COVID improving public health infrastructure

The COVID-19 pandemic brought into sharp relief the lack of support for public health infrastructure. Local and state health agencies are tasked with protecting the public, yet they often do not have the staff, funding or even key data to detect and respond to emergencies. Hospitals and insurers have more resources, but their incentives do not always align with the goal of improving population health.

Here’s the good news: COVID forced the public health field and health care sector to work toward a shared goal of keeping people from becoming so ill that they overwhelm hospitals. Now, a group of health-care leaders — the Common Health Coalition, which represents physicians, hospitals and insurers — is trying to build upon these collaborations to better prepare localities for future health threats.

Dave Chokshi, the chair of the coalition who served as New York City’s health commissioner through the worst of the pandemic, told me in an interview that amid the tragedy and suffering, he saw it was possible to forge connections across historically siloed parts of the health ecosystem. His city’s vaccination campaign, for example, required daily coordination between the health department and hospitals, clinics and insurers. “Artificial walls came tumbling down,” he said.

His worry is that as attention to infectious diseases ebbs, things will go back to the way they were before. By highlighting successes from around the country, the coalition aims to make such collaborations the new normal.

Perhaps the most significant area of positive change has been in improved data collection, exemplified by new agreements to share information across public and private entities. In Dallas, an agreement between a major hospital system, Parkland Health, and the county health department enabled electronic data-sharing to identify neighborhoods with greatest need.

During COVID, this enabled public health workers to identify which areas needed testing and vaccines most. Now, the same agreement supports targeting specific neighborhoods for services such as blood pressure screenings and access to nutritious food.

In Minnesota, a coalition of health systems similarly decided to share electronic health records to facilitate care during covid. The entities have since adapted the system to do the same with substance use. In a recent Health Affairs article, leaders of those systems detailed how such information exchange allows for real-time alerts and early intervention to help reduce overdose deaths.

Meanwhile, in California, a broad consortium of groups came together to share data not only among hospitals and physician groups, but also nursing homes, laboratories and disability insurers. Such efforts improve pathogen surveillance and demonstrate the interconnectedness of health and social services.

Another major advancement is that many hospitals have embraced their role to do more for the communities around them. Indiana, for example, passed a law last year that provides $225 million in funding to core public health services, and hospitals have committed to the effort by designating leaders who work with each county health department on shared priorities, such as obesity and maternal and infant mortality.

“Too often, we don’t think about payers, but this is a particularly important part of the equation because that’s where so many resources originate from,” Chokshi said. He pointed to efforts underway to codify insurance companies’ role in public health responses, for instance, to share what vaccines their members have received with local health departments.

Chokshi is aware of criticism that these actions are not nearly enough. Indeed, some advocates argue that anything short of wholesale reform of the health care system is just tinkering around the edges.

It’s true that far more must be done to reorient the United States toward a culture of public health. But I also think it’s important to applaud the hard-won efforts that communities around the country are rightfully proud of. These entities have chosen, in Chokshi’s words, “action over amnesia.” Others should follow their lead.