Letter to the Editor: Public Health Reform Efforts Should More Effectively Engage Public Health Professionals and the General Public

To the Editor:

At the beginning of the COVID-19 public health emergency, the United States had all of the pieces in place for success—or so it seemed. The authors of the Nuclear Threat Initiative's 2021 Global Health Security (GHS) Index note that “[w]ith its vast wealth and scientific capacities, the United States was ranked first in the 2019 GHS Index and again in the 2021 edition, although in both cases, the highest position was still measured to have critical weaknesses. Despite its ranking, the United States has reported the greatest number of COVID-19 cases, and its response to the pandemic has generally been viewed as extremely poor. The result highlights that although the GHS Index can identify preparedness resources and capacities available in a country, it cannot predict whether or how well a country will use them in a crisis.” ¹ This is one reason for skepticism about efforts to support “modernized public health systems,” such as those described in a recent Population Health Management article. ²

While emphasizing the importance of “trust” and “community engagement” and expressing concern about growing “[p]oliticization” of public health, efforts by various commissions to remake America's public health system reflect a lack of citizen engagement and are more likely to aggravate than to mitigate the circumstances that complicated the United States' response to COVID-19 and to other recent public health emergencies.

Although well intentioned, the members of these panels are not elected and, indeed, generally do not include elected officials or policymakers. There is little accountability, other than perhaps to various funding organizations. Mechanisms for public input, or even that of other public health and medical professionals, generally are limited or altogether lacking.

The best time to engage the general public and public health community is before, not after, reports and findings are issued. Through focus groups, listening sessions, consensus conferences, requests for comment, open and archived webinars and meetings, and similar tools, boards and commissions can ensure they obtain adequate input from health professionals, community organizations, public health staff, faith-based entities, and others, ensuring their recommendations are ultimately grounded in the views of a broad range of professionals as well as the general public. ^3,4

Although genuine concerns, we should be wary of efforts to modernize the public health system that use “denialism” or “politicization” as reasons, implicitly or explicitly, to avoid such engagement. A more grassroots approach to public health reform might better build the trust that was lacking during the COVID-19 emergency and ensure the public health system more effectively responds to future disasters and emergencies.