Public Health Infrastructure is Frail—Focus on Workforce, Data and Equity


During the past three days, I’ve attended the Aspen Ideas: Health Festival and had the privilege of hearing health and public health experts discuss topics facing our nation and world, ranging from the impact of our changing climate on health to cutting edge ideas aimed at improving health to the future of our nation’s public health protection system.

On Thursday, CDC Director Rochelle Walensky, MD, MPH, took the stage with CBS News Chief Medical Correspondent Jonathan LaPook to talk through wide ranging topics, including some of the actions needed to improve the U.S. public health system. In the discussion, Walensky indicated that the nation’s public health infrastructure is frail and that there is work we need to do to strengthen it to take on the health challenges of today, like the COVID-19 pandemic, and tomorrow.

Watch Aspen Ideas Health Session on Protecting the Public’s Health

“We've learned a lot during this pandemic. And I will say, CDC has a strong 75-year history, but never have they confronted a pandemic of this size and scope,” according to Walensky. “One of the things I think this pandemic demonstrated to all of the world are the real challenges with health equity. So, that has to be the foundation of everything we do.”

Walensky also discussed the boom and bust funding cycles the nation’s public health protection system has experienced. “We’ve had this, what I call rollercoaster funding. There's an emergency and then we borrow from one emergency to get to another without a true investment in the infrastructure. In the last decade, we’ve had H1N1, Zika, Ebola, chikungunya, and now we have COVID.”

Part of the infrastructure challenge for public health is its workforce. Walensky said that an analysis from the de Beaumont Foundation found “we’re about 80,000 public health jobs in deficit. So, through this last decade, we have not invested in public health. And that is everything from community health workers, to data analysts, to contact tracers, to genomic epidemiologists, to physicians and state health departments. So, there's just this massive lack of infrastructure and workforce.”

In addition to adding more skilled workers to bolster the public health protection system, Walensky highlighted the need for more robust data capabilities.

She noted that “data has really been a challenge during [the pandemic]. We can't implement things against what we can't see, right?” She continued by indicating that CDC receives data “from over 3,000 jurisdictions. Some of it comes in by fax, and some of it comes in by Excel, and some of it comes in from the cloud. It’s our job to compile and then deliver it back in real-time. We don’t have interoperable data systems to have them all connect, so that we can actually see in real-time.”

Beyond the data itself, Walensky said data authority—the ability of CDC to legally collect the data from states and jurisdictions—is another real challenge to get a complete picture of what is occurring on important health conditions and outbreaks.

She added that even if the nation has the data infrastructure in place it will not be enough if all of the needed data are not flowing through it and doing so with ease. That flow will be dependent on data authority.

“We at CDC do not have the authority to have that data flow through. All of the data that we receive is voluntary—voluntarily reported from jurisdictions and states. And we have gotten more of it [authority] through the public health emergency that is COVID-19, but we’re again limited by it in so many other places. So, I think it’s both a combination of the authorities, as well as the interoperability.”

For its data modernization effort now underway, CDC received an initial $500 million, for which Walensky said she is very grateful.

“We have made a lot of progress during the pandemic for our interoperability of our data systems… But a single health system would take $1.2 billion to upgrade,” she said. “So, there are single health departments that could go through our entire data modernization budget… We've made a huge amount of progress during the pandemic, but we have a lot more that we are working to do and will need resources to be able to do so.”

The COVID-19 pandemic has exposed long-term challenges for our nation’s public health protection system. Though fragile right now, there is much that we can do through commitment, investment, partnerships and new authorities to make our nation’s public health system stronger to protect us all.

Photo of Pierce Nelson
Pierce Nelson is the vice president for communications for the CDC Foundation.