Reimagining Public Health in the Aftermath of a Pandemic

Ross C. Brownson, PhD; Thomas A. Burke, PhD; Graham A. Colditz, MD, DrPH; Jonathan M. Samet, MD, MS

Disclosures

Am J Public Health. 2020;110(11):1605-1610. 

In This Article

Abstract and Introduction

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for society, affecting those already subject to unacceptable health inequalities and resulting in vast economic impacts. The pandemic reminds everyone of the value and necessity of public health.

In the context of an era that will be shaped by COVID-19, we outline the coming series of challenges and transitions in public health and the needed actions over the next 5 years to reinvent our public health systems. Multiple limitations in current US and global public health systems have been uncovered by the pandemic, including insufficient preparedness and surveillance capabilities complicated by long-standing and worsening health inequalities and the rapid spread of misinformation that needs to be countered. We foresee 3 phases for public health over the next 5 years: (1) reactive crisis management, (2) efforts to maintain initial gains, and (3) efforts to sustain and enhance progress.

A reinvented public health system will depend highly on leadership and political will, rethinking how we categorize and address population-level risk, employing 21st-century data sciences, and applying new communication skills.

Introduction

The worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a medical and public health emergency on an unprecedented scale that began only several months ago. Its full impact is not yet manifest, and the course and full consequences of the pandemic are still uncertain. But public health has already been altered, and the prevention measures used for epidemic control have become household words (e.g., social distancing, contact tracing). The reasons behind the rapid spread of coronavirus disease 2019 (COVID-19) in the United States are becoming clearer (e.g., travel, large gatherings, cryptic transmission) as are the public health actions needed to control spread.[1] However, the striking toll of mortality from the virus in the United States compared with many other industrialized nations is alarming and raises questions about preparedness, capacity, political will, and the underlying health of the population. Like other pandemics, this one has thrived on inequity, causing substantially higher mortality among those living in poverty and in some racial and minority groups as well as in the elderly and chronically ill.[2,3] We are also starting to realize the devastating economic impacts on the United States and the world; these impacts come with sweeping consequences for physical and mental health and the health of the population.[4,5]

The emergence of the pandemic and the severity of its course have proven to be a powerful and heeded reminder to all of the value of public health. Public health and epidemiology are now more recognized by the general public and policymakers than ever before. Part of this visibility relates to media attention (including social media), which is known to affect public health policy and practice.[6,7] We compared the media hits via Media Cloud[8] for the terms "public health" and "epidemiology" in the periods January 1 to June 1, 2019, versus January 1 to June 1, 2020 (Figure 1). We found a more than 1000% increase in media coverage of public health and epidemiology, an increase that leads to this question: at this extraordinary moment, how do we turn this increased attention into sustained actions that will enhance public health and improve health and equity?

Figure 1.

Change in Media Coverage of Public Health and Epidemiology: United States, January 1–June 1, 2019, and January 1–June 1, 2020

We address this question as we consider (1) the future course that public health will take as it addresses the challenges brought by the COVID-19 pandemic over the next 5 years, and (2) the pandemic's direct and indirect consequences for population health. We acknowledge the strains on resources to support public health and the competition for governmental funds across diverse sectors.

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