Time to Invest in Public Health

Good morning!

I’m not sure what to ascribe it to – maybe a survival instinct – but one of the things I’ve begun doing as the pandemic has worn on is to look for “silver linings” amid all the challenges.

There are actually a lot of good things that have come from this ordeal: How we’ve risen to the occasion and exceeded even our own high expectations of ourselves. Our creativity and adaptability in the face of the unknown. Most of all, our ability to endure fatigue and heartbreak and still maintain our essential humanity.

One of the big positives I’ve taken away from this experience is how well UMMC, as the state’s only academic medical center, has worked with the Mississippi State Department of Health. This is not really a surprise. We’ve always enjoyed a strong working relationship with the health department. In more ordinary times, we have collaborated on a whole host of activities, like curbing infant mortality and preventing the spread of HIV. Whenever a crisis happens – a tornado, hurricane or an infectious disease outbreak – UMMC has a formal role in the state’s emergency response in lockstep with the Department of Health.

But the pandemic has taken our collaboration to a whole new level from even before the first coronavirus-infected patient appeared in Mississippi in March 2020. From formal conference calls to informal daily conversations to the exchange of reams of data, we have worked the problem together from every angle: PPE, testing, contact tracing, clinical protocols, capacity management, vaccination, IT solutions – you name the topic, we have been on it, together, often in previously uncharted waters.

And the Department of Health has performed magnificently. It starts at the top, with a strong, Board of Health and a history of exceptional state health officers (in my experience) going back to Dr. Alton Cobb and continuing through Dr. Ed Thompson, Dr. Mary Currier and now, Dr. Thomas Dobbs. From my perspective, Dr. Dobbs has been one of the true heroes of the pandemic – seemingly tireless, a strong tactician and the state’s leading spokesperson for letting the science guide our response in spite of misinformation. Day after day, week after week, month after month, he has remained energetic, enthusiastic and strong spirited. 

This is all the more remarkable because the Department of Health has been so impacted by budget cuts over the last few years. As recently as 2017, the department’s state budget was decreased by one-third, which is a startling amount. The main outcome of the cuts then was the reduction of district health department offices, from nine to three. These offices implement the public health activities in every corner of the state. In addition, Dr. Dobbs recently mentioned that the Health Department is operating with one-half the number of public health nurses that it had just four years ago. As part of an organization that depends so heavily on its nurse professionals, it’s hard for me to imagine how debilitating that is. 

This weakened infrastructure of our public health system has real consequences. As I’ve mentioned in a past VC Notes, there are a number of organizations that rank the states based on various measures of population health status. Mississippi ranks at or near the bottom of most of these lists in terms of health status and, as might be predicted, spends the least per capita on public health, about $16 per year.

What to make of all this? There will be another pandemic in our future, we just don’t know when, what, or how bad it will be. We also don’t know how or when this current pandemic will end, or what its lingering effects might be. In any case, our state Department of Health will be front and center in responding to these threats.

I am also concerned about what happens when we return to some degree of post-pandemic normalcy. We have a large amount of what could be described as “deferred health maintenance” that represents a looming threat to the state’s population – people who have not sought nor have been able to seek medical care for new or chronic conditions, not to mention an avalanche of mental health problems brought on by economic and social dislocation. Just this week, our state’s pediatricians expressed concerns that we have fallen behind in our childhood vaccinations for preventable diseases. There are concerns that we have fallen behind on cancer screenings as a state and nation. Predictably, many of these health challenges will fall heaviest upon the people who are least equipped to deal with them.  

When it comes to public health and health status, Mississippi has been at the bottom of the list for too long. We need a strong, resilient state Department of Health that can be proactive with UMMC and all other health providers and communities across Mississippi in responding to these challenges, and that starts with steady, adequate funding. It’s one of the smartest investments we can make as a state to achieve A Healthier Mississippi.