The Time is Now for a Strong Public Health Infrastructure

Host Mighty Fine talks with Richard Hamburg, Executive Director at Safe States Alliance and Sabah Ghulamali, Public Health Advisor to Senator Patty Murray about Public Health Infrastructure. In their conversation, they discuss the definition of public health infrastructure and proposed legislation that would improve it in our nation.

Transcript

Mighty Fine  0:15  
Welcome to Injury Violence Prevention INdepth, a Safe States Alliance podcast. My name is Mighty Fine and I'll be serving as your host. In these episodes, you'll hear captivating conversations with IVP professionals on a variety of issues. To help inform you on the latest trends and hot topics. Today's episode is sponsored by the CDC Foundation. So a big thank you to them for their support. We'll be talking about public health infrastructure, and I'm pleased to be joined by Rich Hamburg who's the Executive Director of the Safe States alliance. We also have with us today Sabah Ghulamali, who's a health policy adviser for Senator Patty Murray. Interestingly enough, Senator Murray chairs the Senate Health Education, Labor and Pensions Committee, and the work is very relative to the conversation we'll be having today. Alright, so let's go ahead and get started. Rich to get us engaged in this conversation. Can you tell us how you would define the public health infrastructure? 

Rich Hamburg  1:09  
So I'll give you a very official version of it. Healthy People 2030 defines public health infrastructure as the necessary foundation for all public health services, vaccinations, chronic disease prevention, public health infrastructure, objectives, address high performing health departments, workforce development, training, data and information systems planning and partnerships. So you know, the nuts the nuts and bolts of public health a strong public health infrastructure thus includes a strong and capable and qualified workforce up to date data, and Information Systems and agencies that can assess and respond to public health needs. And state local public health departments play a central role in this system that put it into context. Our colleagues at Trust for America's Health recently reported or pointed out that under-resourced, understaffed and overburdened health agencies responded to this major pandemic with inadequate systems and the country's long standing failure to invest in disease prevention, address the root causes of poor health and promote health equity. And that made the nation less adequately resourced. So we have a long way to go. But I think we now see why this is such a public health priority. 

Mighty Fine  2:32  
Thanks for that. And Sabah, with your work with Senator Murray, and based on sort of what Rich has set up for it, why public health a priority for her in her office? 

Sabah Ghulamali  2:42  
Yeah, absolutely. And I think what Rich said about there should you know there's really not a doubt why public health is so critical right now after what we've seen this past year. For Senator Murray, I'll say her values have always been about supporting Americans and families and getting help when they need it most. So that help really does matter. And the government should be providing some of that help to people including health and health care. We've seen a lot of people die unnecessarily in this pandemic because healthcare - It was too expensive or hard to get in our health care system was depleted and unprepared. I think Senator Murray has been really crushing it in her long standing commitment to public health. She joined the committee that I'm on now the Health, Education, Labor pensions. So I'll be referring to as the health committee back in 1997. And currently as chair of the committee, so she's the one that's leading the charge for public health and health care. Over the years, she's been a leader on a lot of major and significant bills this having to do with pandemic preparedness, lowering health care costs, medical innovations, we thought that the 21st Century Cures bill and a lot of the Covid 19 pandemic bills like the American rescue plan. So you know, she is she's been really passionate about health and health care and public health for a long time. And I think her history and personal connection to public health really matters there too. She got elected to be Washington's first female senator, as the mom in tennis shoes. That was her motto, and I really loved that story because she really wasn't groomed to be in politics. She was a mom who really cared about people and serving people and getting things done. She wasn't gonna let anything get in her way. Her dad was a World War II veteran and when she was 15, and he was diagnosed with multiple sclerosis. Her mom had to take care of him support a family with seven kids, pay medical bills on top so the senator really brings that firsthand experience, along with other stories she hears from people in Washington to health and public health every day and with every issue that she works on.

