoring and surveillance capabilities,
♦
testing and reporting
deficiencies,
♦
outdated technology,
♦
reckless politicization of public health,
♦
unprecedented levels
of harassment, threats, and attacks from members of the public,
♦ passage of laws and
executive orders limiting public health officials’ authority to issue
commonsense control measures such mask requirements or quarantine and
isolation orders in current and in any future infectious disease
outbreak.
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