By Robyn Stone
Our nation’s lack of investment in the public health system—and that system’s lack of investment in vulnerable older adults—played a significant role in exacerbating the COVID-19 health crisis.
Condemnation of the U.S. public health system has grown fierce in recent months as the rising COVID-19 death toll offers daily evidence that our nation was woefully unprepared for the coronavirus.
It’s hard to argue with the consensus view that the nation’s public health system has failed us all. We were not kept safe by state and local health departments that, together with the Centers for Disease Control and Prevention, make up that system. Vulnerable populations—including older Americans, Americans of color, and poor Americans—are paying the highest price for this lack of preparedness.
Railing against the public health system can be cathartic, but it’s not entirely fair. That’s because we as a nation failed public health in three significant ways.
First, we learned to live with a fragmented health system that discourages coordination and collaboration both within and between sectors like medical care, public health, and aging services.
Second, we accepted the ill-conceived notion that hospitals and medical specialists are more valuable to our health care system than public health workers, gerontologists, the aides in our nursing homes, or the service coordinators and wellness nurses in our senior housing communities.
Finally, we sat by while our government underfunded the public health system year after year.
And what did we get for all this complacency? A woefully inadequate public health infrastructure that simply was not up to the COVID-19 challenge.
This inadequacy has become painfully apparent over the past six weeks. But it has been simmering under the surface, and out of public view, for many years. And for years, it has adversely and disproportionately impacted millions of vulnerable older adults.
Older Americans tend to live in the very hotspots where the coronavirus first appeared and where it is doing the most damage: nursing homes, assisted living, affordable housing communities, and other congregate settings.
Yet, despite this heightened vulnerability, elders have received very little attention from public health departments over the years. Three basic steps could help us move forward with a unified mission to protect the health of older Americans—and revitalize the public health system.
- Put older adults on the public health radar screen.
We need to start educating health departments about the heightened health risks older Americans face during public health emergencies.
Right now, we need those departments to target nursing homes located in coronavirus hot spots—or in potentially at-risk communities—with a combination of testing, contact tracing, comprehensive infection control support, and back-up workers to fill COVID-related staff vacancies.
Over the long term, health departments must take strong action to prepare older adults for future public health emergencies, while also monitoring their day-to-day health needs with an eye toward aggressively promoting wellness and preventing disease.
- Mandate more robust funding for public health.
Health departments simply don’t have the human and financial resources to adequately address the health needs of older adults, particularly during a pandemic. It takes money to step up surveillance and identification of disease hot spots, provide needed guidance and personal protective equipment to providers of aging services, and support those providers with robust testing and tracking tools to contain outbreaks. Let’s give the public health system the money it needs to do those jobs well.
- Insist on better coordination among all health care sectors.
We’re now seeing the tragic consequences of a health system that encourages medical personnel, public health professionals, and providers of aging services to work in silos that rarely connect or coordinate. Let’s agree that every sector of our health care system has an equally valuable role to play, especially during a pandemic. Working together as partners, we can all be the heroes who go that extra mile to safeguard the health and safety of older adults.
There’s plenty of blame to go around for the disastrous response to the COVID-19 pandemic. But our nation’s lack of investment in the public health system—and that system’s lack of investment in vulnerable older adults—played a significant role in exacerbating the health crisis we face today.
Unless we all take some responsibility for our pandemic response, and rigorously demand systemic change, there’s no reason to believe we’ll save more lives during the next pandemic.
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Robyn I. Stone, DrPH, is senior vice president of research at LeadingAge, and co-director of the LeadingAge LTSS Center @UMass Boston. Her widely published work addresses long-term care policy and quality, chronic care for people with disabilities, the aging services workforce, affordable senior housing, and family caregiving.