Dueling Opinions: Setting public health priorities

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How would you describe the state of the public health workforce right now?

Dr. Georges Benjamin: The whole public health workforce is facing challenges. For years, we’ve been talking about the imminent retirement of staffers. And now that’s coupled with the effects of the COVID-19 pandemic and other issues. We’re certainly losing [job] spots. But that’s complicated by the fact there’s still a fair amount of money out there to hire people, but much of it is one-time money.

Brian Castrucci: We’ve taken a jackhammer to our nation and our society by underfunding and understaffing public health. Much like the foundation of your own home, you don’t really think about it until it’s cracked. And then everything else in the house depends on that foundation. We need 80,000 more public health workers just to revive the basic foundational services of public health.

What are some other challenges facing the public health sector?

Benjamin: It’s just the basics, from a public health perspective. We still don’t have an information technology highway in our country for health that allows us to share information securely, reliably and in a timely way. Some health departments are still sharing information by fax. … A lot of the healthcare data exchanges created were patchwork and rudimentary.

Castrucci: No one really understands public health. If you ask someone to draw a hamburger, no matter where you are in the country, it’s going to pretty much look like the same thing. If you asked 10 public health experts to draw public health, it would be 10 different things. So we can’t expect the nation to understand public health when we don’t have a consistent, coordinated message.

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Given the results of the midterm elections, we’re going to have a divided government in Washington for the next two years. How might that affect policy?

Benjamin:The purse-string issues concern me for sure. But what I’m hoping for, at least in the House of Representatives, is that leaders will decide to be proactive and help support the public health system. We know some lawmakers have said they’re going to pursue investigations, possibly related to how the pandemic was handled.

Castrucci: I think it’s going to be really hard to continue to push for funding. But this is where I’m a little different from some of my colleagues. Federal money is great, but we can’t just wait for those funds to do public health. We somehow have libraries in our communities. We have law enforcement. We have any number of things that we’ve figured out a way to pay for locally.

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