Middleboro Review 2: POLITICO NIGHTLY: We're not prepared for the next public health crisis

Wednesday, March 8, 2023

POLITICO NIGHTLY: We're not prepared for the next public health crisis

Medical workers wait for patients at a special Covid-19 intake area in April 2020 in Brooklyn, N.Y. | Spencer Platt/Getty Images

WORKFORCE EXODUS — We might be even less prepared for the next public health emergency than we were for the last one.

After all the billions of dollars on pandemic era upgrades to labs and data and surveillance, after all the studies and convenings and white papers about emergency preparedness, the U.S. still lacks two crucial things in the public health arsenal.

People. And trust.

Without an adequate public health workforce, and without trust in those people and the work they do, the U.S. could get caught flat-footed once again.

Two research papers published this week in the journal Health Affairs quantify what we more or less already knew. America’s public health workforce is depleted . And Americans are a skeptical bunch; they don’t have a huge amount of trust in public health nor its messengers, although the trust deficit may not be quite as deep as you’ve heard.

Unless something changes and fast, “our health departments will be empty and no one will be paying attention until it is way too late,” said Brian Castrucci, a lead author of the workforce study and the president and CEO of the de Beaumont Foundation, which focuses on public health.

Amid low pay, long hours, cumbersome bureaucracy and, nowadays, abuse and threats so severe that researchers found huge numbers of public health workers had at least some symptoms of PTSD, public health workers are quitting in droves — and the exodus began even before Covid-19 made everything harder. Nearly half quit between 2017 and the end of 2021, and it’s not just pandemic-exhausted older workers choosing early retirement. The under 35s are also fleeing. That means not just a loss of workers for now, but no pipeline for leaders of the future, pointed out a worried Georges Benjamin, executive director of the American Public Health Association. “That knowledge base is going out the door,” he said.

The shortages in the public health sector aren’t getting anywhere near as much attention as labor challenges in the health care system. Doctors and nurses and others who take care of patients are of course important, said Castrucci. But letting public health erode leaves us vulnerable in different ways.

“It’s like opening the gates that protect the army,” he said. “If we don’t have a strong public health system, there’s no way we can have enough hospital beds to make up for the problems.”

Fixes can’t be piecemeal. Diseases cross state lines — as do toxic fumes from train wrecks, or the fallout from natural disasters. If even one state is unprepared, people in other states can be harmed.

A big reason people don’t stay in public health is money. Salaries are small. Bureaucracies are large. Since the pandemic, abuse has also been on the rise. And in more than half the states, lawmakers have curtailed public health experts’ ability to make and carry out policies. Castrucci said that’s like using a jackhammer to shatter our own collective safety.

The labor shortage is not because we aren’t training people. To the contrary, we’re turning out people with both undergraduate and graduate public health degrees in droves. Enrollment in these programs surged after 9/11 and didn’t abate. According to the Association of Schools and Programs of Public Health, enrollment grew steadily over the last decade, with another bump up in 2021, after the pandemic hit. There was a small dip in undergraduate enrollment last fall, but graduate schools kept growing.

But people with public health degrees are not all going into public health, at least not in federal, state and local agencies. They go to digital health and tech firms. They go to businesses and consulting firms. Many go into the health sector as managers or administrators of hospitals and clinics. They may be physicians or nurses, who want the extra public health knowledge or credential to enhance their practices.

Emily Burke, who tracks workforce development for the public health school association, said there was an uptick in new graduates going into traditional public health jobs last year. Whether that’s the beginning of a trend, or a one-off, remains to be seen. Whether they stay in public health, or do a year or so and move on, is also an open question.

The distrust in public health has also made it a harder world to work in. Still, the degree of outright, hostile distrust might be overstated, said Gillian SteelFisher, a Harvard T.H. Chan School of Public Health researcher who led the trust study .

Not many of the 4,200 people surveyed had really high trust. Only four-in-10 adults reported a great deal of trust in the CDC. For state and local public health departments, it dropped to one-in-three.

But not many reported zero trust either. The haters on the fringe make a lot of noise and get a lot of attention, from the media and elsewhere. But the focus should be on reaching the tens of millions of Americans with some, but not a ton of trust, said SteelFisher. “You have to bring those people to the table,” she said. This low trust, interestingly, didn’t correspond with how well people thought the public health officials controlled the pandemic. It centered on the belief that federal public health decisions are politicized, not based purely on science, and that state and local officials do a poor job of communicating how people can protect themselves, with recommendations constantly changing in bewildering ways.

Consistent, and frequent communication — including about uncertainty — can rebuild trust. “Here’s what we know today and we’ll be back here tomorrow,” she said. “Inviting people into the process is the critical piece… We have to be trustworthy if we’re going to be trusted.”

Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com . Or contact tonight’s author on Twitter at @JoanneKenen .

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WHAT'D I MISS?

