A report by the Commonwealth Fund offers an indictment of US public health support, and recommends restructuring and resources going forward.

Drawing upon outcomes from the COVID pandemic, where more than 1 million American lives have been lost, and other public health experiences and shortfalls, the Commonwealth Fund has sharp criticism for the American model of supporting and providing public health services.

From their report, several findings are excerpted below:

The Commonwealth Fund Commission on a National Public Health System finds that:

• Public health efforts are not organized for success. Despite dozens of federal health agencies and nearly 3,000 state, local, tribal, and territorial health departments, there is no single person or office at the U.S. Department of Health and Human Services to lead and coordinate the nation’s public health efforts.
• Public health funding is not sufficient or reliable. The chronic underfunding of public health has left behind a weak infrastructure, with antiquated data systems, an overworked and stressed workforce, laboratories in disrepair, and other major gaps.
• Expectations for health agencies are minimal. Funding is not tied to a set of basic standards for the capabilities of state, local, tribal, and territorial health departments.
• The health care system is missing opportunities to support health improvement. It is difficult to convert collaboration with public health agencies during emergencies into sustainable work to address day-today health challenges.
• The public health enterprise is facing a crisis in trust. This crisis relates to experiences with racism and discrimination, ideological opposition, and misinformation.

The United States should build a national public health system to promote and protect the health of every person, regardless of who they are and where they live; implement effective strategies with others in the public and private sectors; respond to both day-to-day health priorities and crises with vigor and competence; and, in the process, earn high levels of trust.

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Dr. Joshua Sharfstein of Johns Hopkins University, former Maryland Secretary of Health and Baltimore Health Commissioner, offered commentary via social media, including a thread of highlights and resource links:

Read the full Commonwealth Fund report: “Meeting America’s Public Health Challenge.“