Words cannot capture the immense toll of the COVID-19 pandemic. The direct clinical impacts of the disease—as well as the ripple effects on our collective mental health, the economy, and our overall well-being—are immeasurably devastating. However, we are at risk of further compounding the tragedy by ignoring lessons we have learned. And therein lies a potential silver lining: tragedy can sometimes drive long-term change.
We are already seeing, for instance, fundamental changes in how hospitals are preparing for future pandemics, how offices can effectively manage a remote workforce, and the accelerated adoption of technological innovations. There are also numerous public policy issues that merit our attention, such as how to design a social safety net that prevents some of the havoc from the pandemic’s economic fallout. I would like to focus on two issues that may be particularly relevant to our audience: the need to address the historic underinvestment in public health, and the need to move beyond the current focus on vaccine equity to encompass broader health equity.
STRENGTHENING OUR PUBLIC HEALTH INFRASTRUCTURE
Public health has long been an underinvested part of our health care system, comprising less than 3 percent of total U.S. health care spending. The consequences of this are not hard to see. Last year, as the pandemic reached our shores in the U.S., it was clear that we could not adequately execute the core public health function of surveillance. An uncoordinated testing strategy and shortages and an inability to adequately trace contacts of infected individuals made it difficult to contain the virus’s spread. And once we had a better grasp of the pandemic’s scope, public health was hampered in efforts to develop policies for containment and to effectively communicate a consistent message around issues like social distancing and masking.
This not only reflects an underinvestment in public health, but just as importantly the lack of public health’s prominence and influence in our overall health system. What we need is not only a temporary surge of funding for public health activities, but a longer-term commitment to public health and its focus on prevention. And in a broader sense, we must all better recognize public health’s important role in keeping our society healthy. Not only will this make us more prepared to respond to the next infectious disease pandemic—it will also help mitigate the ongoing pandemics of chronic disease, substance use disorders, and other threats to our physical and mental health.
MOVING BEYOND VACCINE EQUITY TO HEALTH EQUITY
The disproportionate impact of COVID-19 and its economic fallout on underserved and historically disadvantaged communities is indisputable. New Yorkers from some racial and ethnic groups—including Black, Latino, and Indigenous groups—contracted COVID-19 at a higher rate and were hospitalized and died at a higher rate than other New Yorkers. For those familiar with health care in the U.S., this was not surprising; similar disparities in health outcomes are seen across a wide variety of medical conditions. Though the proximate causes may be related to factors such as poverty, housing instability, and food insecurity, there are deeper roots in structural racism, such as long-standing disinvestment in communities of color. In response, both New York State and New York City have rightly focused on equity in the rollout of COVID-19 vaccines. New York State has launched a New York Vaccine Equity Task Force, and New York City has a detailed COVID-19 Vaccine Equity Strategy.
Despite a bolstered commitment to vaccine equity, wide racial disparities in vaccination rates persist. This is not surprising: Health disparities are rooted in centuries of racism, and even a focused effort right now will only have a limited effect. Achieving health equity—where everyone has the opportunity to be as healthy as possible—will require a long-term commitment, as well as a rethinking of all our systems, policies, and practices. It’s a big challenge and requires the commitment of all of us working in health. We now have a precious opportunity to leverage the momentum around vaccine equity to work toward broader health equity.
More than a year after the beginning of the pandemic, we can finally see light at the end of the tunnel. As we move forward, let us also look back to ensure that the tragedies we endured can help us make a better tomorrow.
This commentary appears in the spring/summer 2021 issue of UHF's Blueprint newsletter.