ACP Policy Paper Provides Recommendations for Enhancing the U.S. Public Health Infrastructure

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The update to a 2012 ACP policy paper aims to ensure the health system is prepared for major public health crises

Sept. 8, 2023 (ACP) — In a new policy paper, the American College of Physicians is calling on the nation's leaders to augment and enhance the public health infrastructure in the United States, and in an accompanying editorial, top officials from the Centers for Disease Control and Prevention express their support for the ACP policy.

“Over the past several years, we have seen how deficiencies in our nation's public health infrastructure left us unprepared to face a major public health crisis,” Dr. Omar T. Atiq, president of ACP, said in a press release. “COVID-19 has demonstrated why we need to ensure that we are fully equipped to respond to future public health emergencies and also how better support for public health in the interim can safeguard the health of everyone in our country.”

The policy paper, titled “Modernizing the United States' Public Health Infrastructure,” was published in the August issue of the Annals of Internal Medicine and updates recommendations that ACP made in 2012 for the U.S. public health infrastructure. “Since it's been 10 years, the College felt it was time to take another look at the topic,” said Ryan Crowley, ACP senior associate for health policy. “The role of public health is crucial, especially as the United States grapples with increasing rates of chronic disease, a behavioral health crisis, high prevalence of maternal mortality, gun violence and, of course, the COVID-19 public health emergency.”

The policy paper, written by Crowley and other ACP representatives, calls for “effective coordination of public health activities, robust and stable year-to-year funding of public health services, a renewed and well-supported public health workforce, action to address health-related dis- and misinformation, modernized public health data systems and greater coordination between public health and medical sectors.”

ACP recommends that the U.S. Department of Health and Human Services designates a new public-health official who would coordinate interagency work and be responsible for public health efforts. “The public health system is fractured. There are literally thousands of state, local, tribal and territorial health departments, as well as several federal agencies, that have some public health charge, so it's difficult to coordinate efforts,” Crowley said. “There should be a high-ranking federal official who dedicates their time to modernizing the U.S. public health system, with emphasis on making it more of a ‘system’ to help enable public health organizations to share data, collaborate and coordinate toward achieving goals. This recommendation was inspired by a 2022 report from several public health experts that was published by the Commonwealth Fund.”

The policy paper also recommends immediate action from Congress to provide sufficient and stable funding for public health at the federal, state and local levels. It also calls for action to address the severe shortage of public health workers. The number of public health workers employed by state and local governments declined by 15 percent from 2011 to 2021, according to a 2021 report from the de Beaumont Foundation, and a 2021 survey by the foundation of state and local public health workers revealed that 27 percent of workers intend to leave their position within a year.

“We need an additional 80,000 public health workers to provide core services and meet expectations,” Crowley said. “Higher pay, loan repayment, leadership training and an emphasis on building a diverse workforce can help the system meet basic needs. Of course, public health departments need stable funding to do this. Public health workers also experience threats, harassment and workplace violence, so there needs to be strict criminal penalties to prevent this kind of behavior, as well as training and support for public health professionals. Public health workers should also be trained in responding to disinformation and misinformation regarding vaccinations, COVID-19 treatments and other topics.”

In addition, the ACP paper calls for increased efforts to combat health-related disinformation and misinformation, especially through social media platforms. ACP has been a national leader in fighting and preventing the spread of falsehoods about medicine.

The paper also recommends the development of a national public health data system that would be capable of sharing real-time information back and forth between public health departments, physicians, hospitals, laboratories and others. “The U.S. public health data infrastructure is outdated,” Crowley said. “A lot of public health departments rely on old technology like fax machines. Again, this partly goes back to the funding issue. If you neglect to provide funding and resources to public health, they aren't going to be able to do their jobs effectively and population health will suffer. The CDC Data Modernization Initiative is working to upgrade the data sharing system at all levels; comprehensive efforts to improve data infrastructure need to happen in a way that protects patient privacy.”

Finally, ACP encourages collaboration between public health and primary care.

In an accompanying editorial, Sherri A. Berger, CDC deputy director for policy, communications and legislative affairs, and Dr. Rochelle P. Walensky, who stepped down earlier this year as director of the CDC, write that they “generally laud the findings” of the ACP policy paper.

“CDC, and our state and local public health partners, are heeding the call to take concrete action, and we report early successes,” Berger and Walensky write. “We also caution that we cannot act alone, and without funding, flexibility and new authorities — in budget, workforce and data — CDC and public health will be unable to respond to and avert the next pandemic. We must advance bipartisan solutions to fund, support, integrate and empower public health.”

ACP is encouraged that the CDC “largely agreed with our recommendations, particularly on funding, workforce and data sharing,” Crowley said. “Federal public health officials have acknowledged that substantial changes need to be made and have emphasized the need to rebuild the public's trust, which really took a hit during the COVID-19 pandemic. Social media makes it so easy to spread rumors and misinformation.”

Atiq shares a commitment to partnership. “Physicians and public health professionals have a shared mission. We need to work together to improve the health of the American public most effectively,” he said. “Public health has long been underfunded and underappreciated. The crucial nature of this work means we need to act now to make changes to reverse that and modernize our public health infrastructure.”

More Information

The position paper, “Modernizing the United States' Public Health Infrastructure,” is available on the Annals of Internal Medicine website.

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