The First Lesson: Yesterday, I read an article in Infection Control Today magazine that asked whether or not our hospitals will get better at infection control (quality and safety) as a result of our experience with the pandemic. The article was aptly titled: “Even COVID-19 Might Not Be Enough to Improve Infection Control’s Standing.” Michael L. Millenson, an internationally-known healthcare expert whose focus is the quality and safety of medical care, was interviewed by the magazine for this story. Millenson speaks at length about our failures in quality and safety:
“It’s really kind of interesting in some ways, perhaps because infection control seems, quote unquote, commonsense. Don’t we know how to do that already? We don’t acknowledge what a poor job we do often of actually implementing what we know how to do. And I think that’s really, to me anyway, one of the most frustrating things. We have interventions that we know how to do. We know they’re important.” (Infection Control Today, April 19, 2020)
Millenson’s central point is that infection control professionals need to make sure that they build on the opportunity that this crisis represents. “I would say that as we emerge from the COVID-19 crisis, it’s very important for infection control professionals to think, “How do we take this crisis and use it as a lever to cause the change that we care about so much?”” (Infection Control Today, April 19, 2020)
I believe he is right and fear that our commitment to quality and safety, across the industry, will continue to be merely lip service. We will continue to see tens of thousands of patients die in our hospitals each year because of preventable hospital-acquired infections. Is the importance of infection control a lesson that we will learn from the COVID-19 experience? Time will tell.
Lesson #2: The Importance of a Strong Public Health System
Throughout this crisis, it has been apparent that we are paying the price for not having a strong public health system in place in the United States. We have failed to invest in public health. I wrote a blog post on April 8, 2020, titled “Why Public Health Matters.” In that post, I started out by saying the following: “In the midst of the COVID-19 pandemic, our nation has discovered that the neglect of our public health system has greatly diminished our ability to respond to a public health crisis – particularly one the size of the current pandemic.”
One of my favorite advocates for pubic health is Brian Castrucci of the de Beaumont Foundation. Here is a link to the Second Opinion Podcast, hosted by Senator Bill Frist, where Brian recently made the case for investing in public health infrastructure. According to Brian, Americans “tend to understand health through an individual lens and so much more as a medical issue. And that’s why so many discussions of health quickly become about pills and procedures rather than about the policies and partnerships that really support good community health. I think the truth is, is that governmental public health supports a better quality of life, thriving communities, a strong economy. And for our current situation, if we had a fully funded, coordinated public health system, this didn’t have to be as bad as it turned out.”
In April 2020, the Trust for America’s Health (TFAH) published a seminal report titled “The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2020.” Here are a couple of excerpts from that report:
“CDC’s Public Health Emergency Preparedness (PHEP) has seen its funding shrink from $940 million in FY 2002 to $675 million in FY 2020.
The Hospital Preparedness Program—part of the Office of the Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services—is the single source of federal funding to help regional healthcare systems prepare for emergencies. Its budget was $515 million in FY 2004 and $275.5 million in FY 2020.”
Within the TFAH report, the organization’s president and CEO speaks directly to our need for a strong and well-funded public health system:
“The increasing number of threats to Americans’ health—from infectious disease to weather events to vaping—demonstrate the critical importance of a robust public health system. Being prepared is often the difference between harm or no harm during emergencies and requires four things: (1) planning, (2) interagency and jurisdictional cooperation, (3) good data, and (4) a skilled public health workforce. Having these elements at the ready requires increasing our investment in public health.”–JOHN AUERBACH, President and CEO, Trust for America’s Health
Our failure to invest in public health is not a Democrat or Republican issue, it is a matter of priorities. If we truly want to improve population health, eliminate health disparities, reduce healthcare spending, and improve health outcomes, investing in a strong and vibrant public health system is one necessary step.
Lesson #3: The Need to Address Health Disparities in America
The need to address health disparities within our country is directly related to our failure to invest in our public health system. On May 6, 2020, The New England Journal of Medicine published an article titled “Racial Health Disparities and Covid-19 — Caution and Context,” written by Merlin Chowkwanyun, Ph.D., M.P.H., and Adolph L. Reed, Jr., Ph.D. However, you don’t have to read the NEJM to be aware of the health disparities among “socially marginalized populations” that have been exacerbated by the COVID-19 crisis. The article is incredibly nuanced and warns against the dangers of having disparity data used to “perpetuate harmful myths and misunderstandings that actually undermine the goal of eliminating health inequities.” According to the authors, disparity data “can give rise to explanations grounded in racial stereotypes about behavioral patterns.”
In sum, to mitigate myths of racial biology, behavioral explanations predicated on racial stereotypes, and territorial stigmatization, Covid-19 disparities should be situated in the context of material resource deprivation caused by low SES, chronic stress brought on by racial discrimination, or place-based risk. (“Racial Health Disparities and Covid-19 — Caution and Context,” New England Journal of Medicine, by Merlin Chowkwanyun, Ph.D., M.P.H., and Adolph L. Reed, Jr., Ph.D., May 6, 2020.)
If we’re going to create health equity in this country, we have to address these disparities. This will only happen if Americans decide that health equity is one of the principles they feel strongly about. As a people, is this one of our core values? Although the COVID-19 crisis has helped to put a greater focus on longstanding health disparities driven by socioeconomic and environmental factors, will it motivate us to address this abomination? Here’s the perspective shared by Michelle A. Albert, M.D. M.P.H., president of the Association of Black Cardiologists, professor of medicine and director of the Center for the Study of Adversity and Cardiovascular Disease at the University of California, San Francisco:
“Our vulnerable interconnectedness highlighted by the COVID-19 pandemic should ignite meaningful solution-focused collaborations among community leaders, scholars, and policymakers to orchestrate sustainable change aimed at addressing pervasive health care disparities.” (Science Daily, “COVID-19 has unmasked significant health disparities in the U.S.,” May 4, 2020)
Fingers crossed that Dr. Albert is right and this obvious vulnerability will lead to greater collaboration and a renewed interest in addressing healthcare disparities.