So many of us were grateful for the new beginning that occurred when President Joe Biden took the Oath of Office on January 20. We knew he was committed to doing the work needed to put an end to the pandemic, as well as address issues of access and equity in health care in our country. We were confident that he would address issues of social justice, climate change, and immigration. Both he and Dr. Jill Biden are deeply committed to higher education, reducing the debt burden of student loans, and improving access to the benefits of education for all. And while I am hopeful for the future, I recognize that there are systemic issues that have prevented change in health care, education, and immigration and equity for as long as I can remember.
Why has the richest, most powerful country in the world had such a weak response to the pandemic that has gripped us for the past year? Granted, most of us have never felt the weight of such a monumental assault on everything we know and all that we do. Yet, across the country, there was very little coordination of what worked and minimal sharing of information – both of which could have radically improved our overall national response. Those who are the most vulnerable, minority populations and the elderly, felt the deepest impact of the pandemic as a result of our inability to have a thoughtful, coordinated response. From my perspective, there were 50 independent states each doing their best, but ineffectively developing a plan to address a virus that was consuming us. I wondered why that was.
When I entered health care, we had a strong public health delivery system. There were national goals that included one public health nurse for every 5,000 people in a community.
Most states had a public health infrastructure that included scientists, mostly epidemiologists, and providers who were part of a county health infrastructure. The members of the county health departments knew their community, knew how things worked, knew who could make thing happen, and were able to influence health through that structure. In many states, we no longer have a county government structure, and with the elimination of that structure went the elimination of the county health departments. Our state health departments are huge and lack the same connection with the community. Their work is critical, and their portfolio is vast. They are chronically underfunded, yet their responsibilities continue to grow. These systemic problems in our public health system continue and realistically will not be solved overnight. It’s unfair to expect a new administration to make that happen. Yet, we have seen what a weak and failing public health infrastructure means when faced with a real crisis like a pandemic.
And now, as we work to vaccinate our population from COVID-19, we once again appear unprepared for the magnitude of the project and are uncoordinated in our approach. With a few exceptions, there is little information that is really helpful to our community, and our models for providing access to the vaccine for the most vulnerable are not designed for them.
They are designed for people who spend a lot of time on a computer and know how to use programs that are fairly sophisticated. Last week, I spent hours on the Mass.gov website trying to enroll my 77-year old sister for a vaccination. She, like many others her age, could have never completed that enrollment form without help.
How can we protect the public’s health if we make it impossible for the people who need the help the most with easy access the public health infrastructure? Are there places where there is success in vaccinating the population and what can we learn from those successes? Is it time to rebuild and re-energize our public health infrastructure in a way that can help coordinate care and improve access to our most vulnerable in the community?
The pandemic has made me far more reflective about why things are the way they are. And while we have systems that perpetuate ineffective health care delivery, I find hope in our students. They come to us with a desire to make the world a better place, and they leave the IHP with the skills and confidence to accomplish that goal. They are willing to stand up for climate justice and social justice, are deeply committed to their professions, are determined to ending discrimination of those who have immigrated to our country, and have an overwhelming desire to improve health care for all. They can make a difference in the established structures; they are the ones who are creating the light at the end of the tunnel.