COVID-19 recovery requires restoring public health investment

One year after Gov. Gavin Newsom issued an unprecedented statewide stay-at-home order in response to COVID-19, optimism for California’s recovery is growing.

It’s been a rough year, which was many years in the making. Our state’s COVID-19 experience confirmed the worst fears of public health officials who have long warned California was ill-prepared for such a crisis. We did not have to endure such incredible suffering and loss, and it did not have to be inflicted so unequally onto communities of color.

Local public health officials know another crisis is not a matter of if, but when. Just as California must recover from COVID-19, it must also overcome a pattern of neglecting vital public health investments needed to respond to and contain disease outbreaks and other disasters.

This is why we are part of a coalition including local governments, community advocates and front-line workers urging California’s leaders to prioritize rebuilding and maintaining the state’s public health workforce and infrastructure. We can’t wait until the next crisis to act.

The job of public health is to keep everyone safe and to promote health for all. California neglected this important work for over a decade. Last year, the budget for California’s Department of Public Health — which oversees programs such as lab services, chronic disease prevention and infectious disease control — was $300 million below 2010 levels. Meanwhile, over the past 10 years, total state spending has nearly doubled.

Chronic underfunding strained COVID-19 containment and recovery efforts across California.

Local and state public health departments have lost 20% of their workforce, and 11 public health labs closed. At the onset of COVID-19, Napa County still had 15% fewer staff than in 2009, and Alameda County had seven people doing outbreak investigations for 1.6 million people.

This decade of neglect gave COVID-19 room to unleash tragic consequences on Californians. Our state’s 3.5 million cases and 55,000 deaths from COVID-19 must become a rallying cry for investment in public health for our communities.

California’s leaders are rightly focused on getting through the current COVID-19 crisis. Over the last year, however, Californians learned how public health infrastructure underpins our most important priorities — such as keeping the economy open and kids in classrooms — so we must think about its capacity to protect the long-term health of our communities.

We urge California’s leaders to provide $200 million annually to begin to rebuild and sustain local public health infrastructure — an amount equivalent to less than 1% of total state spending. This is the path to ensuring our readiness to meet the next crisis head-on.

This investment would enable local public health departments to hire staff, address health equity issues in partnership with communities and build disaster readiness. It would also help California pursue important goals that were put on the back burner during the pandemic: ensuring food safety at schools, restaurants, child care centers and grocery stores. Supporting health equity with programs such as home visitation for new and expectant mothers. Revamping efforts to link people experiencing homelessness with services that promote long-term stability.

A year’s worth of suffering and sacrifices won’t soon be forgotten and must not be repeated.

Another crisis will inevitably come someday. It could be a wildfire, extreme heat or poor air quality — all of these overlapped with COVID-19 — or an earthquake, bioterrorism or another major disease outbreak.

Our responsibility is to act on the painful lessons COVID-19 taught us. By investing in public health, we can avoid the mistakes of our past and ensure California has the tools to save lives before the next threat arrives.

Colleen Chawla is president of the County Health Executives Association of California and director of the Alameda County Health Care Services Agency. Dr. Karen Relucio is president of the Health Officers Association of California and health officer and deputy director of the Napa County Health and Human Services Agency.