— Florida Republicans seek ban on abortions after 6 weeks of pregnancy: Florida’s GOP-led legislature filed bills today that would ban abortions after six weeks of pregnancy but offer exemptions for victims of rape and incest if they can provide official proof of the crime. Lawmakers in the state House and Senate filed similar legislation to make abortions illegal two weeks after a pregnant person’s first missed period, tightening the 15-week ban they approved last year.

— Tucker Carlson ripped by Capitol Police, GOP senators for mischaracterizing Jan. 6: Capitol Police Chief Thomas Manger slammed Fox News host Tucker Carlson this afternoon for airing an “offensive and misleading” portrayal of the Jan. 6 attack on the Capitol . Manger wrote in an internal message to officers that Carlson’s Monday night primetime program “conveniently cherry-picked from the calmer moments of our 41,000 hours of video” to incorrectly portray the violent assault as more akin to a peaceful protest.”

— Eric Adams plans to resettle asylum-seekers across U.S.: New York Mayor Eric Adams announced a shift in policy on asylum-seekers that includes a more formal process of resettling migrants throughout the state and in other cities across the country . The administration plans to brief more migrants on relocation opportunities and work with national nonprofits to identify welcoming cities across the country where they might move, Adams said.

NIGHTLY ROAD TO 2024

THE CENTER WILL NOT HOLD — The centrist political organization No Labels is putting hundreds of petition circulators on the ground in an effort to get on the ballot in key presidential swing states in 2024 . And while the group told POLITICO that it would not run a candidate but rather provide a “launching pad” for another option if major party candidates run candidates that their organization deems unappealing, No Labels does have at least some in Democratic circles spooked.

The public policy think tank Third Way conducted an analysis that suggests an “alternative” put forward by No Labels would siphon votes largely from President Joe Biden in a hypothetical rematch with former President Donald Trump. No Labels, for its part, remains noncommittal as to whether they would run a candidate should Biden be the Democratic nominee.

As No Labels seeks to launch an ambitious third-party presidential ticket, Mark Halperin — who had been No Labels’ highest-paid employee after joining the group in 2021 — is leaving the group .

AROUND THE WORLD

Greek Prime Minister Kyriakos Mitsotakis, second left, visits the location of a train collision in Tempe, Greece. | Dimitris Papamitsos/Greek Prime Minister's Office via AP

CRASH LANDING — Greek Prime Minister Kyriakos Mitsotakis was supposed to be preparing to call an early election — instead he’s dealing with protestors throwing Molotov cocktails at police as a wave of public rage convulses Greece following a train crash that killed 57 people , writes Nektaria Stamouli .

Last week’s train collision was caused when a freight train and a passenger train were allowed on the same rail line. The station-master accused of causing the crash was charged with negligent homicide and jailed Sunday pending a trial.

The crash has raised deeper questions about the functioning of the Greek state, following reports that Athens hadn’t updated its rail network to meet EU requirements and that the state rail company was accused of mismanagement.

Mitsotakis initially blamed the incident on “tragic human error” but was forced to backtrack after he was accused of trying to cover up the government’s role. The first political victim was Transport Minister Kostas Karamanlis, who resigned soon after the accident. Mitsotakis put out a new message over the weekend saying: “We cannot, will not and must not hide behind human error.”

NORD STREAM REPORT — A pro-Ukrainian group likely carried out the attack on the Nord Stream pipelines last year , according to new intelligence reviewed by U.S. officials, reports The New York Times.

The attack on the natural gas pipeline, which links Western Europe to Russia, was among the most consequential unsolved mysteries of Russia’s war in Ukraine. U.S. officials added that they have no evidence President Volodymyr Zelensky or his top lieutenants were involved in the operation.

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NIGHTLY NUMBER

More than $100 billion

The cost of damage caused by last month’s devastating earthquakes in Turkey , according to a United Nations Development Program official. More than 39,000 people were killed in southern Turkey and northwestern Syria following a magnitude 7.8 earthquake and its powerful aftershocks struck Turkey’s southern Hatay province, near the Syrian border. The World Bank previously estimated the damage in Turkey at $34.2 billion, but said recovery and reconstruction costs as well as other economic disruptions caused by the quakes, has drastically raised the estimated figures.

RADAR SWEEP

ALL GAS, NO BRAKES — Across America, electric vehicles and charging stations are popping up as more people convert from gas to electric cars. But one region — and one state, in particular — is lagging behind . The Upper Midwest and Great Plains don’t have nearly as many EV stations as the rest of the country. In particular, North Dakota ranks the worst. The reasons are manifold — the region is a big producer of ethanol, there are concerns about sub-zero temperatures’ effects on battery life and there’s enough empty, open space that it can be hard to know where to place charging stations efficiently. So, what’s it going to take to catch the Upper Midwest and Great Plains up with this rapidly changing technology? Tom Peterson reports for Pew Trusts.

PARTING IMAGE

On this day in 1965: State troopers swing billy clubs to break up a civil rights voting march in Selma, Ala., on a day that came to be known as "Bloody Sunday." John Lewis, then-chairman of the Student Nonviolent Coordinating Committee (foreground) is beaten by a state trooper. Lewis sustained a fractured skull. | AP Photo