The COVID-19 pandemic, one of the most significant public health challenges to face this generation, has not only exposed but substantially sharpened the fault lines in our social, economic, and political systems. Most alarming, these cracks have weakened our federal, state, and local public health institutions and agencies in ways that will undoubtedly impair their ability to positively affect the health of our populations. As we begin emerging from the pandemic and take stock of its impact on our communities and public health institutions, the articles in this month’s issue of AJPH remind us of the work that public health agencies have been doing to understand the true burden of COVID-19 and mitigate its toll in local communities. Against such achievements, these articles also stress that lack of widespread public and political support, underfunding, staff turnover, and staff shortages at local health departments will imperil our nation’s ability to regain the ground we have lost over the past two years.
Jain et al. (p. 24) describe a community-level seroprevalence survey conducted in Maricopa County, Arizona, by the county’s department of public health in collaboration with Arizona State University. The authors’ two-stage cluster sampling design yielded a COVID-19 seroprevalence rate that was 4.4 times higher than estimates derived from traditional public health reporting. The authors note that by using a door-to-door survey, they were able to reach out to vulnerable community members who were less likely to seek COVID-19 testing. This report beckons us to consider returning to the basics of shoe-leather epidemiology: going door to door in the community and obtaining data directly from community members is the type of task that can be carried out only by local health departments.
Also, Johnson et al. (p. 43) describe the San Francisco Department of Health’s leveraging of novel chatbot technology to conduct contact tracing during COVID-19 surges as a means of offsetting workforce shortages. The chatbot was able to facilitate the collection and distribution of information in both English and Spanish, an important feature as Latinx individuals account for 40% of COVID-19 cases in San Francisco but only 15% of the population. Although information on contacts was collected more successfully via telephone interviews than via the chatbot, the latter technology was still able to provide information on ancillary services for individuals who had to self-isolate.
Finally, Porter et al. (p. 39) report on the development and deployment of health equity strike teams by the Arkansas Department of Health to address vaccine hesitancy and reduce disparities in COVID-19 vaccine uptake in the state. Media campaigns featuring trusted community leaders, educational campaigns to build community trust in the vaccines, and processes to simplify vaccine uptake were rolled out with the cooperation of several local community organizations. Together, these efforts resulted in significant increases in vaccination rates among adults 65 years or older and reduced vaccine disparities.
These articles highlight the creativity of local health departments in meeting the needs of their communities as well as the significant time, effort, and commitment to local partnerships that lead to these programs having a positive impact on the health of populations.
Despite these examples of successful public health department initiatives and many others—some described in previous issues of AJPH—trust in public health departments is in peril. Some people, instead of looking to their public health departments for information to prevent illness, scorn these institutions and their staff members. A recent study conducted by the Robert Wood Johnson Foundation showed that 71% of study participants favored increasing federal spending on public health activities and 72% supported the activities conducted by public health institutions as integral to the health of our population (https://rwjf.ws/3HPdAR9). However, the same study revealed substantially lower levels of trust in our nation’s public health institutions. Specifically, 52% of respondents reported high levels of trust in the Centers for Disease Control and Prevention, 41% in state and local health departments, and 37% in the National Institutes of Health.
A report in the New York Times also details the multitude of ways in which the power of local health departments is being whittled away (https://nyti.ms/3cv99MU). Inconsistent funding, a lack of permanent employees, and high employee turnover will diminish the ability of local health departments—our frontline public health forces—not only to prevent future epidemics but to address the ongoing public health crises undermining our nation’s health. Funding streams should not define what public health issues are of consequence in a given community. In fact, it is the other way around: local health departments must retain their authority to investigate and determine the health needs of their communities and make prevention and programmatic recommendations based on the local evidence.
As we begin to emerge from the COVID-19 pandemic, we must fully support all of the work in which health departments engage. This involves preparing for the next epidemic as well as returning to the prepandemic agenda: overdose prevention, childhood vaccinations, maternal and child health, oral health, mental health, and so forth. These are not and should not be controversial activities, and public health department employees must be able to carry out this work without fear of harm. This is public health of consequence, and this is what local and state health departments do.
CONFLICTS OF INTEREST
The author has no conflicts of interest to disclose.