The COVID-19 pandemic has demonstrated that the nation’s public health infrastructure and
workforce, long neglected, are critical to the country’s security and stability. As your constituent, I urge you to include the Public Health Infrastructure Saves Lives Act (PHISLA, S.674) in the infrastructure and jobs legislation to strengthen our nation’s public health capabilities.
The legislation would fill long-standing gaps in public health, enable modernization of archaic
technologies and systems, and build a foundation for a more effective, efficient public health
response to future pandemics.
The pandemic exposed the deadly consequences of chronic underfunding of basic public health
capacity. The costs can be measured in over 600,000 lives lost in the U.S. alone, the largest drop
in gross domestic product since 1946, trillions of dollars in response and relief funding, and the
closures of thousands of schools and businesses. Health agencies were gravely outmatched by
the virus, responding to the outbreak with a depleted and exhausted workforce and archaic
technologies. Local health departments have lost 21 percent of their workforce capacity since
2008, while state health agencies lost nearly 10 percent of full-time equivalent staff since 2012.
While supplemental funding has been critical to addressing the COVID-19 pandemic, most of
these are not sustainable positions. Fire departments do not eliminate firefighters and equipment as soon as a blaze is contained; yet public health follows a repeated pattern of underfunding, followed by supplemental funding and short-term hires, followed by retrenchment and layoffs.
The result is lost expertise, failure to update neglected technologies, difficulty recruiting and
retaining expert workforce, and an inability to address chronic health disparities.
PHISLA would establish a Core Public Health Infrastructure Program at the Centers for Disease
Control and Prevention (CDC), awarding grants to state, local, Tribal and territorial health
departments to ensure they have the tools, workforce, and systems in place to address existing
and emerging health threats and reduce health disparities. PHISLA invests in the foundational
capabilities of public health.4 Because public health is largely funded by disease or condition,
there has been little investment in cross-cutting capabilities that are critical for effective public
health. These capabilities include: public health assessment; preparedness and response; policy
development and support; communications; community partnership development; organizational competencies; accountability; and equity. The legislation includes strong accountability measures through public health accreditation. The legislation dovetails with the public health workforce provisions of the American Rescue Plan (ARP), as PHISLA ramps funding up just as ARP money begins to expire.
Now is the time to learn the lessons of this devastating pandemic. We simply cannot prepare for 21st century
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