Building an effective national public health system

The Covid-19 pandemic revealed what we already knew, because it had been revealed in previous public health crises. Our public health "system" is fragmented and incapable of effective response to emerging problems. At the federal level, responsibility for public health is dispersed among multiple agencies with no overall coordination. Of course, incompetent and even delusional presidential leadership didn't help, but muddled and often contradictory messages coming from CDC, the Surgeon General, and the Director of NIAID, with no real coordination by the Secretary of HHS, happened without the help of the Idiot in Chief. 

But the deeper problem is that public health is a state responsibility, which states in turn delegate in substantial part to localities, and the infrastructure and competence just isn't there in many places. We also don't have adequate national public health data systems in many respects. Yes, CDC gets a lot of data but there are long delays in reporting and a lot of it is either incomplete or of dubious quality. 

The Commonwealth Fund convened an expert committee to evaluate the state of public health in the U.S., and their report is available here. I'll chop out the verdict from their executive summary and we can discuss their recommendations in coming days.

• Public health efforts are not organized for success. Despite dozens of federal health agencies and nearly 3,000 state, local, tribal, and territorial health departments, there is no single person or office at the U.S. Department of Health and Human Services to lead and coordinate the nation’s public health efforts.
• Public health funding is not sufficient or reliable. The chronic underfunding of public health has left behind a weak infrastructure, with antiquated data systems, an overworked and stressed workforce, laboratories in disrepair, and other major gaps.
• Expectations for health agencies are minimal. Funding is not tied to a set of basic standards for the capabilities of state, local, tribal, and territorial health departments.
• The health care system is missing opportunities to support health improvement. It is difficult to convert collaboration with public health agencies during emergencies into sustainable work to address day-today health challenges.
• The public health enterprise is facing a crisis in trust. This crisis relates to experiences with racism and discrimination, ideological opposition, and misinformation.