While COVID-19 is still circulating, public health and emergency management officials are already thinking ahead to the next threat. An expert panel at the recent MACo summer conference brought policy makers concrete recommendations for improving public health infrastructure in a way that will not only allow a better response to future emergencies, but also improve community health on an ongoing basis. The panel was moderated by Senator Brian Feldman, Vice-Chair of the Finance Committee.
Dr. Meenakshi Brewer, St. Mary’s County Health Officer, kicked off the session by discussing community resilience and the important role public health plays. Among her key suggestions for improving public health infrastructure were:
- Improve epidemiology and health informatics at the local level. Most health departments in Maryland lack staff with this expertise and it is critical to identifying and tracking disease to plan an effective response.
- Improve data systems and interoperability. Dr. Brewer noted that state and national data systems are outdated and do not talk to each other, causing a huge disconnect that compromises public health’s ability to respond.
- Increase the communications staff for local health departments. Public education and information sharing are vital in an emergency and to improve population health. However, most local health departments lack trained communications professionals who can lead strategic communications and sufficient budgets for other communications specialties, like graphic design and videography.
- Improve behavioral health systems to be able to respond in times of crisis. There is a shortage of behavioral health access in normal times, but a crisis increases the need as both those involved in the response and members of the public need additional services to manage anxiety, depression, isolation, and other conditions impacting their mental health.
Jack Markey, Director of the Division of Emergency Management for Frederick County discussed the intersection of public health and emergency management. He emphasized that everyone working in local government has a responsibility for being part of an emergency management response and a public health response. Markey advocated for strong working relationships between the emergency management and public health and encouraged counties who were operating separate responses to be more collaborative.
To end the panel, Dr. Larry Polsky, Calvert County Health Officer delivered an impassioned plea for a revolution in public health. He noted that an incremental approach had been a failure, resulting in public health that was underprepared to respond to emergencies and to do more to improve population health. The primary reason for this is lack of adequate funding – only 1% of healthcare dollars spent go to public health prevention and preparedness. This has crippled the ability of local health departments to recruit and retain good staff and created an overreliance on consultants who don’t know the communities they are working in.
Among other recommendations, Dr. Polsky highlighted the following:
- Information technology is rudimentary and must be improved. Old data systems require time-intensive manual data entry and because the systems don’t communicate, already overtaxed staff has to do the data entry multiple times into different systems.
- The State lacks sufficient lab capacity to do the kind of timely testing needed for a public health emergency response. Positive COVID-19 tests should be able to be tested for variants much more quickly.
- Public health has no behavioral economists on staff to help guide public education efforts. These professionals use data and knowledge of human behavior to help craft more effective health education and prevention efforts.
Dr. Polsky’s final recommendation was for a realignment of healthcare funding in Maryland. He specifically advocated for legislation that would reallocate a hospital’s community benefit spending to local public health efforts. There is currently no transparency or accountability for the expenditure of these funds. Additionally, when hospitals and private medical practices keep Medicare costs below a predetermined threshold, they share in the savings to the system. However, public health receives no such share in the cost savings, despite saving taxpayers and private insurers money. Research has shown that effective public health programs not only result in healthcare cost savings, but also decrease costs to education, social services, housing, and criminal justice systems, yet the investment in public health has decreased sharply over the last decade.
More about MACo’s Summer Conference: