Editor’s Note: Rear Admiral Susan Blumenthal, MD, MPA (ret), former US Assistant Surgeon General, is the Senior Medical Advisor at amfAR, a Senior Fellow in Health Policy at New America, Clinical Professor at Tufts and Georgetown University Schools of Medicine, and a Visiting Professor at the MIT Media Lab. Rebekah Gee, MD, MPH is CEO of Healthcare Services for Louisiana State University and a member of the National Academy of Medicine. She formerly served as Louisiana’s Secretary of Health where she led the state’s Medicaid expansion. The views expressed in this commentary belong to the authors. View more opinion at CNN.
Covid-19 has crippled the US economy, compromised the health of our nation and exposed the shameful health disparities that negatively affect people of color and those living in poverty. In light of the devastation this pandemic has wreaked on our country, it is urgent for the US to invest in public health to better detect and prevent the spread of infectious and chronic diseases, redesign America’s health care system for equity as well as effectiveness, and collaborate across multiple sectors of society to meet the basic needs of all Americans.
Our country urgently needs a Public Health New Deal modeled on the framework of the New Deal, a series of public works projects and social and economic reforms enacted by President Franklin Roosevelt in response to the Great Depression. A study published last week in JAMA found that the lack of a consistent, well coordinated response combined with weak national public health infrastructure likely contributed to the high Covid-19 death rates in America. The results reported in this study indicate that Americans are dying at a rate higher than 18 other high-income countries and provides a stark reminder that the United States absolutely could have done better.
Two weeks ago, several senators introduced the Public Health Infrastructure Saves Lives Act which would bolster efforts to fight Covid-19 and help build public health systems to respond to future emergencies, develop policies and regulations, forge strategic partnerships, and address health disparities. This is a step in the right direction, but we need to do more.
The guiding principle of a Public Health New Deal is that it must be an all of government approach that is comprehensive and integrated across federal, state and local agencies with an emphasis on prevention and preparedness as well as addressing the many social, economic and environmental factors that contribute to health. That’s because America’s health crisis does not have a single cause nor is there a silver bullet solution.
It’s important to note that spending more money on medical care is not a straightforward solution that necessarily results in improved health outcomes. The US spends 18% of its GDP – nearly twice as much as other high-income countries – on medical care. But these expenditures deliver shockingly poor results.
Americans live shorter lives and have poorer health than people in many other countries. The US ranks 43rd in life expectancy globally, has the highest chronic disease burden and an obesity rate that is two times greater than the OECD average, and ranks worst among comparably wealthy nations on delivering timely and effective medical care
Chronic diseases, many of which are preventable, account for 75% of our nation’s health care costs, yet in 2018 only 2.6% of our entire health budget was spent on public health programs.
Our nation’s comparatively poor health is not the result of insufficient spending but rather too little investment in prevention and social programs relative to medical care. Decades of scientific research reveal that what matters most in determining a population’s health are income level, educational attainment and health behaviors as well as the communities we call home – with their transportation systems, workplaces, schools, air quality and access to clean water and healthy food.
The Covid-19 pandemic provides us with a historic opportunity to implement a Public Health New Deal that addresses these drivers of health and modernizes essential components of America’s public health infrastructure to enhance disease surveillance, data collection, testing, health communications and equal access to medical care and preventive services, including vaccines.
To advance health, we must adopt a holistic approach promoting policies that address the socioeconomic and environmental factors that contribute to health. America leads the world in technology innovation and now our ingenuity must be applied to reengineering our public health system.
A Public Health New Deal must also address the basic needs of all Americans such as economic security, educational opportunity, affordable housing, community safety, healthy food, and access to health care in order to successfully promote health. Combatting the climate crisis with initiatives such as the Green New Deal will also be critical to improving public health.
As a result of global warming, mosquitoes, ticks, rodents and other vectors are expanding their geographic ranges, altering long established patterns of disease. Additionally, climate change poses a threat to food security, access to clean water supplies, and our mental health, while increasing air pollution also raises the risk of chronic disease.
In this extraordinary, challenging time, collaboration and innovation in an all of government response, coordinating federal, state and local agencies with the private sector is needed to rebuild America’s public health system. Investments in public health must be large and sustained.
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The “boom and bust” cycle of public health funding that occurs in response to a crisis must be replaced with enduring support to construct modern, agile public health infrastructure for this decade and beyond. In an interdependent and interconnected world, America must rapidly re-engage with other nations, including rebuilding our global alliances in the World Health Organization so that together we can better address Covid-19 and other health concerns.
A Public Health New Deal can move us towards a healthier future for all Americans in the 21st century and build the bedrock for a more effective, resilient, and equitable health care system in the years ahead.