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America’s public health infrastructure needs consistent funding

State and local leaders are responding to the coronavirus crisis with one hand tied behind their backs

As our nation confronts the COVID-19 pandemic, we have once again become aware of the critical importance of our state and local health departments. They are the backbone of our nation’s response system.

This is not a new story: Just in this century, we have confronted major infectious disease outbreaks — SARS, H1N1, MERS, Ebola, Zika and dengue. Now COVID-19. Every president, every governor and every city and county chief elected official has had to mobilize their public health systems to respond to each of these crises. These challenges seem to be occurring with greater frequency due to climate change, animal-human interaction, a growing world population and antimicrobial resistance.

But local and state leaders have responded with one hand tied behind their backs. It’s because we, as a nation, have chosen not to consistently fund a strong public health system that can quickly alert us to new problems, build resilient communities that are healthy and socially connected, and create a reserve capacity to respond to an emergency of any kind.

Instead, we have reacted to each crisis with “special funding,” expecting our nearly 3,000 public health agencies across the country to rapidly ramp up at a moment’s notice. And then, when the crisis is over and it’s out of the national news spotlight, we return to lower funding levels and let that public health infrastructure deteriorate. In fact, since the Great Recession, frontline state and local health departments have lost more than 56,000 positions due to funding cuts. 

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There is a better way, and we should use the coronavirus crisis to put it in place, before we become complacent yet again. As Congress considers additional measures to respond to COVID-19, we urge them to establish a permanent Public Health Infrastructure Fund. This mandatory appropriation would fund strong public health systems in every community, assuring that where you live doesn’t determine how well your public health agency can protect you. The fund, first proposed by a group of public health experts convened by the Public Health Leadership Forum, would provide sufficient funding to provide certain foundational public health capabilities such as surveillance, lab capacity and all hazards preparedness. With consistent funding, state and local elected officials will know that they can build their capacity without the rug being pulled out from under them the next year as Congress moves on to another crisis.  And they — and the American people — will be healthier and better prepared for future public health challenges.

How much would this cost? It has been estimated that we need an additional $4.5 billion a year to close the gap between what we currently spend on public health and what we would need to ensure that all communities across our nation are served by a strong public health system. This would bring per capita spending on foundational capabilities from $19 per person to $32 per person. But it’s a fraction of what we are spending now to respond to the COVID-19 crisis and could well reduce how much emergency money we might need during future crises.

Designed properly, this fund would not only assure all Americans that they will be healthier and better protected, but it will also hold health departments accountable for these new resources, by ultimately requiring them to be accredited, just like hospitals. 

Congress and the president are rightly focusing most of their attention to responding to the current emergency. But they will be setting up the next Congress and the next president for another major crisis if they don’t also fix our underinvestment in America’s public health infrastructure.

Tom Daschle, a South Dakota Democrat, is a former Senate majority leader and co-chairs the Bipartisan Policy Center’s Health Project.

 Bill Frist, M.D., a Tennessee Republican, is a former Senate majority leader and a heart transplant surgeon. He co-chairs the BPC’s Health Project. 

Andrew von Eschenbach, M.D., is a BPC senior advisor, a former commissioner of the Food and Drug Administration and a former director of the National Cancer Institute under President George W. Bush. 

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