What happens when a pandemic
strikes a country that’s gutted its public health system?
Americans getting mixed messages tonight
at a time we can ill afford it.
There's so many questions about testing in the U.S.
Hospitals are reeling,
with New York City's mayor
warning they will run out of supplies
by this weekend.
Hey guys, it's Dena.
And by now, it’s pretty obvious
that COVID-19 has revealed a
massive public health crisis in the U.S.
But how did American public health get so bad?
A big reason is that the U.S. government has continuously
put profits over public health.
We've cut basic public services,
and then everything else
we've assented to this system
that basically says
you've got to be for profit to matter.
The U.S. government’s response to the coronavirus pandemic
has been a massive failure.
Since March, the country has scrambled to stop a virus
that public health services could have helped contain.
But, what exactly is public health?
It’s all about saving lives through prevention
and focusing on the
overall health of the community.
Think of it this way:
While a doctor in a hospital may treat your illness,
those who specialize in public health
want to stop the illness from even happening in the first place.
Things like vaccinations,
testing and tracking disease outbreaks ...
those all fall under public health.
When it's there, it's doing its job,
and it's eliminating threats
before you even know that they're threats.
And then, when it's not there,
it's failed and all of a sudden
you're dealing with a pandemic.
That’s Dr. Abdul El-Sayed. He's an
epidemiologist and public health expert
who just published a new book
called, “Healing Politics:
A Doctor’s Journey Into the Heart of Our Political Epidemic.”
He also ran for governor of Michigan
with Bernie and AOC’s support in 2018.
I called him up to learn more about
what our public health system in the U.S. is lacking.
You think about a pandemic like a fire.
You know, if you put your fire out
when it's in your toaster,
then it never engulfs the house.
But if you wait until it engulfs the house,
then, at that point, you're trying to prevent it in the neighborhood.
The problem is the U.S. has often
not only ignored the fire,
but has taken steps that have directly made the fire worse.
For example, in 2016 President Obama created a task force
within the National Security Council to deal with pandemics.
Sounds like a useful thing to have, right?
Well, unfortunately, the Trump administration
disbanded it in 2018.
Key officials who left or
were fired were never replaced.
I’m a business person. I don’t like having
thousands of people around when you don’t need ‘em.
It kind of feels like we could have used the people whose
job it was to sound the alarm ahead of a pandemic.
Anyway, in the U.S., the main federal agency
that does public health work
is one you’ve been hearing a lot about:
The CDC ...
The CDC just issued a stark warning.
The CDC issuing these new guidelines
calling for an eight-week ban
of large gatherings of 50 or more people.
But here’s the problem:
The Centers for Disease Control and Prevention's budget has fallen 10%
over the last decade.
That’s right, even under President Obama.
President Trump has tried to slash funding
for the CDC and other public health programs
quite significantly ever since he came into office.
Now, the good news is that
only Congress has the power to approve budgets.
And, so far, they’ve turned down most budget cuts
to the CDC
proposed by the president.
But that’s pretty much the only good news.
The director of the CDC has also said that
decades of underinvestment in public
health in the U.S. has had significant consequences.
When it comes to COVID-19, that means
fewer staff and resources to do what he calls
the “bread and butter of public health,” which include:
robust testing,
isolating those who are infected
and tracing all their potentially infected contacts.
South Korea, for example, successfully
contained the pandemic using these
public health practices,
especially through early mass testing –
something the U.S. has severely failed at.
Trump falsely claimed that the U.S. tested more people in eight days
than South Korea had tested in eight weeks.
But, the truth is that
South Korea’s rate of testing per capita
was actually more than 6 times
that of the U.S. by late March.
The unfortunate reality is that we just have not had a federal response
that is befitting this moment.
And so it's left it to state and local leaders,
who are fighting valiantly on the front lines,
trying to support
their communities and protect.
But even at the state level, American public health is in deep trouble.
There are more than 3,000 state, local and tribal
public health agencies across the U.S. and its territories.
Those public health departments get 50 to 70%
of their funding from the CDC.
And during the Great Recession of 2008,
state and local departments were also cut,
leaving them understaffed and under-resourced.
In fact, only 51% of the population
is served by a comprehensive
public health system in the U.S.
Not exactly an ideal situation when the country is in the midst of:
the greatest single public health threat
that we've seen in over a hundred years.
Now, the CDC has gotten emergency funding
that it’s passed on to state and local agencies.
But that’s just it, it’s emergency funding,
a Band-Aid and nothing long-term.
Research has repeatedly shown us that investments in public health
save costs in the long run.
So why isn't the U.S. investing in it more?
Well ... turns out, there’s a lot of money to be made in treating people
after they get sick.
The medical system in the U.S.
is designed to maximize the profits of
health care insurance companies, Big Pharma
and for-profit hospitals.
The U.S. spends more on
health care goods and services
than any other country in the world.
It spends nearly $11,000
per person annually on treatment.
But for prevention? Not so much.
Less than 3% of that health spending
goes to public health.
When you break it down,
the U.S. government dedicates
just $19 per person
for public health funding each year.
Providing preventative public health services is a
public good, which just isn’t a hot commodity.
Imagine trying to sell somebody a non-thing.
That's kind of what we do in public health.
Over in Europe, many countries have universal health care.
And Spain even nationalized its private hospitals
to help combat COVID-19.
Meanwhile in the U.S., both Republicans and Democrats
have allowed the market to take over the state when
it comes to providing health care services.
When you decide that something is no longer a public good,
when you decide that there ought to be a profit motive underneath it,
what you're basically saying is that people who can't pay
are getting – should get excluded.
Using Dr. El-Sayed’s example,
it’s clear that the COVID-19 pandemic
is a fire that’s already engulfed the neighborhood.
So ... what’s next?
If we don't want to be here again,
then we damn well better start investing in public health.
And so, if the U.S. government runs the CDC
and runs our major public health institutions at the federal level,
investing in them over the long-term saves the U.S. government,
the American taxpayer, a lot of money.
That leaves us with the potential to have better health
and spend less overall than we would right now.
What's lost is that, you know, CEOs at health insurance companies
are not making $19 million a year. But, to me, I'm OK with that.
Poor investment in public health
can have far-reaching consequences.
AJ+ has taken a closer look
on the pandemic’s impact on hospitals
in New York and across the country.
And we also have a video that examines
why Black people are dying at higher rates.
So make sure you check out all those videos
if you want to learn more.