Pandemic makes case for investment in public health

The first doses of the SARS-CoV-2 vaccine arrived in Arizona mid-December. It is surreal to be writing that sentence just nine months since the World Health Organization declared the pandemic.

Not to diminish the importance of the yearslong, collaborative research efforts that made this achievement possible, but if a solution like this can be brought to market in less than a year amid a strained health care system and economy, it gives me hope that there is little we cannot accomplish.

But now that there is hope on the horizon, we need to decide what our “new normal” will look like. Returning to the status quo is not an option. Just as the wars and tragedies of the 20th century taught us, profound suffering demands profound change.

Since the Great Recession more than a decade ago, the health care industry has, at large, been characterized by declining funding for research and public health, increasing costs for education and growing anti-science sentiment, all of which placed us in an ill-equipped position to adequately respond to the current challenge.

We must increase support the institutions and professionals that have been stretched to the limit during this crisis. The annual budget of the National Institutes of Health (NIH), which provides much of the funding for academic research efforts, increased 128% from 1998 to 2008 (roughly $13 billion to $29.6 billion), but since has only risen 24% ($36.6 billion as of 2018).

Less funding means 1) fewer resources to support research studies and 2) more strain on academic research institutions since a portion of their annual budgets depend on grants their faculty is awarded. The trends are similar for overall public health spending. A 2016 article in the American Journal of Public Health reported that from 1960-2008, per-capita public health spending rose over 600%, but has since declined and is projected to continue the downward trend.

This is problematic because the decreased funding has translated to less capacity and support for state and local health departments, the boots-on-theground professionals who perform surveillance, perform predictive analytics and manage outbreak investigations.

Crucially, public health departments also provide outreach to underserved or high-risk communities. As the SARSCoV-2 pandemic has highlighted, these communities often experience the worst health outcomes.

Hanging over all is the systemic increase in the cost of pursuing an advanced degree in health care or public health. Increasing trends in college tuition are well-documented and outpace compensation.

In 2018, Forbes Magazine reported that tuition costs have increased eight times faster than wages over the past 30 years.

Though most who pursue careers in public health are not driven by money, prohibitive student loans alongside lower salaries for jobs in the public sector are often a deterrent. Existing programs to incentivize professionals to enter public service (e.g. public service loan forgiveness programs) act to alleviate some of these barriers, but are often difficult to navigate.

Finally, anti-science rhetoric has served no other purpose than to stifle our ability to improve public health preparedness and health. Understanding the risk factors for disease, improving health care delivery, and developing new therapeutics and vaccines is an arduous and rigorous process.

At its core, science is an iterative process that is constantly seeking to prove itself wrong. But if we are to continue to advance, the public must prioritize the voices of trained professionals and support the scientific process.

A pandemic of the current magnitude will always strain the health care ecosystem, but with more foresight to support and maintain scientific enterprise, education, public health capacity and research efforts, we will be more prepared for the next public health emergency.