Center for the Future of the Health Professions Nov. 2021 digest
Posted: November 9, 2021
This month, The Center for the Future of the Health Professions will be posting another monthly op-ed column for 2021. Our columns represent strong, informed, and focused opinions on issues that affect the future of the health professions. As mentioned in the past, the center was developed to provide state, local, and national policymakers and health system stakeholders with accurate, reliable, and comprehensive data and research about the healthcare workforce, so they can effectively plan for a sustainable future and make the best use of available resources.
This month features a discussion titled “The Pandemic: Potential Renaissance or a Missed Opportunity for the Future of Public Health?” by a trio of public health professionals at A.T. Still University’s College of Graduate Health Studies – Mary-Katherine McNatt, DrPH, MPH, MCHES, CPH, COI, chair and associate professor, public health; Marsha Presley, PhD, MPH, research associate, public health; and Jaana Gold, DDS, PhD, MPH, CPH, professor, public health.
Face mask mandates, COVID vaccination clinics, and hand sanitizer recommendations. After living through a COVID-19 pandemic for the past 20 months, the general public has frequently associated these terms with public health. For the public health professional, public health means so much more, especially with the profession’s future facing a critical and pivotal turning point.
Historically, public health has ensured the health of communities and their populations primarily through disease prevention and investigation and health promotion and education. For centuries, public health has ensured safe drinking water, mandated childhood vaccines against dangerous diseases, and led investigations to determine the source of foodborne outbreaks. While much more went on behind the scenes, little was known by the general public about this overlooked profession. If public health was talked about in the media, that meant there was a crisis or what we in the profession call “game day,” which meant a full-scale public health response was required.
For the past 20 months, communities have faced one public health crisis after another: the COVID-19 pandemic, hurricanes,1,2 wildfires,3 systemic and violent racism,4,5,6 riots and social unrest,7 social isolation,8,9, 10 food insecurities,10 limited healthcare access,10 and more. For the first time in a long time, public health was all over the media. Initially, the public began to understand the importance of the public health profession. Moreover, mainstream media was finally discussing that health was affected by where one lived and the environment in which one worked. There was a glimmer of hope that acknowledging health disparities meant we might finally begin to address the root causes and communities and government agencies would collaborate to contain the COVID-19 pandemic.
As quickly as that hope came, bleak reality set in. Science and public health suddenly became politicized. Proven infection control methods became controversial to many in society. Public health officials, professionals, educators, and researchers were disparaged, threatened, and even physically harmed,11 with threats extending to their family members. Many public health workers even quit their jobs due to the stress and threats.11
What many public health professionals have prepared for their entire career and thought it would be an opportunity for public health to shine turned into an uphill battle. In the past, public health professionals were viewed as respected individuals of science. Now, with so many people dismissing science as authoritative, we must reprove ourselves and our knowledge base. We must prove that our expertise is authentic.12
One problem was public health officials were muzzled early in the pandemic.13 Detailed preparedness plans had been developed in 2009, but most had not been updated or reviewed since then.14 Once the pandemic hit, politicians feared economic backlash more than they feared the deaths of their constituents. Well-developed plans lay fallow. When public health officials were allowed to speak, politicians, protagonists, and hucksters all vied to undermine their messages. People died by the hundreds of thousands.15
The elusive nature of a novel virus, fatal to so many, yet completely asymptomatic in others, added to the public’s confusion. Surviving infection was seen as proof the threat pandemic was overblown. Anger and fear replaced reason. When data indicated long-vulnerable populations with pre-existing health inequities were more likely to die from infection, the message received was a robust and healthy person would survive the pandemic. Dominant messaging showed no pity for the weak, and there was little push to correct imbalances in health equity. When novel vaccines against SARS-CoV-2 were developed in apparently record time,16 American ingenuity was not celebrated. Instead, misinformation campaigns17 sold the vaccines as dangerous and untrustworthy. As billions hesitate or refuse to be vaccinated, the pandemic continues to rampage out of control.15
Nevertheless, hope remains. Rising vaccination rates18 will hopefully allow us to establish a level of control over the virus in the near future. While the pandemic by itself may not have piqued enough of the public’s empathy for vulnerable populations, the viral video of the murder of a man in police custody by an indifferent and apparently nonrepentant police officer19 demonstrated racism is an ongoing affliction that needs to be eradicated. Following the murder, numerous TV shows and videos, journal articles, and social media posts addressed the ongoing effects of racism, including structural racism and health inequities, that affect black populations and other people of color. At least some white people are listening.