Mighty Fine  4:46  
Public health, a lot of us have those stories, you know that we just have personal connections to the different things that impact our mental and physical well being and I love to hear when we're able to translate that into the work in that same level passion guides the work that we do sort of picking up on in that same realm. Why should a comprehensive national infrastructure package include a public health component? you've alluded to it already. But, you know, tell us a little bit more about that, from your perspective. 

Sabah Ghulamali  5:17  
Yeah, absolutely. I think it's to avoid what we've been seeing the last couple of years, which is the cycle of crisis and complacency when it comes to building and maintaining the public health infrastructure. Public Health saves lives, we know it, we have all the evidence we need from last year. It's not just in the research and literature. I mean, it's it's what we all have been living through. Public Health, I think really touches everything. There's no one getting traced, tested, treated without the workforce behind it. There's no one to build the literal infrastructure of America, which we've been talking a lot about, while people are sick and dying. And you know, germs don't respect our boundaries and borders, we have to find and prepare our public health system before the crisis hits in order to save lives during one. And I'll just, you know, just to give you some facts, only half of Americans were served by the public health system before this pandemic. Public Health Workforce lost 56,000 people during this pandemic and state health officials estimated a quarter of their workforce was eligible to retire. So we have a lot of work to do, not just in ending the pandemic, but in building and maintaining a system that can address pandemics, other public health challenges, and prepare for future ones all at once. Research shows that we have to invest $32 per person to support a robust public health infrastructure. And right now we're only investing $19 per person. So it's going to be $4.5 billion dollars per year in order to support a foundational public health capacity. And I know that sounds like a lot, but before you think it's too much I'll remind you that our current US healthcare spending in 2019, was $11,582 per person. So a lot more than the $32 it would take to support a public health system. The United States is spending $3.6 trillion on health every year. And less than 3% of that is on public health. So public health is really a drop in the bucket when it comes to you know, compared to health care spending, but it has an enormous payoff. So last year, Senator Murray introduced the Public Health Infrastructure Saves Lives Act, which I'll be referring to as PHISLA. PHISLA would prevent us from ever being in the situation again, because it provides billions of dollars and dedicated annual funding for federal, state, local and tribal public health departments. It's going to commit resources at every level, to protect our communities through disease surveillance, contact tracing, communicating science based information, helping train and retain a skilled public health workforce, and fund efforts to improve health equity. So at its core, it's going to be establishing a grant program for this work that ramps up over five years to meet that 4.5 billion needed in annual public health investment. 

Mighty Fine  8:13  
Something that we are very familiar with in the injury violence prevention space specifically. And we've you know, reaching out we've had conversations about how funding is not commensurate with the actual burden and impact of injury and violence prevention. So kind of taking it from the 30,000 foot lens and shifting and zeroing in on injury and violence prevention. Rich, what are some things that Safe States are thinking about and what's your vision for a society for injury and violence and for thinking like really utopic? What did that look like from Safe States perspective? 

Rich Hamburg  8:49  
So you know, I think the key word is prevention. We're in the middle of a pandemic, and people understand a vaccine can prevent disease, a disease, but many people aren't as familiar that injuries and accidents are preventable in some way, shape or form. And And right now, injuries are eroding the foundations of community health, but they don't have to. Robust investments, and Sabah pointed out, you know, we can have the same speech every year for the last several decades. It's pennies on the dollar health care dollar are spent on on prevention and public health. So robust public health investments can remarkably reduce injuries across the lifespan, whether it's the risk of drowning as a child, being involved in violence as a young adult, or falling in later life. COVID again, it showed us all how important it is that our public health agencies are strong, well equipped, well staffed and fully prepared to move quickly in an emergency and that's not just investing while there's an emergency. That's why Senator Murray's legislation and the key to the prior Prevention Fund, that we all had a role in helping to lead over the years if we all know that money will flow when there's an emergency, but we can be tremendously more prepared if we more adequately fund our public health agencies. So a stable, secure foundation would let public health agencies build up and build out agencies can't count on consistent funding for essential injury prevention needs, you know, a fair system is is one that also is able to reach all states and territories. As an example, right now, only 23 out of 50 states without even talking about territories have a core injury and violence prevention program in place. And in fact, Safe States will be publishing a blueprint supporting a nationwide expansion of the core of the CDCs injury Center's Core State Violence and Injury Prevention Program. So you know, we need we need a more than adequate amount of resources in all 50 states, and as you know, with with the outbreak, if you can't have some strong public health rules and regulations in 20 states, because an outbreak, you know, does not respect that - not too dissimilar, you know, for the rest of us, you know, different types of public health emergency.

