Dado a que este es un blog sobre salud publica en América Latina, voy a compartir un enlace en español para quie mis amigos pueden leer sobre la realidad choque sobre la caida de sistemas de salud públic en los Estados Unidos. Han sido muchos cortes de servicios y de empleos en salud pública desde 2008. ¿Está listo los Estados Unidos para vacunar una población de 330 millones? Se presentan ejemplos en Florida sobre la caida de salud pública y como los trabajadores han sido silenciado. Incluso programas de vigilancia y control de zancudos han sido cortadas.
Given that this is a blog about public health in Latin America, and I have written about the decline in public health under the Maduro regime in Venezuela, I had expected to write more about that. However, rather than the once-wealthiest country in Latin America, I need to focus on the “wealthiest country in the world,” the United States.
Kaiser Health News is presenting a series on the decline of public health departments in the United States both before and during the COVID-19 crisis. This series was reported using extensive funding and employment data from the Census Bureau and professional associations.
An analysis by Anna Maria Barry-Jester, Hannah Recht, Michelle R. Smith, the Associated Press, and Lauren Weber indicates that at least 181 public health officials across the United States have resigned, retired, or been fired since April 1 of 2020. Some have been receiving hate mail and feel that there are other safer and possibly more remunerative places to work, despite the fact that they usually have specialized training in public health or epidemiology or mosquito control.
This has occurred at a time when interest groups such as anti-vaxxers and anti-maskers have been launching vitriol against state and local public health officials. These groups are mostly right-wing. (Caveat: Robert F. Kennedy, Jr., prominent anti-vaxxer is registered as a Democrat, but he has recently spoken in front of right-wing groups both in the US and in Germany).
Burnout, job pressure from the pandemic, political pressure (even death threats), and normal retirements have been factors in the departures of public health officials. The departures have been all over the country, but with more numerous foci in Colorado, Kansas, Iowa, Wisconsin, Kentucky, North Dakota, Maryland, Washington, and California. They represent a brain drain that will take years and millions of dollars to repair.
This is occurring at a time when both the Federal and some state governments are neither cooperative with nor supportive of public health. The 24 state governments are considering proposals to limit the emergency powers of public health agencies. This is linked to pressure from the right-wing special interest group ALEC. .
Recently, the Shawnee County, Kansas Board of Commissioners loosened pandemic-related restrictions. This occasioned the departure of health officer Gianfranco Pezzino. He resigned from the Shawnee County, Kansas public health department with a letter that stated, “
- You disregard data and best practices that have been proven to be effective all around the world in favor of your own narrative, anecdotal evidence, and opinions not based on facts.
- You do not value the opinion not only of your health officer, but also the most qualified health and public health professionals in our community.
- You value the pressure from people with special economic interests more than science and good public health practice.
…Therefore, I am resigning my position as Shawnee County Health Officer effective immediately.
What are the “pre-existing conditions” to this sudden rash of resignations and retirements of public health officials across counties and states? Lauren Weber, Laura Ungar, Michelle R. Smith, Hannah Recht, and Anna Maria Barry-Jester wrote a damning article for the Associated Press. in which they said,
“Since 2010, spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%, according to a KHN and Associated Press analysis of government spending on public health. At least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a skeletal workforce for what was once viewed as one of the world’s top public health systems.”
Professor Lawrence Gostin of Georgetown University was quoted as saying,
“What we’ve taken for granted for 100 years in public health is now very much in doubt,”
Robert Redfield, the CDC Director told the AP that his “biggest regret” was “that our nation failed over decades to effectively invest in public health.”
Take these three quotes and they can be condensed into the conclusion that the United States is losing or has lost the pre-eminent position it once held in worldwide public health. Although incoming President Joe Biden will likely reverse Donald Trump’s decision to withdraw the United States from the World Health Organization, some of the damage has already been done. The worst of that damage is probably the loss of the United States’ position as a leader in global public health. Other countries, including those in the developed world, will see the United States as being highly unreliable because whether it supports public health is dependent on who is in power, and what ideology is in power.
In the case of the United States, it is overwhelmingly right-wing ideology that is antagonistic to public health. Whether that ideology is manifested by budget cuts at the local public health department or by people refusing to wear masks in public and refusing to distance, it is enormously damaging to the health of people in the United States. Budget cuts since 2010 have hurt Minnesota and other states’ coronavirus response.
All this sounds really familiar to me, because it resembles what happened to public health in Venezuela since 2014 that led up to the enormous malaria resurgence. In Venezuela, corruption and kickbacks from illegal mining are the commercial interest that led to the decline in malaria surveillance and reporting. Health officials faced reprisals when they diagnosed cases of malaria in clinics. There was a rise in infant mortality and suppression of the publication of the Boletín Epidemiológico.
In Venezuela, it has been corruption under the Left-Wing regime that has damaged public health. In the United States, the combined effects of Right-Wing ideology are the culprits:
The United States has many excellent schools of Public Health and related fields, such as Entomology. Thousands of people have graduated from those schools and bring strong skill sets to a field that is desperately needed.
Talent is being wasted. Shameful.