Public Health Authority Under Threat
Recently, some states have moved to limit public health authority in response to perceived government overreach and outrage over handling of the pandemic. They seek to prohibit mask wearing, ban the use of quarantine, block employer vaccine mandates, give legislatures unilateral power to stop public health actions, and other moves that stand in the way of Public Health’s mission. These threats compromise Public Health’s ability to respond to COVID-19 and other future threats.
Eroding Authority
Between legal challenges and a precarious policy landscape, underfunding of public health programs and infrastructure, and turnover of the public health workforce and brain drain of expertise, Public Health faces an uphill battle in delivering the Essential Public Health Services and realizing its vision. Declining trust in institutions make more difficult our efforts to respond to population health threats.
Policy Landscape
The evolving policy landscape poses novel challenges to public health authority, as new laws emerge that curtail the powers of public health officials and restrict evidence-based measures to protect public health, and existing public health orders are overturned. These new moves to limit public health authority are examined below.
Chronic Underfunding
Public health agencies across the country face chronic underfunding. Underfunding makes it difficult to maintain adequate staffing levels, compensate and support employees, implement essential programs and services, and respond to emergencies. The impact of disinvestment was never more evident than during the COVID-19 pandemic, when response efforts failed to meet demand in many places due to underinvestment in the Essential Public Health Services.
Workforce Challenges
Over the last several years, public health entities have seen a mass exodus of personnel. During the COVID-19 pandemic and since, many exhausted, burned-out, underpaid, and demoralized public health workers left their jobs, and some, the field. In some places, public health experts and officials were replaced by local voters with officials who committed to reigning in public health authority. Turnover in who is doing the work of public health has implications for institutional knowledge and trust, and creates challenges and opportunities in advocating for public health authority.
Declining Trust
For much of our public health history, high levels of trust in institutions (as well as trust in science and expertise!) have aided public health responses. Public trust and trust and institutions has declined in recent decades. In the last several years, failures of and frustrations with the COVID-19 response have pushed trust to a breaking point. Low levels of trust threaten our ability to maintain and regain public health authority. Building public trust sets the stage for expanding public health authority.
New Moves to Limit Public Health Authority
Against a backdrop of eroding authority, some legislatures and courts are taking decisive actions to weaken public health authority further with new moves that stymie response efforts. Such actions create and perpetuate health inequities and undermine the public’s trust in public health institutions, further eroding authority.
- Restricting the scope of an emergency order
- Limiting the duration of an emergency order or state of emergency
- Enabling legislatures to terminate an emergency order
- Requiring vaccinations
- Imposing mask mandates
- Closing schools, businesses, or places of worship during public health emergencies
- Imposing isolation or quarantine measures
Responding to Threats
Amidst these existential threats, public health stands to leap forward. As stewards of public health, we can work together to strengthen public health authority and advocate for the public’s health.
Strengthening Public Health Authority
The ongoing restriction and reallocation of public health authority delays response public health emergencies and shifts power away from experts. In contrast, strengthening public health authority can help shore up the public health system by:
- Authorizing public health officials to handle crises efficiently and create detailed response plans, minimizing the impact of emergencies;
- Enabling swift and effective response to contain outbreaks of infectious diseases, such as COVID-19; and
- Providing the tools needed to implement interventions that promote health and address health disparities.
Instead of weakening public health authority, to adverse consequences, we can strengthen it–and secure vital conditions that all people need to be healthy and well.
Through advocacy we can strengthen public health authority.
Advocating for the Public’s Health
Strengthening public health authority requires sustained advocacy and collective action. Through advocacy we can defeat bad policies that limit and erode public health authority, and support good policies that expand and secure public health authority. Regardless of who you are or what your role is, you have the potential to make a difference on issues of public health authority.
Through intentional and intersectional advocacy we can protect and expand public health authority.
Reflection Questions
- What are two ways public health authority is being eroded? What are the implications of this reduction in authority?
- Share an example of a legislative action that was taken to reduce or limit public health authority? How might this type of action impact public health outcomes?
The next module covers advocating for public health >