On New Year’s Day, after a pickup truck plowed into a crowd in New Orleans, dozens of victims were transported to the hospital. The chief medical officer of the New Orleans University Medical Center reported it was the “highest number of critical patients the hospital has ever seen.” A few days later, a patient died as a result of H5N1 virus, or bird flu. It was the first such death in the United States. And then, wildfires started to tear through Los Angeles County. And North Carolina and Tennessee are still dealing with the aftermath of a devastating hurricane.
In the wake of so many crises, everyone is searching for explanations. Politicians, pundits, and ordinary people are asking, “What more could have been done to prevent this disaster, or better prepare for it?” Strengthening public health is one important answer — but across the country, health departments are seriously underfunded.
In California, people with asthma, pneumonia, and other pulmonary diseases remain at high risk due to smoke exposure. The death toll has reached 29, experts predict that thousands will ultimately die from inhaling the toxic smoke, and many more will undoubtedly suffer. In California, North Carolina, and Tennessee, the displacement of families raises tough questions: Where will people live? Where and when will children go back to school? How will people go back to work or find jobs? Even for people who can remain in their homes, work, and attend school, these disasters have lingering impacts long after the news cycle has moved on. Besides the physical damage they leave in their path, they fuel an already significant mental health crisis.
Over the last few years, the federal government has funded local efforts to mitigate health impacts due to wildfires — providing grants to enhance air quality in public buildings, for instance, and initiating programs to ensure wildland firefighters are receiving quality mental health care. Still, federal funding for natural disasters is often reactionary, not preparatory — and quickly fades as headlines do. Natural disasters are growing stronger and more frequent. Innovative public health programs, from septic safety campaigns during hurricanes to outreach to vulnerable populations ahead of tornadoes, are critical to preparation.
Public health is also critical to reducing incidents of violence. Nationwide, health departments are drawing on data to identify risk factors and develop more effective prevention strategies for their communities. In 2022, Republicans and Democrats in Congress passed legislation to implement some strategies pertaining to gun safety, such as state crisis intervention court proceedings and school safety support. Consistent investments will yield considerable returns. According to experts, every dollar invested in community violence intervention programs yields $41 in community savings for medical and legal expenses.
The ROI is similar for epidemics. So far, only one person has died from H5N1, but one million died from COVID-19. I’m an epidemiologist by trade. I’ve worked in health departments in Georgia, Texas, and Pennsylvania — and I can say with confidence that there isn’t one department in this country that is completely ready for another pandemic. Some preparation measures were passed in 2022, as part of the bipartisan PREVENT Pandemics Act, including public health programs aimed at strengthening the supply chain and enhancing data collection. Coordination among health departments will be vital in our pandemic strategy moving forward. According to a recent poll released by the de Beaumont Foundation and Harvard T.H. Chan School of Public Health, most Americans would support COVID-era policies during a future pandemic, including masking, closures, and vaccination requirements. But to implement with minimal disruption, health departments must be in a constant state of readiness.
Some may note that in the current political climate, such preparation may prove impossible. But public health has often brought leaders on both sides of the aisle together. Legislation was passed to provide care to veterans exposed to burn pits, combat the opioid epidemic, provide COVID-19 relief, and reduce gender-based violence. The challenge isn’t polarization; it’s timing. Preparation and prevention are both urgent and important — and we must encourage action before an emergency, not only during or after.
Last week President Trump appointed Gerald Parker to lead the White House Office of Pandemic Preparedness and Response Policy. I’m hopeful that his decades of experience working in both Democratic and Republican administrations – in the Departments of Defense, Homeland Security, and Health and Human Services – will allow him to bring leaders to meet our shared needs.
We are just over a month into the year, and we’ve already experienced such loss. The impact of these tragedies is clear; the need for public health investment must be equally so. Because every emergency is a public health emergency.
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