The pandemic has taught us many valuable and challenging lessons. We have had to stand up for our profession and defend every decision. Through true passion and strength, public health professionals have survived in the public health field these past months. Public health as a profession is facing a critical transition period, a time where every small decision will affect the long-term future of and the public’s trust and perception of the profession. Throughout history, from a scientific perspective, pandemics have served as turning points. For example, in the Middle Ages, the bubonic plague pandemic led to the start of the Renaissance period.20 Will the COVID-19 pandemic serve to introduce a similar transformative period, or will it become a missed opportunity?
References:
1Shultz JM, Kossin JP, Hertelendy A, et al. Mitigating the Twin Threats of Climate-Driven Atlantic Hurricanes and COVID-19 Transmission. Disaster Med Public Health Prep. 2020;14(4):494-503. doi:10.1017/dmp.2020.243
2Shultz JM, Kossin JP, Ali A, et al. Superimposed Threats To Population Health From Tropical Cyclones in the Prevaccine Era of COVID-19. Lancet. 2020;4(11):e506-e508. doi:10.1016/S2542-5196(20)30250-3
3Wildfires—A Growing Public Health Crisis. AJN. 2020;120(12):14. doi:10.1097/01.NAJ.0000724172.95963.d3
4Racism is an Ongoing Public Health Crisis That Needs Our Attention Now. APHA.org. https://www.apha.org/news-and-media/news-releases/apha-news-releases/2020/racism-is-a-public-health-crisis. Published May 09, 2020. Accessed October 08, 2021.
5Racism is a Public Health Issue: What George Floyd’s Death Can Teach Funders. The Colorado Health Foundation. https://coloradohealth.org/insights/good-health/racism-public-health-issue-what-george-floyds-death-can-teach-funders. Published June 01, 2020. Accessed October 08, 2021.
6Timeline of Violence as a Public Health Problem. cdc.gov. https://www.cdc.gov/violenceprevention/about/timeline.html. Accessed October 08, 2021.
7Bylander J. Civil Unrest, Police Use Of Force, And The Public’s Health. Health Aff. 2015;34(8). doi:10.1377/hlthaff.2015.0717
8Loneliness and Social Isolation Linked to Serious Health Conditions. cdc.gov. https://www.cdc.gov/aging/publications/features/lonely-older-adults.html. Accessed October 08, 2021.
9Holt-Lunstad J. Social Isolation And Health. Health Aff. https://www.healthaffairs.org/do/10.1377/hpb20200622.253235/full/. Published June 21, 2020. Accessed October 08, 2021.
10O’Connor SW. 4 Key Public Health Issues in 2021. Northeastern.edu. https://www.northeastern.edu/graduate/blog/public-health-issues/ Published April 20, 2020. Accessed October 08, 2021.
11Mello MM, Greene JA, Sharfstein JM. Attacks on Public Health Officials During COVID-19. JAMA. 2020;324(8):741-742. doi:10.1001/jama.2020.14423
12Simmons-Duffin S. Poll Finds Public Health Has A Trust Problem. npr.org. https://www.npr.org/2021/05/13/996331692/poll-finds-public-health-has-a-trust-problem. Published May 13, 2021. Accessed October 08, 2021.
13Schwitzer G. Federal Health Agencies Block Journalists’ Access to Covid-19 Experts & Information. HealthNewsReview.org. Published March 26, 2020. Updated April 03, 2020. Accessed October 08, 2021.
14Amesh AA, Toner E, Inglesby TV, MD. Priorities for the US Health Community Responding to COVID-19. JAMA. 2020;323(14):1343-1344. doi:10.1001/jama.2020.3413
15COVID-19 United States Cases by County. jhu.edu. https://coronavirus.jhu.edu/us-map. Updated daily. Accessed October 08, 2021.
16Petri W. COVID-19 Vaccines Were Developed in Record Time – But are These Game-Changers Safe? The Conversation. https://theconversation.com/covid-19-vaccines-were-developed-in-record-time-but-are-these-game-changers-safe-150249. Published November 20, 2020. Accessed October 08, 2021.
17Pazzanese C. Battling the ‘Pandemic of Misinformation’. Harvard.edu. https://news.harvard.edu/gazette/story/2020/05/social-media-used-to-spread-create-covid-19-falsehoods/. Published May 08, 2021. Accessed October 08, 2021.
18Adams K. States ranked by percentage of population fully vaccinated: Oct. 8. Beckershospitalreview.com. https://www.beckershospitalreview.com/public-health/states-ranked-by-percentage-of-population-vaccinated-march-15.html Updated daily. Accessed October 08, 2021.
19Hernandez J. Read This Powerful Statement From Darnella Frazier, Who Filmed George Floyd’s Murder. npr.org. https://www.npr.org/2021/05/26/1000475344/read-this-powerful-statement-from-darnella-frazier-who-filmed-george-floyds-murd. Published May 26, 2021. Accessed October 08, 2021.
20Friedell E, Janik A. A cultural history of the modern age: renaissance and reformation. Oxford: Routledge; 2017.