US health system can build back stronger, NAM experts assert
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* Kim Krisberg

Health departments play a critical role in pandemic response, but the challenges they faced in the last year were indicative of flaws in the system as well as chronic underfunding, according to a new report from the National Academy of Medicine.

The report, “Public Health COVID-19 Impact Assessment: Lessons Learned and Compelling Needs,” is part of a new NAM project to undertake a sector review of the U.S. health system, assess weaknesses before and during the pandemic, and look for opportunities for improvement. The public health report was released in April along with an assessment on care systems.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/51/5/11.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/51/5/11.1/F1)

“The public health sector must not only be reinforced and appropriately staffed so that it can respond to the next epidemic — it must be rein-vigorated so that it can respond to threats we cannot imagine,” said Bob Hughes, PhD, president and CEO of the Missouri Foundation for Health and one of the report’s co-leads, in a news release.

The public health report called out challenges practitioners faced during the pandemic, including unclear lines of authority, gaps in data and surveil-lance, and the politicization of public health measures. Authors, who include APHA Executive Director Georges Benjamin, MD, noted that “elected leaders need to affirm their support for data-driven decisionmaking and the nonpartisan nature of health departments to ensure their credibility.”

The assessment also shared priority actions and policy considerations for the public health sector, such as transforming public health funding, affirming the mandate for public health, investing in work-force development and community engagement.

For example, the report called on policymakers to develop flexible public health funding sources, as opposed to the current funding framework that focuses on categorical funding. Authors also stressed the need for better interoperability and national standards to ensure health data is routinely disaggre-gated by race, ethnicity and other sociodemo-graphic factors. The report also recommended dedicated funding for addressing racial and socioeconomic inequities in health.

“COVID-19 presents a bittersweet opportunity to really focus on, appropriately fund, appropriately staff and shore up public health leadership, work-force and infrastructure, not only to be ready when the next epidemic arises, but to be able to effectively carry out the day-to-day services on which the nation’s health depends,” said Karen DeSalvo, MD, MPH, MSc, one of the coauthors of the public health assessment and former U.S. acting assistant secretary for health, in a news release.

Forthcoming reports in the NAM series will cover research, health payers, clinicians, quality, safety, patients, digital health and more.

To access the full suite of NAM assessment reports, known together as “Emerging Stronger after COVID-19: Priorities for Health System Transformation,” visit [www.nam.edu](http://www.nam.edu).

*   Copyright The Nation’s Health, American Public Health Association