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Public Health Should Be as Reliable as Our Highways

Health protection should not depend on local decisions or stop abruptly at political borders

Epidemics don’t recognize state or city boundaries, the authors write. So why should our public health system? Above, traffic moves across the Woodrow Wilson Bridge along the Capitol Beltway in July. (Chip Somodevilla/Getty Images file photo)
Epidemics don’t recognize state or city boundaries, the authors write. So why should our public health system? Above, traffic moves across the Woodrow Wilson Bridge along the Capitol Beltway in July. (Chip Somodevilla/Getty Images file photo)

OPINION — Check your morning news and you are likely to read distressing stories about the threat of a bad flu season, the consequences of natural disasters like wildfires in California, unacceptably high maternal and infant death rates, or the opioid epidemic.

All these emerging challenges occur on top of our nation’s chronic public health issues, like heart disease, cancer and HIV/AIDS, which continue to take a toll on the length and quality of life for people in the United States. This also takes a toll on the health and vitality of our communities and comes at great cost to our federal and state health care budgets.

As we face these challenges, we turn to local public health agencies to protect us: by addressing policy solutions and building the multisector collaborations it takes to lead a community response.

A public health system with foundational capabilities is one with the ability to track the health of a community through data, case findings, and lab tests; the capacity to respond to emergencies of all kinds; the experience to translate public health science into appropriate policy and regulation; the adeptness to communicate effectively with the public with timely, science-based information; and the power to harness and align community resources and actors to advance the health of the entire community.

The American people should rightly expect that where you live should not determine your level of public health protection — but current data tell us it does. Only 51 percent of the U.S. population is served by a comprehensive public health system.

Look to the highways

Because daily public health demands and emergent challenges like epidemics and natural disasters do not recognize state or city boundaries, America should be protected by a strong public health infrastructure. Health protection should not depend on local decisions or stop abruptly at political borders. Instead, it should be more reliable, like the interstate highways. Foundational public health capabilities should be part of our nation’s infrastructure.

Organized around this common-sense notion that all people in America deserve public health protection, the Public Health Leadership Forum, a project of RESOLVE, with funding from the Robert Wood Johnson Foundation, brought together a panel of experts to inform recommendations on how we might commit to building our nation’s public health infrastructure.

Using a national study conducted by the University of Kentucky, the panel found that supporting foundational public health capabilities across the country would cost an estimated $9.5 billion a year.

That sounds like a lot of money, but it comes to only $32 per person per year. Compare that to the estimated $11,193 per person we spend on health care, and it is a great return on investment.

Indeed, total spending for foundational public health capabilities is less than one-fourteenth of the increase in per capita health care spending in the last year.

Based on current investments by all levels of government, the University of Kentucky estimated there is a $4.5 billion gap between what is now in place and what is needed to achieve a truly nationwide public health infrastructure.

Higher standards

To close this gap, we recommend creating a Public Health Infrastructure Fund. This recommendation is part of a new white paper we are releasing this week during an event at the Bipartisan Policy Center. The paper calls for investing $4.5 billion annually in establishing and sustaining foundational public health capabilities.

It also identifies key principles that would guide the Public Health Infrastructure Fund, including:

  • All people in America should be served by a public health agency that ensures equitable access to and protection by foundational public health capabilities.
  • Financing of foundational capabilities is a governmental responsibility and should be assured through sustainable, dedicated revenue streams. Local, state, and federal governments should share in financing those capabilities as all levels of government ultimately benefit from them.
  • Foundational public health capabilities should be assessed and provided in every community based on national standards — and maintaining those standards should be a condition of continued funding.

We recommend that this Public Health Infrastructure Fund should be a mandatory funding stream, awarded through the states to state and local health departments on a per capita basis. The fund would have a 10 percent state matching requirement, with a set aside for technical assistance, research, and demonstration project.

As a new Congress is seated next month, there is no doubt that rebuilding our nation’s overall infrastructure as well as taking on the new (and old) threats to our nation’s health and prosperity will be high on its agenda. We hope Congress will also see investment in a Public Health Infrastructure Fund as a critical step to assuring all people in America have the public health protection they should expect and deserve.

Karen DeSalvo, MD, is professor of medicine and population health, Dell Medical School, University of Texas, Austin, and former HHS acting assistant secretary for health.

Jeffrey Levi, PhD, is professor of health policy and management at the George Washington University’s Milken Institute School of Public Health.

Both formerly served on Bipartisan Policy Center task forces.

The Bipartisan Policy Center is a Washington, D.C.-based think tank that actively promotes bipartisanship. BPC works to address the key challenges facing the nation through policy solutions that are the product of informed deliberations by former elected and appointed officials, business and labor leaders, and academics and advocates from both ends of the political spectrum. BPC is currently focused on health, energy, national security, the economy, financial regulatory reform, housing, immigration, infrastructure, and governance. Website | Twitter | Facebook

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