Story at a glance
- A myriad of challenges currently face the nation’s disjointed health care system while staff shortages and funding issues point to future struggles.
- A new report from the Commonwealth Fund Commission on a National Public Health System calls for a complete overhaul of the U.S. public health system and lays out how changes will improve care down the line.
- Proposed reforms include updating infrastructure to better aggregate health data and installing a leader for the public health system within the Department of Health and Human Services.
As the nation continues to reel from the COVID-19 pandemic, efficient and equitable health care delivery is hampered by more frequent natural disasters and increased rates of overdoses and gun violence — all of which necessitate immediate and long-term care for patients and survivors.
Facing staffing shortages and funding reductions, the current U.S. health care system is ill equipped to deal with current and future influxes of care demand.
In a new nonpartisan report published by The Commonwealth Fund, experts laid out a potential framework for a national public health system aimed at addressing the myriad of issues plaguing the health care system in the United States.
“The consequences of these deficiencies reach far beyond the current pandemic and undermine the nation’s ability to respond to ongoing and pressing health challenges,” authors wrote. “The pandemic exacerbated a national mental health crisis, especially among millions of children and young adults who have been knocked off their life trajectories.”
Written by the Commonwealth Fund’s Commission on a National Public Health System, members include former FDA commissioner Margaret Hamburg, former North Carolina health secretary Mandy Cohen, and former CDC director Julie Gerberding, among others.
A disjointed web of national, state, tribal and municipality health systems hindered a quick response to the COVID-19 pandemic, while current funding for a robust public health system is woefully low, they stressed.
Challenges in data aggregation, aggravated by outdated technology and gaps in insurance coverage, also mark major hurdles to improving Americans’ health overall, not to mention rampant medical misinformation proliferating on social media and performance of low-value, high-cost procedures leading to wasted resources.
To address setbacks, experts provided a list of actions that can be taken at the congressional, administrative and local levels.
One key recommendation is the creation of a role within the Department of Health and Human Services (HHS), such as an undersecretary for public health, to oversee and coordinate a national public health system. Priorities would include to “strengthen the nation’s public health infrastructure, including data systems, workforce, laboratories, and procurement, and to bring together state, local, tribal, and territorial health departments to promote coordination.”
Citing the often multifaceted nature of public health, authors also called for increased cooperation between HHS and other federal agencies. For example, because built environments play a role in individuals’ exposure to pollutants, increased cooperation between health agencies and the Department of Transportation can help mitigate future chronic health conditions resulting from unhealthy levels of exposure.
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When it comes to support, in addition to providing emergency, short-term support services for local public health systems, congress should supply sustainable funding for these departments, amounting to $4.5 billion each year, to ensure long-term stability following acute crises.
“In exchange for this support, the nation’s public health departments should be expected to meet basic standards for delivering these core capabilities as assessed through a revised accreditation process,” experts proposed.
Increasing trust within the communities they serve will also be paramount in this effort, while measures like increasing staff diversity and community representation can help foster shared decision making with the public.
Improving integrity and ethics through efforts like acknowledging past failures and implementing Government Accountability Office recommendations will add to the system’s credibility.
Sweeping improvements will be costly, and the panel calls for approximately $8 billion in annual investments toward improving information technology and infrastructure. But compared with the “trillions of dollars lost as a result of the inadequate public health response to the pandemic,” this total pales in comparison, they said.
Chronic disease alone costs the health care system around $216 billion each year, resulting in $147 billion in lost productivity, data from the CDC show. As part of the recommendations in the report, authors also underscore the need for increased prevention efforts and interventions to improve health outcomes.
Increasing the sharing of secure, accurate health data between agencies can help in this effort and better target outreach efforts to vulnerable communities.
“By establishing a truly national public health system, this nation will be better able to save lives during future pandemics and other emerging health crises, address health challenges like overdoses and maternal mortality, improve the quality of life and economic well-being of our nation, and advance equity,” experts concluded.