Achieving Equity Warrants Change in Public Health Policy and Investment, Panel Says

Panelists of a keynote session at AHIP 2022 discuss how lessons learned from investment and infrastructure in public health during the COVID-19 pandemic can be leveraged to promote equitable care for all Americans and prepare for the next public health emergency.

As the COVID-19 pandemic continues to subside nationwide, leveraging the investment and infrastructure created to support community health will be key to promoting equitable care for all Americans and preparing for the next public health emergency, noted panelists of a keynote session at AHIP 2022.

Addressing the difference in public health perspective since the onset of the pandemic, Leana S. Wen, MD, MSc, FAAEM, emergency physician and professor of Health Policy and Management at George Washington University, highlighted that as vaccines have led to a marked decrease in rates of COVID-19 hospitalizationa, mortality, and cases, its impact also spotlights a common trend of reactionary vs preventive strategies by Congress and policymakers.

“We have these great tools, including antiviral treatments, that are underutilized still, and I'm very concerned that we will not have the resources to be able to purchase them going into the future now that we have had this successful decoupling of [COVID-19] infections and severe disease,” said Wen.

“We need to have the resources to be able to respond and I would hate for that to be the lesson that we forget in all this. If there’s anything we’ve seen throughout the decades it’s that prevention is key and waiting until something catastrophic has happened before you invest in it is to blame.”

Bechara Choucair, MD, senior vice president and chief health officer of Kaiser Permanente, added that although lessons learned from the pandemic led to improvements in response to infection surges and community engagement, many mistakes were also made, in which there remains much work to be done on public health preparedness.

Data capturing and data sharing were 2 central focuses of improvement he mentioned to improve preparedness. By having surveillance systems interconnected at a local, state, federal, and global level, Choucair said this will assist in pathogenic monitoring and shortening the time between data sequencing and having the tools to intervene.

“The shorter that interval is, the more likely that we're going to be able to jump on this operation and stop it before it becomes a pandemic. For us to be able to do that, we have to be able to get to the science, but also get to the manufacturing and distribution of diagnostics, vaccines, and treatments globally,” he noted.

“As we think about public health protocols, it's also time for us to take a step back and think about how our global public health protocols look worldwide so that we are functioning under the same sets of protocols at a global level to be able to get us better prepared for the next pandemic.”

Along with optimizing preventive data capabilities, ensuring equitable health and well-being of communities in the United States and globally was mentioned by Choucair as another key factor in improving public health preparedness.

“On the individual level, we know people in this country are dealing with housing and income issues, food issues, transportation issues—you have to be able to support individuals on a one-on-one basis. Making sure that we're paying attention to our members’ social needs the same way we pay attention to their physical health and mental health.”

Georges C. Benjamin, executive director of the American Public Health Association, added that to address the social inequities prevalent across US communities, such as homelessness and financial disparities, intervention is warranted on the policies that cause an upstream effect on these issues.

However, having the infrastructure and investment needed to create change on a local level is complicated by the lack of engagement from lobbyists, he mentioned.

“When I was the deputy health officer of the Department of Health and Mental Hygiene in Maryland, we had all these public health programs and it would be me, our legislator, and someone who couldn’t find somewhere to eat their lunch at my hearing. When I became the secretary of Maryland’s Medicaid program, the room was packed with lobbyists,” said Benjamin.

“So, I would argue that I would like to see lobbyists show up to more health hearings, zoning hearings, housing hearings, and food insecurity meetings because if we address those root causes, we can get the health sector out of the landlord business and back into the policy business. If you want to scale this up and get to a whole lot of people, this is how we have to do it.”

Panelists then concluded on future strategies to better manage the health and well-being of US communities. Plagued by disinformation during the pandemic, social media was mentioned by Benjamin as an opportunity to relay the right information through trusted sourches in bite-sized amounts to better inform individuals nationwide.

“In the 90’s we had to educate people about HIV/AIDS, somehow we forgot that—we just didn't invest in the growing needs for communities to bring community navigators. Local news resources can be quite limited and have all kinds of other challenges. To rebuild the communities most at risk, we need to continue to invest in the infrastructure of those systems,” said Benjamin.

“Trust is not built overnight. If there are individuals who feel like they've been ignored by the medical system, why would they believe us when we’re coming in with vaccine information?” added Wen. “I do hope that we take the lessons that we’ve learned and understand that investment has to come over time. Sometimes, it will take ongoing short-term investments on our way to long-term action.