The United States is in the midst of both a public health crisis and a health care crisis. Yet most people aren’t aware these are two distinct things.
And the response for each is going to be crucial.
If you’re not a health professional of some stripe, you might not realize that the nation’s public health system operates in large part separately from the system that provides most people’s medical care.
Dr. Joshua Sharfstein, a former deputy commissioner for the Food and Drug Administration and now vice dean at the school of public health at Johns Hopkins University in Baltimore, distinguishes the health care system from the public health system as “the difference between taking care of patients with COVID and preventing people from getting COVID in the first place.”
In general, the health care system cares for patients individually, while public health is about caring for an entire population. Public health includes many things a population takes for granted, such as clean air, clean water, effective sanitation, food that is safe to eat, as well as injury prevention, vaccines, and other methods of ensuring the control of contagious and environmental diseases.
“It’s pretty invisible” if the public health system is working well, said Sharfstein, who also once served as Maryland’s state health secretary. “It’s the dog-that-doesn’t-bark agency.”
But while public health isn’t as flashy as a new drug or medical device or surgical procedure, it can simultaneously affect many more lives at once.
Dr. Arthur Kellermann, a former emergency-room physician and public health researcher at Emory University in Atlanta, told me: “I’m sure I saved more lives keeping Georgia’s motorcycle law on the books than all the trauma resuscitations I did.”
Still, because the public health system mostly operates in the background, it rarely gets the attention or funding it deserves―until there’s a crisis.
Public health is “a victim of its own success,” said Jonathan Oberlander, a health policy researcher and professor at the University of North Carolina–Chapel Hill.
“People can enjoy clean water and clean air but don’t always attribute it to public health,” he said. “We pay attention to public health when things go awry. But we tend to pay not a lot of attention in the normal course of events.”
“In the U.S., 97 cents of every health dollar goes to medical care,” he said. “Three cents goes to public health.”
It wasn’t that long ago when rebuilding the nation’s public health infrastructure was a top priority. In the wake of the Sept. 11, 2001, terrorist attacks and the anthrax attacks a month later, Congress devoted significant time, attention, and dollars to public health.
Those choices on public health can come back to haunt us. Now, as the United States mourns the COVID-19 deaths of more than 90,000 people in just about three months, public health professionals again have the attention of policymakers. The question for them is, how best to seize the moment?
“The trick is to put in solutions that will work for a long time,” said Sharfstein. “It really matters how you handle a crisis because it might determine how you handle the next 50 or 60 years.”
The clock is ticking.
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