The current COVID-19 pandemic has exposed deep fault lines within our public health and health care systems. These fault lines are not new, and they do not adversely affect everyone in the same way.
While it is true that the novel coronavirus is presenting itself as an equal-opportunity virus in terms of transmission, the options available to reduce the risk of exposure to oneself and one’s family, and the literal probability of survival if infected, are anything but equal in the United States.
Although our system vulnerabilities have not been foremost in the minds of the majority of Americans, those of us working in public health have been issuing warnings for what feels like an eternity.
In 2019, a report by Trust for America’s Health attempted to sound the nation’s alarm bell once again, compelling members of Congress and other decision-makers to heed what a 10 percent reduction in funding for the Centers for Disease Control and Prevention, and the loss of 55,000 public health workers since 2008, has done to erode the public’s health. In the report’s recommendations, increases in federal investments in public health is deemed “the most efficient, commonsense way to improve health and health equity.”
What we are seeing right now during the coronavirus pandemic — in real time, playing out before our eyes like a nightmare that none of us can escape — are the consequences of the public health community’s warnings being repeatedly ignored.
To some extent, each one of us is feeling these consequences in some way. However, as with other crises, natural disasters or emergencies, the social, financial and health impact of this pandemic will have a far-more negative outcome for some individuals than others.
As public health nurses, we know who will really bear the burden of the COVID-19 pandemic: communities marginalized through their experiences with slavery, colonization, segregation, economic oppression and structural racism. Our national and state policies reflect our values and our priorities, which have perpetuated social, economic and health inequities. As such, it is not accidental that these groups have gone without health insurance, paid sick or family leave benefits, stable or affordable housing, and food security since the inception of the United States.
For decades, our underfunded public health infrastructure has failed to deliver in addressing the root causes of these inequities — now widely referred to as the social determinants of health. As a result, more Americans lie vulnerable in the path of this virus.
The costs of this pandemic will further marginalize communities as families lose elders as leaders and communities lose experienced voices in determining their destiny and challenging oppressive structures. This is not the disease of the moment — this is the disease of the century; and we need to fight it with the long game of rebuilding our public health infrastructure from the ground up and transforming the policy missteps of the past.
As noted in a policy statement by the American Public Health Association, the public health nursing workforce has been on life support itself for the better part of a century since the last great epidemics. Yet, it was through the core work of public health nursing, including working at the frontlines of case identification, contact investigation and support for families in quarantine, that we indeed made progress through those challenging times.
Now is not the time to give up on public health. Now is the time to mobilize our collective wherewithal to provide the social and health care safety nets and other supports to the people who need them most and minimize the gap of vulnerability — both as we confront this virus today and in how we craft our society in its aftermath.
It is a time to reinvest in our ability to respond to emerging threats such as the coronavirus and the high rate of preventable chronic disease that has escalated in our country in recent decades. This cannot be accomplished without the Centers for Disease Control and Prevention acting as an independent, science-led agency, and providing it along with state and local health departments funding at sufficient levels to conduct the work of protecting the public’s health that extends well beyond this immediate crisis.
Public health nurses are trusted and skilled at working in marginalized communities. They focus on the big picture and practice holistic care. They are central to the work of ending inequities by partnering with marginalized communities, advocating for changes and emancipatory policies, and preventing disease spread.
Only when we collectively decide to invest in them and our public health system can we build our nation’s resilience against this present, and future, threats.
Dr. Ifeyinwa Asiodu is a public health-oriented, nurse-scientist, and lactation consultant whose research is centered on the intersection of racism, systemic and structural barriers, and increasing equitable access to breastfeeding resources, lactation support, and donor human milk in black communities.
Dr. Robin Evans-Agnew is a public health nurse professor and activist at the University of Washington, Tacoma, working primarily with Latino communities and asthma inequities.
Dr. Shawn Kneipp is a nurse scientist whose work focuses on health equity, public health nursing interventions, and the prevention and management of chronic disease among socioeconomically disadvantaged groups.
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