Early in my career, I worked on the Navajo Nation as a pediatrician for the Indian Health Service, the federal agency that provides health services to American Indians and Alaska Natives.
IHS is a fully integrated system in which there are no boundaries between the medical office and the community — doctors and other clinicians work shoulder to shoulder with community health workers, environmental and sanitary engineers, and other public health leaders. I saw firsthand the benefits of this kind of collaboration.
When one of my patients was behind on immunizations at our health center, we had our public health nurses administer the vaccinations at the patient’s home. For patients without an easy way to and from their clinic appointments, community health representatives would contact them to provide transportation. When one of my patients suffered from respiratory disease related to inadequate household ventilation, this coordinated system would work to secure healthier housing and offer other mitigation strategies.
From this experience, I learned that to successfully improve the health of the public, we need strong federal, state, and local public health systems to work closely in partnership with the health care system.
An effective public health system prevents disease and promotes health with the goal of helping everyone live healthier, longer lives. However, long-standing structural and financial challenges are limiting the public health system’s ability to do just that.
Challenges also arise from the patchwork oversight and coordination of public health activities. Even when individual efforts succeed, our public health system suffers from a public relations problem — prevention is often invisible, and lives saved cannot easily be counted.
A strong, effective public health infrastructure helps people stay healthy and makes us more prepared to cope with crises — like pandemics — when they occur. The COVID-19 pandemic presents us with the opportunity to strategically invest in and modernize our public health system. Ideally this will include:
Partnerships, like the ones that work so well on the Navajo Nation, are critical to improved public health. And, these relationships must be built and strengthened over time, not only during crises. When public health systems work together with health organizations, community institutions, and businesses, we’re better able as a society to weather short-term crises as well as long-term public health challenges.
Making long-term investments in relationship-building and trust-building between these groups can start from our common goals. The onset of the COVID-19 pandemic drove home for many of us working in the organizations that make up the country’s health system just how tightly our priorities intersect with those of the overarching public health system.
I know from my experience at Kaiser Permanente during the pandemic, our intentions have consistently been aligned with the public health system’s. From the need to rapidly deploy testing at scale, triage and care for people exposed to the coronavirus, and keep our front-line staff safe, we both prioritized identifying effective strategies for reducing virus transmission and getting people vaccinated for their own safety and that of their communities. We both saw the value of rapidly accessing and using data effectively to help make decisions that could reduce transmission and protect residents. And we both saw the need to address health equity in everything we do, recognizing the need to support communities facing the greatest challenges in areas like housing, transportation, and food security.
As these partnerships strengthen and grow, people in our communities will start seeing and feeling the difference. And as the public’s confidence in public health grows, policymakers will be more willing to trust in our public health systems as well.
To get to that ideal state, we must listen to the public’s concerns and fears and strive to communicate in clear, timely ways. Health care organizations and public health institutions have to be fully aligned and coordinated in messaging and ensuring that messages are tailored for the diversity of the public.
Our health care and public health systems have risen to the extreme challenges presented by the COVID-19 pandemic, saving millions of lives through advanced care, vaccines, and public health measures. And despite these current challenges, there is hope for a better future. As we continue to address the pandemic, we have the opportunity to learn from our experiences and strengthen these systems in ways that promote the public’s health, prioritize prevention, and advance health equity.
To hear from additional public health experts, check out “Public Health and the Delivery System: Vital Connections” from the Institute for Health Policy forum held in December 2021.