July 5, 2022

What the pandemic taught us about public health

We must learn from our response to COVID-19 to improve health in America and in the world.

By Bechara Choucair, MD, Executive Vice President, Chief Health Officer

Since early 2020, we’ve been living through the most consequential public health emergency in a century. With millions of deaths worldwide, continued uncertainty and unease, and ongoing disruptions to our daily lives, many people are exhausted and ready to declare the COVID-19 pandemic over.

The difficult reality to accept is that it’s not.

At the same time, we’ve come a long way. We’ve seen achievements we never thought possible in research, manufacturing, distribution, and communication.

As White House vaccination coordinator in 2021, and now back as Kaiser Permanente’s chief health officer, I’ve seen firsthand how a pandemic response can — and must — work. The world has learned a lot. We have to leverage that learning. Let’s start with these top 3 recommendations, because making significant changes in these key areas will help us successfully manage our way out of this pandemic and better prepare us for the next one.

Thinking and acting globally

Better preparation begins with having processes in place for better data collection and data-sharing to ensure cases of infection that emerge at the local level are quickly identified. Surveillance, or the ongoing systematic collection, analysis, and interpretation of health data at the local, state, federal, and global levels, needs to be interconnected. This will give scientists and public policymakers a more accurate and reliable picture of how the virus is spreading. A robust interconnected surveillance system will allow the development of strategies to contain and mitigate spread.

Once a virus is identified and studied, scientists should quickly develop diagnostics, vaccines, and ways to treat the illness. We have seen significant progress in this area, but it’s not enough. The manufacturing and distribution of those life-saving tools must occur more quickly and on a global scale. The faster this process occurs, the more lives will be saved, and we may prevent outbreaks from becoming pandemics. If we fail to recognize the interconnectedness of the world in which we live, we will fail to emerge from this pandemic. And our ability to plan for the next one will be fragmented and hampered by supply chain complexity, capacity limits, and other resource constraints.

When a collective crisis hits, it cannot be overcome with individual responses. Sadly, this global crisis has been met with an “every country for itself” mindset. That type of thinking limits our ability to respond quickly and effectively and contributes to growing inequities at home and abroad. Policymakers and health and science experts need to reset their thinking about manufacturing, financing, and distribution of critical supplies and interventions. We need to keep an eye on resilience, sustainability, and equity. Doing so will set up every country for greater success when the next crisis hits.

Modernizing our public health system

Since the beginning of the COVID-19 pandemic, the health care industry — care delivery systems, retail clinics, provider organizations, and health plans — has rallied in ways we never could have imagined to meet the public health needs of our communities. But we need to recognize that our work in communities, no matter how robust or responsive our programs are, is not a substitute for a highly functioning public health system.

Modernizing our public health system to ensure that we are prepared to address future challenges will require policy changes and financial resources. It is important that health system representatives participate in a robust debate and contribute to the public policy process. I am heartened to see the many thoughtful and well-considered reports, roadmaps, and playbooks that continue to emerge. Just last month the Commonwealth Fund published recommendations for building a national public health system, including:

  • Providing adequate and reliable public health infrastructure funding, paired with expectations that states, localities, tribes, and territories meet standards for protecting their communities
  • Reconvening the National Prevention Council to guide a coordinated, multi-department, multi-agency, “all-of-government” approach to the drivers of health
  • Involving community partners in decision-making about public health and improving efforts to better prepare for emergencies
  • Facilitating alignment and coordination across federal and state data reporting and modernization efforts

While public health infrastructure varies across states and localities, bringing about these improvements will bring us one step closer in a long journey to strengthening the public health system.

Strengthening the resilience of our health care system

To this end, Kaiser Permanente has supported continued federal investment for vaccine distribution and the mobilization of public health workers. We’ve also called for greater support for Medicaid and our safety net health care workers to help address health disparities and issues with access to care, especially during the pandemic.

In addition, our health system needs to get and stay better prepared for surges in demand. Health systems can offer valuable expertise in scenario planning and strategies to ensure that facilities have adequate capacity and that qualified professionals are available to address a crisis in the future. Our workforce of the future will need to be agile.

Foundational work to strengthen our health care system begins with creating initiatives to close critical workforce gaps and prepare our future workforce. We’ve learned so much about how to create flexible staffing models, and how to incorporate telehealth and other tools to provide care during a crisis. These lessons should be built upon, not discarded.

Advancing health equity

The pandemic not only brought to light the large gaps we have within the health care system and disaster preparedness in our nation, it also put a magnifying glass on the health inequities that underserved communities have been facing for decades. People of color and people with low incomes experienced barriers to obtaining COVID-19 testing, personal protective equipment, and the vaccine, in addition to long-standing issues accessing care.

Good health includes having a safe place to live, healthy food, enough money to pay the bills, and strong social connections — the essentials of life. This means we as health care leaders need to shape the systems, processes, and interventions that help people get and maintain access to these basic social needs. And we have to approach this work with the same rigor we do for physical and mental health.

At Kaiser Permanente, we understand our role in creating affordable and accessible care for our members and the communities we serve. We believe that if our goal is health equity we need to double down on our efforts to create conditions for health and equity in our communities. We need to recognize that optimizing health is not only about physical health. It’s about mental health. And it’s about social health. Each one of these areas has been under strain for so many people across this country. While each one of these domains has been negatively impacted by the pandemic, the surge in social health needs has been remarkable. As health systems, we are all too often ill-prepared to address the social health of the people in our care. Our work to assess those we serve for gaps in basic needs and connect them to resources is more important than ever.

And we saw the fragility of a national pandemic response plan that relied on a chronically underfunded public health system and thinly stretched health care systems. There is an opportunity now for policymakers and public health and health care systems to come together to promote and advance health equity in communities that are facing the greatest barriers to receiving care.

Looking ahead

Public health and health delivery system stakeholders share a common goal to apply the lessons we’ve learned in our response to COVID-19 to make investments that will better equip all of us moving forward. As we work to improve our public health and health systems, keeping equity at the center of our collective decision-making will help us avoid the disproportionately higher rates of exposure, illness, hospitalization, and death in our communities of color and in people with low incomes. Otherwise, these disparities will continue to show up even after the pandemic ends.

Taking this opportunity to learn from the pandemic response to build, equip, and strengthen a sustainable public health and health care delivery system will help us meet our long-term needs, with our goal of realizing better health and a better future for everyone.