Rebuilding Our Health System Means Tearing Down Some Walls

Chelsea Cipriano and Dave A. Chokshi, MD

“How can we get ready for the next health crisis?” Answering this question is vital to ensuring that our already-declining life expectancy doesn’t tailspin during the next health emergency, as it has with the COVID-19 pandemic.??

In just the past two years we have seen the reemergence of polio, detection of locally acquired malaria, a national mpox outbreak — and an assault of extreme weather events, unprecedented overdose deaths, and a historic rise in infant mortality. It’s not a matter of if, but when, the next public health threat crescendos into a crisis.??

Being ready for the next crisis is not simply about stockpiles, more plans, and better medicine. More fundamentally, it depends on rebuilding our fragmented health system into a stronger, more resilient whole: one that both protects against existing threats and can rapidly respond to new threats when they arise.??

Imagine our health system as a house. A particularly brutal storm has come through, leaving the home full of holes and broken windows and a flooded basement. Before we refurnish this house, we need to address its major structural weaknesses. America’s health system has weathered its harshest hurricane in more than one hundred years. It must undergo a major renovation to ensure it is ready for the storms on the horizon.?

COVID-19 exposed the existing cracks in the foundation of our health system. For example, during the height of the pandemic, the United States often had to look to the United Kingdom and Israel for real-time data about variants of the virus because these countries’ public health and hospital data systems were linked — and ours were not. Public websites showing case, hospitalization, death, and vaccination rates needed to be created on the fly with limited time and resources. We saw additional cracks in both testing and vaccine distribution, where state and local health departments had the supplies but frequently did not have the capacity nor partnerships with their local health systems to rapidly deploy them.??

At the same time, the pandemic offered us a tantalizing glimpse into what a more cohesive system might look like. In Dallas County, health system leaders connected data systems to better identify areas of higher COVID-19 risk and then sent out alerts based on that risk. In Idaho, a grocery pharmacy chain and the health department worked together to increase vaccine access for people in rural areas. Indiana created the Governor’s Public Health Commission, investing in local public health action on issues like diabetes prevention and childhood lead screenings. New York City established the NYC Public Health Corps — a community health worker program designed to grow the workforce and improve preparedness for emergencies, while addressing inequities in communities hit hardest by the pandemic. These new nodes of health infrastructure were created in crisis, and must remain in times of relative stability as well.??

But a house is more than a set of rooms, and rebuilding a house requires a new blueprint. One immediate priority should be bridging two key components of our health system: the public health sector, which is concerned with the health of entire communities; and the health care sector, which has historically focused on individual patients. Patients may not know the difference between public health and health care, and they likely don’t know that the two have not always worked together well. But they would experience the tangible benefits of these sectors coming together — and not just during crises like COVID-19.??

Imagine a physician in her clinic, seeing a patient who years earlier had been diagnosed with hepatitis C — an infection that can lead to cirrhosis or liver cancer. The patient unfortunately did not receive treatment after diagnosis. Hepatitis C is a curable disease, yet less than a third of patients receive timely treatment, in no small part because the right collaborations across our health sector seldom exist. ?

The patient’s health care system and local public health department could have worked together to help ensure the patient was reconnected to care after their diagnosis. Additional partnerships, for instance between the state health department and health insurance plans, would have allowed for the physician to start affordable treatment for the patient that same day, in her clinic. Together,?the different sectors of our health system can work together seamlessly, behind the scenes — with the patient’s health as their common goal. ?

The good news is that there are health leaders strapping on their proverbial toolbelts to construct this reimagined health system. The “Common Health Coalition: Together for Public Health” is one such group of leaders. The Coalition — founded and led by the American Medical Association, the American Hospital Association, AHIP, the Alliance of Community Health Plans, and Kaiser Permanente — aims to strengthen these critical joints between health care and public health. Early priorities include building relationships among public health agencies and health care organizations well in advance of an emergency, as well as agreeing upon a common lexicon for data systems.?

To be prepared for the next big threat to health — be it climate change, novel infections, overdose, misinformation, or the loneliness epidemic — America cannot return to the storm-torn house that is our current health system. We have the scaffolding, and we are drafting the blueprints. With them, we have the opportunity to rebuild our health system into something that can withstand future threats and best serve our communities with the expertise, compassion, and equity they deserve.?

Ms. Cipriano is a public health professional and the Managing Director of the Common Health Coalition; Dr. Chokshi is the Chair of the Coalition and previously served as the 43rd Health Commissioner of New York City. Learn more at CommonHealthCoalition.org.?