Reimagining public health: COVID-19 brings lessons for public health infrastructure

The COVID-19 pandemic exposed gaps in public health infrastructure, related to chronic underfunding. Yet the pandemic has also opened opportunities for strengthening the foundational capabilities of public health agencies across the United States, according to a report in a special supplement to the Journal of Public Health Management and Practice.

"The pandemic response highlighted the importance of having a robust public health infrastructure that is well-supported in the areas of foundational capabilities," according to the paper by Maria Courogen, MPH, of the Washington State Department of Health and colleagues. The article appears as part of a special issue devoted to public health transformation and innovation.

'Resetting the course for foundational public health services'

Courogen and colleagues outline efforts by three states—Ohio, Oregon, and Washington—to develop and advance Foundational Public Health Services (FPHS), defined as the "minimum package of public health capabilities and programs that no jurisdiction can be without." In 2016, the three states received funding to define, measure, and advocate for the governmental public health system. The authors write that "the pandemic revealed the consequences of underinvesting in public health" and "brought opportunities to accelerate FPHS work and challenges to its progression."

• In Ohio, the pandemic highlighted the training and technical assistance needed for local health departments to earn PHAB accreditation—a unique requirement of state law. However, efforts to fill FPHS gaps are complicated by funding shortfalls, while recent policy changes will have "far-reaching, unintended consequences" for the ability to respond to future communicable disease threats.
• In Oregon, COVID-19 brought attention on existing public health modernization initiatives, focused on high-risk populations systematically underserved by the health system. Lessons from the pandemic include increasing preparedness to respond to multiple, simultaneous public health threats, enhancing integration with community partners, and initiatives prioritizing health and equity.
• In Washington, pre-pandemic investments in public health were "relatively small," compared to the assessed gaps. In the wake of COVID-19, public health leaders worked to increase knowledge and appreciation of the FPHS, motivating increased funding to meet those needs. Other outcomes included creation of a new Public Health Advisory Board and new requirements to diversify local boards of health to include community members and health experts.

The states' work in "defining, measuring, and advocating for FPHS proved beneficial when it came time to respond to a pandemic," Courogen and colleagues write. "Ohio, Oregon, and Washington are resetting the course of FPHS to adequately fund and measure progress in these Foundational Capabilities." These three states are alongside 16 others in PHNCI at PHAB's 21^st Century Learning Community, focused on advancing public health transformation.

Professionals and policymakers are challenged to "seize the opportunity to reimagine public health," according to an introduction by Reena Chudgar, MPH, and Jessica Solomon Fisher, MCP, of PHNCI and PHAB. "We must work together, collaborate with cross-sector partners, and share and cede power with and to the communities we serve to identify solutions to transform public health practice."

Newly revised in 2022, the FPHS "provide(s) clarity for the reform needed within our US public health system," according to a commentary from Paul Kuehnert, DNP, RN, FAAN, of PHAB and colleagues.  "The pandemic has demonstrated the critical need for and importance of a strong public health system and infrastructure," they write. "We have the rare opportunity to harness policymaker interest and federal funding to transform and modernize public health in the United States."