Public Health Flaws at a National and State Level | Teen Ink

Public Health Flaws at a National and State Level

July 20, 2021
By gracewang430 BRONZE, Plano, Texas
gracewang430 BRONZE, Plano, Texas
1 article 4 photos 0 comments

The US was not prepared to handle the COVID-19 pandemic. A huge medical shortage at the beginning of the pandemic forced doctors to get tests out fast enough and log all cases accurately to keep citizens up to date. As borders began to close around the world, scientists around the country hurried to get the vaccine out as soon as possible. All in all, this pandemic exposed many flaws in the public health system which need to be addressed as soon as possible to ensure we are prepared for the next pandemic.

Firstly, our public health system re-enforces racial discrimination that leads people of color with worse off health and fewer opportunities to get treatment. For example, a shortage of ventilators during COVID-19 forced doctors to have to make the decision of who to give the ventilator to. In order to decide, physicians used unfair metrics that put people of color (such as African Americans) at the back of the line for a ventilator. For example, a doctor will first assess a person's baseline health to determine if they should receive a ventilator. If the assessment returns the result that shows the patient will die very soon (for example the next day), then the ventilator may go to someone who still has a longer time to live (for example 5 months) in order to not waste supplies. By taking life expectancy into account (which is one of the metrics used to assess someone's baseline health), black people will always be at a disadvantage since African Americans unfortunately have a lower life expectancy on average compared to white people (as a result of less healthcare access, higher poverty rates, and physician treatment refusal). Because African Americans often have poorer health compared to whites in large cities, every single metric used to assess a person's baseline health will put African Americans at the end of the line for a ventilator. Such health policies in America are extremely problematic and need to be fixed immediately to ensure that people who are disadvantaged are also able to access equal benefits. Either such health assessment measures mentioned above need to be removed immediately, replaced with new ones, or adjusted to account for minority populations.


Next, public health is vastly underfunded and understaffed, which is especially the case in my state. Texas spends just $17 per resident on public health compared to $54 in Alabama, $51 in Tennessee, and $44 in Oklahoma. So why such low funds? The answer lies in national priorities. People simply don’t see public health as a department that is important. When public health is doing their job, disease outbreaks don't happen which makes governments feel like funding isn't very important since it feels like outbreaks aren't very common. Only in a national crisis like COVID do governments start to realize how important funding is. The fact that funding only starts to pour in during or after a health crisis is troubling, as it creates severe medical supply shortages and can allow a pandemic to spiral out of control. Aside from funding alone, the grant system in many states is highly restrictive in nature. In other words, only a small and restricted percentage of grant money is allowed to feed into hiring staff, and another small percentage is allowed to go into technology, etc. This is because government officials (not epidemiologists who are skilled in their fields) decide what portion of the grants can go to what sector within public health. That's why during COVID-19, epidemiologists were struggling to adapt to having so many cases to document since not only is this department historically understaffed, their software for case documenting is extremely outdated and some counties only rely on things like excel (which is not a very good database when having to share/log thousands of cases).


The third issue with public health is a lack of coordinated communication and the absence of a shared database. This lack of communication is also reflected by the fact that in many situations, disease cases are "double logged". This means if a child isn't feeling well at school and goes to the nurse and the nurse determines that the child has COVID-19, the nurse will then inform the public health department and they will log it as one case. Then the child sees the doctor for their condition and the doctor also logs this as one case. Now there is a double log and the covid case count then becomes inaccurate which becomes troubling when the CDC uses such inaccurate data to create a national picture of COVID-19 cases.


Another flaw in the public health system that is specific to Texas and many other states is influenza reporting. In Texas, influenza is not a virus on the "notifiable conditions list", meaning people (such as school nurses, pediatricians, physicians, hospital workers, etc) are not required to report cases of influenza they see to the public health department in a county. The fact that flu reporting is voluntary is very problematic because it means flu cases end up going UNDERreported since reporting is optional, meaning national public health agencies such as the CDC will never be able to get a fully accurate picture of flu cases in regions like Texas which may be an issue because mutant flu strains that could be deadly could be missed. In addition, it is extremely difficult to amend the notifiable conditions list as the amending process is slow and laborious, de-incentivising people from adding reportable diseases. 


The last hole in the public health system in the US is there is no national or state level pandemic plan. This means that if another pandemic hits our country, we may risk repeating the same mistakes that happened during COVID which could risk thousands of lives. In order to move in a positive direction, we must use this pandemic as a learning experience and make sure we do not make any of these mistakes again. This means we must act quickly and enforce better policies in the health system while patching up holes that were exploited during COVID-19. 

The author's comments:

Grace is a senior in high school who is deeply interested in both health policy and public health and she hopes to raise awareness on these topics in her community. 

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