How the Trump administration can protect public health

We are lucky to live in an age when scientific research was able to create a highly effective vaccine within a year of the COVID-19 virus entering America, one that helped prevent serious hospitalizations and death. Vaccines not only work, but they were largely responsible for our ability to reopen our economy as the pandemic abated.

The ability to stop person-to-person transmission of a deadly airborne respiratory illness should be among the highest priorities of a nation, regardless of who sits in the White House. After all, viruses are nonpartisan, and vaccines are our best defenses.

We must not forget how frightening it was when literally hundreds were crowding our emergency rooms trying to breathe. Nor should we forget that as the pandemic struck, the chronic underfunding of public health departments left most unable to do basic public health practices like contact tracing, immunization programs, or tracking the virus’ spread. In frustration, many county leaders fired their public health directors rather than being willing to hear their recommendations. Over 1.2 million Americans are estimated to have already died from COVID-19, and the virus is unfortunately still evolving into other potentially deadly variants.

The work of protecting the public’s health requires experienced leaders who understand disease processes, appreciate medical research, prioritize prevention and outreach to the most vulnerable, and believe in basic public health practices like vaccination and fluoridation.

As a former health commissioner of Philadelphia, I have concerns about the announced efforts to downsize the federal workforce. For too long, our country has treated the public health workforce like seasonal workers in a department store, rather than recognizing that the work of keeping the air clean, water pure, food nutritious, and surveilling disease threats is a full-time, 24/7 activity.

Public health and prevention are the foundation upon which we build our health system, and decimating public health will risk more environmental catastrophes or disease outbreaks with far greater costs to our economy and American lives.

It is wise for the incoming administration to focus on chronic diseases and risk factors. Much scientific research has shown a direct link between chronic diseases and major risk factors such as smoking, sugar-sweetened beverages, and environmental and toxic pollution. In Philadelphia, too many lives have been lost or permanently disabled because of the absence of gun regulations. The risk factors for chronic diseases also extend to how we raise our children and adverse childhood experiences, especially child and sexual abuse.

Dismissing or dismantling the lessons learned from these risk factors could create its own epidemic of very expensive chronic diseases or needless disabilities. Our life expectancy is far worse than that of other developed nations, despite spending far more on the treatment end of health care rather than public health and prevention. We need leadership and funding to change our direction.

Critics of public health professionals complain that we seem to be always saying the world is on fire. OK, but compared with how much we spend on health care as a nation, is it not worth asking ourselves if we couldn’t do a better job of getting bang for our buck? Every other country with better health statistics spends less money per patient than we do. If our new health leaders want to disrupt the apple cart, they would do well to learn lessons from other countries’ health-care systems and take their best ideas.

None of us want to live through another pandemic, but another one is very likely to occur in our lifetime. As the Trump administration chooses who will lead our national health efforts, it is essential it understands and values public health. Just as we value other public safety investments like our national defense or, more locally, police and fire departments, our public health workforce and medical research need to be fully supported.

The cost of being unprepared to face another public health emergency is unacceptable.

Walter Tsou is a former health commissioner of Philadelphia.