Nation’s Public Health System Needs Support Not Criticism

I had my first experience with our nation’s anemic approach to prevention as an elementary school student.  For months parents had been clamoring for a crossing guard near the neighborhood school, asserting that the students needed a protected way to cross a busy road.  Alas, the school district ignored the pleas until a student was injured by a car; a few days following the incident, a crossing guard appeared, chaperoning students safely in both the morning and afternoon.  In the eyes of the students and parents, however, the response was too late.

Our nation’s recent response to the Ebola virus reminded me of this early lesson.  As a culture, we wait until a crisis has occurred to take action, when investing proactively in prevention not only saves lives but saves money.  Call it what you will—penny wise and pound foolish, short-sighted, or just plain stupid—we can no longer be on our heels; we must invest in mounting and sustaining a proactive response to public and global health.  Our nation’s public health system does not need more critics, it needs resources.

For years, decades in fact, public health advocates and experts have been calling upon our nation’s elected officials to invest adequately in a strong public health infrastructure “just in case.”  My involvement in these issues dates back to 1995 when working for the American Public Health Association, where before it was considered mainstream to talk about biosecurity issues, we urged national attention to—and investment in—a system to respond to (god forbid) a bioterrorist event.  Folks on Capitol Hill thought we had been reading too many sci-fi novels, yet in 2001, when the Capitol was attacked by anthrax, we were sorry to have been right.

Now, with Ebola in our country, people are asking, “How could this happen?” and “Why don’t we have a vaccine to protect us?”  The answer is that unfortunately, our nation’s leaders govern and fund by crisis.  Our nation’s elected officials jump from one threat to the next—playing a life-threatening game of whack-a-mole.  The result is a fragmented and weakened domestic public health system that does not have the resources—human, infrastructure, or financial—necessary to stand-up the prevention and response system we need day-in and day-out, year after year to keep our nation secure.  Funding by crisis results in more unnecessary crises.

The solution, long urged by public health advocates is a sustained infusion of resources in domestic and international public health infrastructure so we have the system in place to prevent problems before they occur and respond swiftly and effectively when they cannot be prevented.  The challenge we have in domestic public health is that when it is successful there is no evidence—the outbreak does not occur, the drinking water is safe and people do not get sick, people do not die from the flu, etc.  Such “non-events” are invisible and invisible things are not usually what elected officials find compelling.

As client Karen Goraleski, Executive Director of the American Society of Tropical Medicine and Hygiene recently observed in The Hill, “You don’t dismantle the fire department because you don’t have a fire there in 10 years … That’s what has happened in a continued reduction in funds for tropical disease research funding.”

With Ebola in Texas and New York and possibly arriving other states, perhaps this is the wake-up call our nation’s leaders need to shift to a public health funding, policy, and programmatic strategy that embraces the long-view and provides sustained and coordinated investment in preparing for, tracking of, and responding to infectious disease—both domestically and internationally—because, as we have just learned, these threats are just a plane ride away.


Ilisa Halpern Paul, MPP, is president of the District Policy Group at Drinker Biddle, a bipartisan, boutique, full-service advocacy, public policy, and government relations group. The views expressed are the author’s own.


Morning Consult