Why Rebuilding the Public Health System is Crucial to Health Care’s Future

Just before the global pandemic, I wrote a book on Precision Health – describing how our health and health care stands to be transformed by recent breakthroughs in biomedicine, consumer health devices, and data science.

A critical point I make clear in the book is that these tools hold great potential for personalizing health care to a level of precision that’s never before been possible. But it is not enough to use these advancements to treat disease; true transformation will happen when we apply these tools—and our focus—upstream, to predict and then prevent disease, person by person.

The pandemic has underscored just how important it is for our system to focus on maintaining people’s health – at both the individual and community level. COVID-19 has already claimed half a million American lives; and we know that those who are obese, have diabetes, asthma, or other conditions are more likely to become severely ill when infected by the virus. Moreover, we know that these kinds of conditions disproportionately affect underserved communities.

In America today, our ZIP Code system remains the single greatest predictor of human health. It is a potent proxy for the opportunities and quality of public services available to each of us, as well as the health risks we face. Issues such as poor diet, smoking, physical fitness and air and water quality profoundly influence our health and strongly correlate to the place we call home.

Traditionally, public health agencies have done the important work of engaging these community issues to improve health—and fight off infectious disease. But we’ve allowed this system to atrophy. Public health represents less than 3 percent of the $4 trillion spent on health each year in the United States. What’s more, roughly half of Americans live in an area without a full array of public health services.

These services include assessing health needs within a community and connecting people with care and other public services. It also extends to functions that are crucial to fighting a pandemic, such as communicating health information to the public, conducting epidemiological surveillance, and administering vaccinations.

As a nation, our investment in public health has withered, even as our needs have grown exponentially. Looking to the future and planning for a post-pandemic landscape, we must prioritize rebuilding our public health system, both for the good of the individual and that of our communities.

Here are some resources for further reading on the benefits of public health services, reasons the U.S. system has recently been underfunded, and how the pandemic exposed our shortcomings:

• Opinion: Always the Bridesmaid, Public Health Rarely Spotlighted Until It’s Too Late This NPR piece spotlights historical achievements of the U.S. public health system and discusses more recent decisions to deprioritize funding.
• It saves lives. It can save money. So, why aren’t we spending more money on public health? This New York Times article provides a detailed look at public health endeavors in the United States and explores reasons this sector lags behind in funding despite successes.
• Lack of health services and transportation impede access to vaccine in communities of color This article from the Washington Post describes how people in underserved communities face logistical obstacles to COVID-19 vaccination that are unrelated to the health care system.
• Public Health Systems Still Aren’t Ready for the Next Pandemic This piece from the Pew Charitable Trust’s Stateline news service illustrates how neglect of the U.S. public health system led to gaps in the country’s pandemic response, and discusses remedies that governments are considering for the future.