Mighty Fine  11:28  
Definitely. So you talked about funding and some steps. So, can you give us our listeners a taste of what, what are what's something that needs to happen with some steps need to happen to bring this sort of vision to reality? And you can delve more deeply into the funding piece where we know that's a little bit more complicated, or something else, you know, what more can we be doing? 

Rich Hamburg  11:51  
Well, I think the important part is is to prioritize public health between major public health emergencies. And at this point, it's not like we we sit back and wait for what the next emergency will be, they all overlap. So in the middle of a pandemic, we're still right in the middle of an opioid epidemic and overdose epidemic, it's actually gotten worse, and we haven't gotten through an obesity epidemic and so on down the line. So I think the concept is, you know, you never let your guard down. And yes, we should continue to support and individuals out there listening to this podcast should contact members of Congress and, and other policymakers just to ensure that there's a prioritization for public health funding, and specifically to address injuries and, and violence prevention. But also, the idea of having a mandatory fund, we have mandatory funds for lots of other things and for public health, it's critically important and Senator Murray's legislation would make a pretty large dent in underfunding. And the you know, I have to say that there have been many reports over the years that have made the case that public health is chronically underfunded, but then also that the investments made in public health have a return on investment. And some of them have strong return on investment. There's always a health related return on investment, and there's often an economic return on investment, and we have to do a better job of making that case. 

Mighty Fine  13:26  
Yeah, that's what I was going to ask and just elevate here. I think we may have talked about this on the podcast before, I think we do a pretty good job within our public health circles. And we talk about the importance of public health. But you know, what more needs to be done for these sectors that are impacted by public health issues, but maybe not see them immediately as public health? How do we get them to have the same level of understanding and appreciation that we do have for these issues? And if you have any thoughts about that. 

Sabah Ghulamali  13:55  
Again, like I think a lot of what we're trying to do is highlight for people that there's really no aspect there's really no sector that isn't affected by the health and well being of its workforce. You know, we we've seen that with with many of the crises in the last, you know, decade, whether it was the opioid overdose crisis, and it's a you know, up to COVID. I mean, there's there's far reaching impacts, there's impact on the workforce, there's impact on our families, there's impact on our ability to think and produce, you know, afford even to be able to take care of each other during this time. So. 

Rich Hamburg  14:33  
Yeah, and I think that it's becoming clear the linkage between the business community and and the importance of investing in public health and in fact, this past year, the the former Surgeon General released a report focused on community health and economic prosperity. So in essence raising the awareness of the US health disadvantage and demonstrating to business leaders the opportunity investing community health can bring to the business bottom line, and the health of the economy. So the message that we can and should hear Safe States over the past year, year and a half has had a project with several other several members of the business community. And we funded a number of, of seed grant programs for businesses. One of them was the construction industry that was investing in the mental health of their workforce through suicide prevention program. And there were many others like that. So I you know, I do think it'll, we have a lot of work to do to get a stronger buy in and understanding of of that important return on investment. 

Mighty Fine  15:52  
Sure. And I think that economic opportunity piece is one that we need to really hone in on a little bit more on public health, because I think we talk about it, but there's a lot a lot there and thinking about that recognize as an equity issue. What do you both have to say about health equity as a component of a public health infrastructure? What does that look like for you? 

