Disease Fighting is a No-Win Business
In October 2001, the biological defense community got a wake-up call. The nation was reeling from 9/11 when the Anthrax-laced letters appeared. It had personal relevance. A month earlier, I had transitioned from aviation safety to biological defense research. I wasn’t only focused on the research prospects. Terrorists had a sophisticated weapon, and I worried it was a harbinger of a new normal.
My biodefense job meant frequent interactions with the public health community. In most circumstances, they would be in charge of the aftermath of a bioterrorism event. We talked about highly-lethal disease involving tens to hundreds of thousands of people at once. About how to distribute drug stockpiles, and to whom. We discussed when to use quarantine, and how to detect attacks before people got sick.
Society needs insurance policies for high-risk, low-probability events. There’s a reason we have nuclear defenses, federal bank insurance, and environmental protection. Put public health in that category too.
I’ve moved on from biodefense, but I still interact occasionally with public health regarding natural disease. Preparing for catastrophe isn’t their main gig — they improve health every day. They keep tuberculosis patients at home and away from us, while delivering meals and support. They control disease-carrying pests. They map chronic and infectious disease patterns, and interact with community leaders in umpteen languages. Those help medical resources get where they’re needed. They run educational campaigns to mitigate major health issues, like addiction, obesity, diabetes, and mental health. And they help stabilize health-torn countries, keeping dangerous pathogens from our shores.
Public health workers altruists that represent the best in public service. Every field has politics, but I have yet to meet a public health worker who doesn’t put the population first. They are passionate about what they do. They are supremely educated and work for far less money than they could make in other health fields. They work in the toughest sections of cities and countries because that’s where they’re needed. They’re rational and caring and, unfortunately, vastly underappreciated.
We notice public health when something goes wrong. The latest crisis is coronavirus. The opioid epidemic still rages. Ebola is back in Africa. Public health may get a temporary funding boost in emergencies, but it evaporates when attention wanes.
U.S. funding for public health has been flat or slightly down over the past decade, despite calls for modernization. Their budgets have been shoestring since I’ve known them. The world’s health environment is more complicated than ever, and public health is a good investment. Return on investment can exceed ten times the outlay.
When stuff hits the fan, they have to bring the tools they have. But it takes time to identify the infectious agent, human susceptibility, potential exposures, and the appropriate responses. The outbreak can be over by the time they understand how it happened or the level of danger. The insights are valuable though, as much to prevent the next outbreak as to manage one. Robust public health doesn’t wait for a crisis.
Delayed understanding of outbreaks needn’t be a permanent condition. Rapid and cheap diagnostic devices would illuminate more infections. Data analytics could improve mid-course decisions or recognize more disease clusters. Some of that is happening, but far more could be done. That takes money to hire data scientists, pay for research, and build and sustain information systems.
Wait, but isn’t [pick your favorite big data or philanthropic giant]doing that? Yes, sometimes public health gets ‘help’. But too often it isn’t coordinated with them. The engineers can miss the mark. One example is mining Tweets for health information. That would provide uncertain health information, on unknown people, at unknown locations, to decision-makers who have no good course-of-action. At this point, pre-clinical information is less actionable than a health care encounter. Getting them data already in the care system should be a higher priority. Infections of concern to public health are significantly under-reported.
Public health is a no-win business. When done well, their value is invisible. That’s the side-effect of prevention. Humans only live one reality. Nobody can see what would have happened if public health were absent. They get blamed for scaring the public (e.g., 1970’s Swine Flu), but also blamed if an outbreak mushrooms.
I dealt with rare possibilities when I was focused on aviation safety. Thankfully, planes don’t crash that much. But the aviation system and its actors are visible to the population, and the crash remnants end up on camera. Not so for public health. Most of the population doesn’t deal directly with public health. Neither the victims nor the people who protect us make the TV news. And the health issue that never emerged, because of their efforts, doesn’t leave a footprint like a near-miss plane crash.
Hopefully, the coronavirus will get under control. But what then? Based on history, we’ll return to ignoring public health. When the next crisis comes, they will be in the same state. They need money to fix the issues before the next emergency.
They deserve better. We deserve better. Can we finally invest in public health?