Jefferson Ketchel, MA RS, is the Executive Director of the Washington State Public Health Association. In this commentary, he discusses sustained investments in public health. This piece is part of a series of commentaries focused on transforming public health released throughout this week. The other commentaries are available here and here.

If you do not change direction, you may end up where you are heading.

-Lao Tzu

In life there are few certainties, but 2020 has had several, so far.

It was hard to imagine it was only just over a year ago that we were in the midst of a measles outbreak and working together to address the opioid crisis. As we struggled to stop the spread of disease and prevent illness and premature death we should have realized at the time these events were canaries in the coal mine warning us of a fractured system that would soon be put to an ultimate test.

However, I am truly impressed with what we are able to do with what we have. Thanks to tireless and courageous people in healthcare, and with the planning, contact tracing, social distancing, and mask utilization, Washington State has done a decent job flattening the curve. Some of these tools are as old as history, but that is because they work. This was accomplished without a vaccine, therapeutic and adequate testing capacity, limited PPE, AND with a barebones public health system. At the same time, that system is getting by on some incredibly outdated and sporadically functioning technology. Imagine how many illnesses could have been prevented, economic damages minimized, and lives saved if we had the public health system our communities deserve and one that addressed racist structures that perpetuate poor health for marginalized populations?

Public health has gotten used to one-time funding amidst crises. However, it does not solve much and perpetuates the failed system that will once again not be properly prepared for the next event or address systemic injustices. This emphasizes that we are a Band-Aid society that prevents us from getting to the root of problems. Just imagine what could be done with sufficient health monitoring, disease investigation, coordination, and a focus on healthier communities.

Health shouldnt be a luxury item. Public health has developed the Foundational Public Health Services, which are services that are unique to government and should be afforded to all Washingtonians. If they were present state-wideconsistently and equitablywe could raise all boats and be able to coordinate and prevent crises big, small, and persistent. While some small investments have been made (without them, things would have been much worse), public health has attempted for several years to get these services sustainably funded but have hit wall after wall.

While the social determinants of health (racism, housing, education, employment) have significant impacts on healthy years of life, the political determinants of health impact our ability to actually fix them. There are powerful lobbies for tobacco, sugar-sweetened beverages, and others. Where are the lobbies for public health?

I ask that health care and insurers be leaders in advocating for investment in the public health system. Alone, no hospital, clinic, or payer can solve public health problems.

The system is working exactly as it was designedand were getting what we paid for. We can do so much better. We need your alliance. Join us.

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Healthcare and Insurers, we need to talk. signed Public Health - State of Reform - State of Reform