Rich Hamburg  16:16  
Well, so our position at Safe States, and I'm sure many feel the same is that everyone should be safe from injuries and violence. But our country has a long establish, it has long established systemic barriers rooted in oppression that result in people of color, those are economically disadvantaged, geographically isolated, not having full access to the social economic resources that can protect against injury and violence. So clearly, this disparity and the resulting adverse health experiences, adverse childhood experiences are counter to our country's principles, our founding principles and shared understanding that the opportunity should exist for everyone. So, you know, I think moving forward, you know, we need to address these issues. Just to give a couple of examples. You know, we know that rates of suicide in rural communities are substantially higher than in metropolitan areas; transgender individuals experience increases in homicide victimization; or loss more years of life to police shootings than white people; black males are more likely more than twice as likely than white males to die from from firearms. So you know, that list goes on. And on. So health equity, anti-racism, recognizing systemic racism and the root causes is a critically important part of the public health response. 

Mighty Fine  17:48  
Absolutely. Sabah, anything you want to add to that...

Sabah Ghulamali  17:52  
Amazing summary. You know, if the question is, is equity important in public health? I mean, the easiest question that we've talked about today, and the answer was yes, you know. So yeah, so actually, last year, Senator Murray released to help staff report on COVID-19 and achieving health equity. And it really puts up you know, it really calls out the fact that across all age groups, in all regions, people of color have had higher rates of COVID-19 infection or are more likely to die from the disease. It's particularly true of people of color who have a disability, if they're older adults, if they have pre existing conditions, are in the LGBTQ community or low income workers. So just like what Rich was saying, I mean, this is an intersectional issue. The high rates of infection and mortality in communities of color are driven by those health and economic systems that were built on the foundation of abuse, discrimination, racism, and neglect. And all of these issues continue to hurt our communities of color today. We actually recently had a hearing on health disparities specifically and Senator Murray there talked about how, when we talk about inequities, what we're really talking about is the reality that people's health suffers because of systemic issues, like how far they are from quality, affordable, accessible, culturally competent care, all of which are key factors in being able to get the health care system to work for Americans, and whether they're recruited for clinical trials or the healthcare workforce, and issues surrounding social determinants of health, which is things like where people were born, live, and work. So we're really overdue and considering all of these issues, and considering in working in health care equity as a key component into public health. And, you know, we have to we have to do better - too many people's causes of death period has been racism. 

Mighty Fine  19:52  
And yeah, and I think you bring up a great point. It's really about uprooting those systems that create these pillars of disadvantage and being intentional about that through our policies, practices, and even our customs. So thanks for elevating that. And picking up on that. And some of the things that you mentioned Senator Murray working on, are there any updates you can provide on your legislative agenda for for this coming year?

Sabah Ghulamali  20:18  
Senator Murray and Senator Burr have planned to work together in a bipartisan way to pass a major package this year on public health and preparedness. I'm really excited about it and what we're going to be able to accomplish in this package not just to respond to COVID-19, but to make improvements in public health that are going to benefit us for years to come. Negotiations are still very nascent, I can't share much at this time, but we are widely considering all aspects of public health and what we can do better and I think the things that we've talked about here today show what a breadth that public health covers.

Mighty Fine  20:51  
If you came here not really understanding the public health infrastructure, I have a better understanding based on the conversation we had today. But for those that are listening and thinking about like, okay, well, what can I visual do? Or what can my organization do within this realm of the infrastructure and, you know, taking action on some of the things that you both mentioned? What would your recommendation be to them? How can I , your average Joe, I was going to say Mighty. Joe, maybe more common than Mighty. Nonetheless, how can your average Mighty do something in the space of public health infrastructure? If it seems like a nebulous topic, then what what can I do? 

Sabah Ghulamali  21:29  
Well, I was gonna say, well, as an average Sabah, I would really encourage you to call your senators and representatives. Rich said this earlier, and just you know, have to bring it up again, that's the most important thing that you can do. Let them know that public health is a smart investment, you literally cannot go wrong when you're investing in your safety and well being - in that of your family, your neighbors, your community. I mean, that's, that's what we're here to do. And my own personal advice to all of you listening out there, please be kind to each other, follow safety guidance as it comes out. And please, please, please get vaccinated. If you don't know how call your public health department. We'll, you know, do what you need to to get to get vaccinated. 

