BERNARD COLUMN: Public health and LaGrange

Bernard is a retired corporate executive

LaGrange is home to the District 4 regional public health office, which serves a 12 county area of middle Georgia. I visited that office recently and met with key staff, who are an experienced group of public servants. Dr. Beverly Townsend, MD, the interim District Health Director, was part of this group.

One topic we discussed is that Georgia's county public health departments, which are funded by local, state and federal sources, accomplish much more than most taxpayers realize. The lack of appreciation is inevitable, given that ordinary Georgians have many other things to be concerned about, including the pressures of making a living and raising their families. However, the more you know about public health, the more you appreciate it.

The mission of the Georgia Department of Public Health is "to prevent disease, injury and disability; to promote health and well-being; to prepare for and respond to disasters." Public health departments provide- environmental health/regulation (for example, restaurant inspections); women's health services; screenings; immunizations; planning for catastrophes; prevention/control of communicable diseases; coordination with mental health services, and health education.

Each of Georgia's 159 counties has a board of health, a BOH. In addition, there are 18 regional health districts statewide. Theoretically, each has a physician as district director managing operations as CEO of each county board. Although the boards are legally separate entities, the Georgia Department of Public Health has oversight for boards.

I was Director of Health Planning in the 1970s, establishing health goals for Georgia, and identifying the resources needed to be effective. District health directors and boards of health (like the one I now Chair in Fayette County) are now the primary entities performing this vital function. Close coordination and support from other departments of the local, state and federal governments, as well as from the private sector, are critical to the success of this mission.

Every objective study that's done finds that healthcare financing and public/private delivery systems in the US are inferior to other developed nations.

And the health status of Americans also ranks on the bottom versus wealthy countries.

Major actions are needed to correct these problems, but our citizens do not fully comprehend the issues and must before funding is appropriated. The situation is exacerbated by the current tribalistic nature of our politics. Therefore, our political structure is not ready to take the most effective strong measures, like universal healthcare insurance coverage, available in every other developed nation.

However, there are many short-term things that can still be done in a bi-partisan way on the Federal level to incrementally improve the public health system, for example- 1. public health educational loan repayment, 2. additional public health infrastructure dollars and 3. guaranteed funding for local health departments. All three are needed for our Georgia public health departments, which have been sorely underfunded by both the state and federal government for a long time.

Nationally, hundreds local and state health officials have resigned their positions to work in for-profit businesses or retire. One-third of the remaining officials will be gone a year from now due to burnout, as well as poor pay. A recent national analysis found that local public health departments need at least 54,000 more full-time equivalent positions — an increase of 70 percent — to provide a minimum set of public health services. If there was a fully funded, generous national public health employee school debt repayment program to offset the money borrowed by students to get through nursing, med school, residency and so on, we would have more luck recruiting an MD and staff for Georgia's health districts.

Currently, national public health funding is usually tied to a particular disease, like Covid-19. Thus, the local health department never gets adequate funding to bring their broader IT and communications systems up to date. Thus, there were problems under the pandemic. Problems which will reoccur in the next crisis unless addressed now.

Federal legislation is also needed which will require funding to be delivered to the local health departments directly. The alternative is what exists now- insufficient funding going to the state… with a significant proportion inevitably being spent for state government bureaucracy in Atlanta and other state capitols.

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