Editorial: Make public health a priority
When legislators gather in Richmond in January for the new session of the General Assembly, improving the state of public health in Virginia should be high on their agendas.
The COVID pandemic showed the critical importance of public health while also sorely straining health departments everywhere. Public health workers were stretched to their limits as they tried to provide testing, treatment, vaccinations (once they became available) and contact tracing. They worked with inadequate resources to give people accurate information about the pandemic and ways to protect themselves. They tried to monitor COVID’s progression and figure out what to do about various areas and communities that were especially hard hit.
Virginia’s public-health system was already struggling before COVID made things worse. Inadequate money spent on public health here meant that many positions went unfilled, information technology was out of date and health departments lacked clear ideas about their mission and how to achieve it.
A recent report from the Joint Commission on Health Care (JCHC) said Virginia ranks 38th nationally in per capita spending on public health, and that it was one of only seven states that cut public health funding in the months leading up to COVID.
If it somehow wasn’t before, it should be obvious now that building and maintaining a strong public health system is essential. COVID lingers, striking with new variants, and experts have warned of yet another spike this winter. Long COVID is a problem for many, and we still have a lot to learn about that. Meanwhile, we have flu, RSV infections that can easily turn into bronchiolitis or pneumonia, and other health threats to contend with. As COVID showed, we don’t know what unpleasant surprises might lurk.
Public health centers play an important role providing essential care such as childhood vaccinations. The sharp drop in vaccination rates during the pandemic could mean outbreaks of various illnesses.
The JCHC report found a range of problems, many related to lack of funds. Staff positions, including directors of local health departments, go unfilled because salaries aren’t competitive.
With the current doctor shortage in Virginia and nationwide, that’s likely to get worse.
Record keeping and communication are outdated and inadequate. Statewide, the system needs better management and accountability, with clearly defined standards. There are questions about the role of local health departments, as many move away from providing direct services such as primary care, prenatal care, clinical care and preventive measures.
The lion’s share of public health funding comes from Washington, and federal pandemic funds helped during COVID. The study showed that Virginia needs to do more to strengthen and maintain the public health system without relying so heavily on federal funds.
The report proposed several policy changes that might help, including developing a management and assessment process for local health departments, creating infrastructure for centralized data, increasing fees local health departments charge for such things as health inspections, and putting in place a student-loan replacement program to attract and keep employees.
The legislature should carefully consider these and other proposals. Legislators did approve one change this year that might help – expanding the qualifications for health directors from physicians only to include those with advanced public-health degrees.
State leaders need to ask the big questions about what we want and expect from the public health system, and what we can do to achieve those goals. Those questions will raise others, such as how great a share local areas should bear for funding health departments, especially low-income and rural areas.
Recent history has shown how unwise it is to skimp on funds and attention for public health systems. Preventive measures are always important, helping to avoid illnesses or injuries. And we never know when another unexpected health crisis will demand a quick, strong response.
The JCHC report raises important warnings, and it offers some solutions. Lawmakers should pay close attention when they start work in the new year.
