Every night at 8pm, my neighborhood in Los Angeles, like many, cheers for the front-line health care providers who care for our communities. My family joins in the nightly raucous thanks. But a few nights ago, we paused.
Where were the cheers for the public health professionals?
Medical professionals have been in the spotlight, doing the essential and dangerous life-saving work with COVID-19 patients. Elected officials have too, making and explaining decisions about the delicate balance of public safety with economic hardship in daily news briefings. Yet all have been guided by (or, in some unfortunate states, dodging) the input of public health experts, who have been operating mostly out of the spotlight.
By and large, it is public health professionals, including many public health trained physicians, who lead the prevention work. They have trained in both the science of disease transmission and the social science of prevention.
Both my wife and I trained in public health, but we are not on the frontlines. The public health front lines are the local health departments where epidemiologists are coordinating the collection and reporting of health statistics. This is also where public health trained health educators are developing messages and tools to communicate health information. And it’s where public health services and policy professionals are strategizing and directing staffing and resources. This is supported by public health researchers who seek to understand the virus and model its transmission to inform our safety. The Commissioned Corps of the US Public Health Service, composed of more than 6,500 public health professionals, supports these activities at the federal level.
Public health’s “Super Bowl” event
Those who work in public health now commonly refer to the COVID-19 pandemic as our “Super Bowl” event. Yet few in our field will ever see their organizations (the health departments, laboratories, and research institutes) highlighted on the scoreboard. The CDC, which should be taking center stage despite major missteps in developing testing for COVID-19, has been effectively sidelined [PDF]. The closest we may get is the nearly ubiquitous reference to the coronavirus dashboard (certainly a type of scoreboard for countries and states) produced by Johns Hopkins University, home of the first school of public health in the U.S.
It is not a new phenomenon for public health to be working out of the spotlight. It is easy to revere the dramatic battles in hospitals to save the lives of those suffering from COVID-19 and other conditions. So, too, we revere the individuals who deliver these treatments. On the other hand, public health prevention activities like physical distancing and virus modeling are harder to appreciate. These actions create hardship, involve uncertainty and face increasing resentment. The many small protests around the country are essentially calls to reverse such prevention orders. And the president has amplified their voices. Yet it is the public health science behind physical distancing that is keeping this pandemic in check worldwide, and likely tens of thousands more of us alive in the US alone.
Public health is rarely dramatic. But it is no less heroic.
Public health professionals earn their credibility by producing and using data. Our persistent efforts to increase vaccinations, curb air pollution and protect children from tobacco advertising are data-driven, critical, life-saving work. But progress is slow and generally would make for terrible television. Is it for this reason that we are willing as a nation to divert nearly a fifth of our economy to treating health problems, while just about 2.5% of all health spending [PDF] goes to public health activities to prevent them? Yet, for pennies on the dollar, public health saves lives.
In this COVID-19 era, our communities feel strange and uneasy, and the lockdowns strain our hospitals, essential workers, schools, and families. Everyone deserves a nightly round of applause for their sacrifices. But let’s also cheer the public health professionals who are guiding us behind the scenes through this crisis. How the pandemic ends is unknown. But those of us in public health are encouraged that the vast majority of people trust the science-driven physical distancing actions being taken to end it.
Even out of the spotlight, it is encouraging that the world (and our own families) better understands what public health is. Last night, our family grabbed its two loudest noisemakers: a cowbell and our 2-year old daughter. We celebrated, just for a minute, the public health professionals who, for pennies on the dollar and out of the spotlight, are working so diligently to steer our world through this pandemic.
Gregory Stevens