Public Health and Political Dysfunction

Politics Spread COVID: Developing a Public Health Response

 By now the broad outlines of the circumstances leading to one million American deaths from COVID-19 are familiar: the pandemic was politicized from the outset; public health professionals were pushed aside and sometimes attacked; in many areas compliance with public health recommendations was low and vaccine uptake was much less than required to meet the threat; the public health community tied itself in knots trying to figure out how to cut through the plethora of misinformation; people in marginalized populations died in vastly disproportionate numbers in spite of years of preparation to prevent just that outcome. It wasn’t just that there were some unfortunate failures in an otherwise excellent response; the United States is tied with India for the worst overall mortality rate. Public health professionals worked so hard for so long to be ready for this moment. How did things go so wrong?

Public health values the autonomy of persons and that includes the right to decline public health advice. But there are times when a health threat is so serious it constitutes an existential crisis. In that case public health becomes part of our nation’s emergency preparedness system and may need near universal compliance from the public to avoid a mass casualty event. The legal basis for this is codified in State public health codes. But during the COVID pandemic public health found itself battling governors, legislatures, courts, and even school boards and ultimately was unable to communicate what was required to a sufficient number of people.

This happened at least in part because of profound changes in American politics that mean the relationship between public health and the rest of society is now unlike what is assumed in the dominant models of public health such as those advanced by the CDC. These models identify major domains of public health competency. It is assumed that if public health carries out the functions contained in the domains health will be better as a result: If public health offers health education correctly then the public will change their behavior accordingly and avoid preventable disease. If public health issues lawful emergency orders then elected officials will support the orders and the public will comply, preventing the transmission of disease. As the politicization of the pandemic and subsequent deaths show, these assumptions are no longer valid and under such circumstances we cannot assure the health of the public as we are required to do. If people are to be assured of health and safety during times of crisis public health must engage with elected leaders to rebuild our collective understanding of our responsibilities to the public.

The public health community must launch an inclusive dialog about how to develop the capability to grapple with the political dysfunction that has resulted in so much needless illness and death. We are not claiming to know how to address political dysfunction ourselves; we are certain we do not. However, we have faith that this community does contain that knowledge and that we must begin seeking a way forward together.