Intended for healthcare professionals


Covid-19 failures show the US needs a national public health system, commission finds

BMJ 2022; 377 doi: (Published 23 June 2022) Cite this as: BMJ 2022;377:o1552
  1. Janice Hopkins Tanne
  1. New York

The high covid-19 death rate in the US and the nation’s failures to tackle public health problems such as drug overdoses, diabetes, and maternal mortality show the need for a national public health system, a non-partisan commission has concluded

The commission organised by the Commonwealth Fund laid out a plan for a national public health system on 21 June 2022 and said work should now begin on creating it.1

The Commonwealth Fund is a private, non-profit foundation that supports independent research on health policy reform and a high performance health system. The commission of public health experts was chaired by Margaret Hamburg, former head of the Food and Drug Administration and former assistant secretary of the Health and Human Services Administration for Planning and Evaluation.

More than one million Americans died from covid-19, one of the highest death rates in the world. “The scale of this catastrophe demands a commensurate response: the development of a national public health system to protect millions more from ongoing health crises and future emergencies,” the report said.

David Blumenthal, president of the Commonwealth Fund, said, “We hope this report will spark honest, fruitful debate and set us on a clear path to reforms that are sorely needed and long overdue.”

Although the nation has nearly 3000 state, local, tribal, and territorial health departments, there is no single person or office at the Department of Health and Human Services to lead and coordinate their work. The report cites gaps in tracking covid-19 because of delays in providing tests and “archaic approaches to aggregating data.” During the pandemic there were also problems in developing guidance and communicating accurate information “amid a torrent of falsehoods, some spread deliberately.”

The report says the US needs a national public health system that can protect and improve health, advance health equity, and respond to emergencies for everyone. It calls on Congress, the administration, and states, localities, and territories to join in the work.

The commission suggested a five point approach to implementation:

  • · The Department of Health and Human Services should be a centre for building a national public health infrastructure to serve all, no matter where they live. Congress should appoint an undersecretary for public health, a new position, to head the work

  • · Congress should provide reliable, stable funding for state, local, tribal, and territorial health departments that are chronically underfunded, often short staffed, and lack modern data systems. They need to be organised for success. Funding should be tied to a set of standards and a revised accreditation process for health departments. The cost of building a public health workforce and a modern public health information system would be $8bn a year, the commission estimated

  • · The healthcare system should work more closely with the public health system, for example by regularly sharing data both during emergencies and normal times. It would build on some successful collaborations established during the pandemic

  • · Public health leaders need to build public trust through greater engagement with communities and shared decision making, by supporting community based organisations and improving communications to tackle problems in health literacy, misinformation, and disinformation

  • · Building a national public health system should begin immediately and does not require new legislation.

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