Daily Editor Henry Astor brings you the highlights from the remarks of Sylvia Burwell Mathews and Dr. Dave A. Chokshi, two eminent leaders in American public health, on the American public health system and how we can strengthen it.
On Thursday, February 11, 2021, the Mailman School of Public Health hosted a town hall event called Optimizing Federal and Local Public Health Systems for the Next Pandemic. Moderated by Dean Linda Fried, the event featured prepared speeches and Q&As from two experts at the federal and local levels in public health on the topic of improving public health infrastructure in the United States in a post COVID-19 world.
First to speak was Sylvia Mathews Burwell, current president of American University in Washington, DC. Burwell also served as Secretary of Health and Human Services as well as Director of the Office of Management and Budget under former President Barack Obama. She emphasized the need for high quality execution and care, access to that care for all (while stopping short of an endorsement of universal health care), and the wise use of new data and technology to deliver optimal public health outcomes.
Perhaps it should come as no surprise that Burwell says the US has failed at all three of these pillars of public health delivery in its handling of COVID-19. According to her, it should be gravely concerning that, one year into the pandemic, the American public has not internalized the need for a three-pronged approach which she sums up as “prevention, detection, and response.” Rather, the country is mentally approaching COVID-19 as an endemic disease, like seasonal influenza and the common cold. This failure she blames not on lay Americans unversed in public health response but on the arms of state and federal governments who did not take COVID-19 seriously soon enough.
Burwell, in her capacity as Secretary of Health and Human Services, worked closely with domestic and international partners during the 2014 Ebola epidemic in West Africa, which was devastating to that region but fortunately was contained and prevented from morphing into a global pandemic thanks in part to a robust response at the local level in the affected countries. She uses this epidemic as an example of how local public health networks can be leveraged to minimize damage to communities caused by infectious diseases; one example she gave was that community health networks put in place to deliver the polio vaccine in Nigeria were reactivated to conduct contact tracing, which stopped Ebola from reaching community transmission levels in Africa’s most populous nation. This basic element of a public health response is so far missing in the United States, according to Burwell. There hasn’t been an adequate national framework for pandemic response, something Burwell says can be remedied when Americans start to treat public health as a matter of national security instead of, in her words, as something “nice to have.” She says that public health requires investment, just as we invest in education, defense, and infrastructure.
Next to speak was Dr. Dave A. Chokshi, New York City’s Commissioner of Health. Chokshi has only recently come to the fore of public health in the City, as he took on his current role in August of last year in the wake of the resignation of NYC’s former Commissioner of Health, Dr. Oxiris Barbot. Chokshi reiterated many of Burwell’s points on the need for strong local community health networks and also drew attention to disparities in public health outcomes for Black and brown communities. He contextualized COVID-19 as an event that could enter the annals of history as a “forgotten pandemic,” like the 1918 flu, or as an opportunity to fortify our public health for the future. In order to make the latter a reality, however, Chokshi says we need to realize that “health equity is not a sideshow… It is the main event.”
Chokshi advocates for the use of a variety of valued community leaders beyond just medical professionals to deliver public health. He suggests leveraging celebrities, faith leaders, and business leaders who are familiar to and with members of communities in order to inculcate the need for mitigation measures as well as encourage vaccine uptake. Advancements in medical technologies can only go so far; many communities lack trust in those advancements while, in Chokshi’s words, “Trust is essential for turning vaccines into vaccinations.”
Another underrated factor in pandemic response which Chokshi highlighted is the concerning prevalence among the American population of chronic comorbidities caused by lifestyle factors like poor diet and lack of exercise. While he didn’t give many specific policy recommendations on how to improve Americans’ eating and exercise habits, Chokshi did emphasize that if we can approach public health in this holistic manner, we may blunt the impact of infectious disease by ensuring the population is more likely to survive infection. Part of this process, too, is equity. Class has a prolific effect on, in particular, the types of food to which one has access; Chokshi pointed out that healthy eating is a practice that is, at this moment, reserved for the wealthy. In his view, reducing comorbidity requires an effort to increase access to fresh produce and other healthy food options for the working class.
Despite the uniquely gnawing uncertainty of our current era, Burwell and Chokshi spoke with clarity and certainty on how our country and world arrived at this point and what we can and should do now to ensure better outcomes going forward. They are experts in the truest sense, putting their experiences and knowledge to use for the betterment of humanity. Let us hope that they can continue to be heard and that their good wishes for society can come to fruition.
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