Rich Hamburg  22:17  
So, so my blog is continuing on a regular basis to raise awareness of the importance of our public health system, the public health infrastructure. And you know, and that may mean, continuing, you know, as individuals to educate policymakers on some key points. I mean, one is right in the moment now, chronic underfunding of core public health programs created situations in which local health departments were fighting a 21st century pandemic with 20th century tools and resources. Public health underfunding meant the system didn't have the resources needed to prevent health inequities and chronic diseases, to address adverse childhood experiences, overdose, and suicide prevention, which are the three priorities of the nation's leading public health agency, the Centers for Disease Control and Prevention. So the CDC is the primary federal provider of public health funding to states.  Over the past decade, the CDC's core budget fell by 2%, when adjusted for inflation. So in the middle of all these chronic situations, the one public health agency that most needs, you know, that provides many of the resources that are being utilized at the state and local levels. And that's another thing to educate federal policymakers that this money is flowing to states and localities. And then just to just to double down on the fact that, you know, $3. some odd trillion spent on public health is survived mentioned earlier and under 3% on public health so from an action standpoint, you know, we need to substantially increase core funding to strengthen the public health system. We need to invest in chronic disease, substance misuse and suicide prevention. Not only are we encouraged by the public health infrastructure, save lives act that we've discussed, all during this podcast, but also so encouraging, that the Biden-Harris administration recently announced an investment of $7.4 billion from the American rescue plan to recruit and hire public health workers to respond to the pandemic and prepare for future public health challenges. So we've all gotten used to doing things remotely, virtually, but it's all about boots on the ground. It's all about the boots on the ground. And, you know, we need to ensure that there's, you know, up there that there are a) professionals in the field that will promoting professionals to come to the field that are promoting a diverse set of individuals to enter the field. And then you know, and through all of that, we'll be more adequately prepared. 

Sabah Ghulamali  25:15  
Mighty, I knew your question, the issue that you brought up earlier about, like, what really is public health infrastructure? How does it translate to the average everyday person, you know, what PHISLA is really trying to do in reality is things like, once the funding gets down to public health departments, they could scale up needs for testing, for a contact tracing, they could do better at providing guidance for schools, businesses, communities, they can provide more effective, culturally considerate education campaigns, community partnerships, they can collect data better, there can be strong leadership in these in these departments. I mean, they're, they are doing an amazing, amazing job at, you know, with what they have so far in this past year, and many are burnt out, tired, stretched too thin. And we just want to make sure that these people who are serving us every day, can continue to, you know, without it being such a huge sacrifice. 

Mighty Fine  26:16  
Absolutely in a round of applause to them for keeping things going, and the great work that they're continuing to do - given the circumstances and the struggles that happen there. So thanks for elevating that. I think the other thing too, that you both speak to is really not under estimating the power and our individual and collective voices when we're thinking about shifting and shaping the public health infrastructure in this country. So kudos to you both for bringing that up. You know, I've enjoyed the conversation today. Hopefully the listeners at home did as well. Thanks to you both. If you don't have anything else for folks listening in, I'll end the call here, but encourage you all, who are listening to keep the conversation going and continue to tap into the podcast to learn more about what's happening in the space of injury and violence prevention, but certainly public health generally as well.

Mighty Fine  27:09  
Thanks for listening to IVP in depth. Be sure to subscribe and listen to us on Apple podcasts, Spotify and Google podcasts. You can also follow Safe States on Twitter at Safe States on LinkedIn and be sure to check out our website at www dot Safe states.org for more injury and violence prevention tools and resources. Again, we'd like to thank our sponsors at CDC Foundation for supporting Safe States and helping us to bring you programs such as this, this is your host Mighty Fine signing off and until next time, stay safe and injury free.

Transcribed by https://otter.ai