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Opinion: The Diminishing Role Of Public Health

Hugh Greene
Via Jacksonville Daily Record
Hugh Greene

Editor's Note: The following opinion piece is by Hugh Greene, Retired President & CEO of Baptist Health and a contributor to First Coast Connect with Melissa Ross.

What has been glaringly apparent to me in the past few months of the pandemic is the diminished role of public health.

Before I comment further, let me be clear that I am not intending, in any way, to be disparaging toward the work of our current county health department or its leadership. They work hard every day and are about important work.  Yet, to say that they operate with a lack of resources is an understatement

Especially during this pandemic, where has the voice of public health been and does that voice speak with real authority locally in the midst of this coronavirus crisis?

Let me speak from my past personal experience. As CEO of a major health system, I experienced the vital role of public health on many occasions, whether it be the operation of clinics for the uninsured or its leadership in times of community crises. For example, in the midst of hurricanes in the early 2000’s, we faced necessary evacuations, including the need to move hospitalized patients to safer locations across our county. The lead role was played by the leadership of Duval County Department of Health in coordinating our response. It was a role that could make the best community decisions with authority and autonomy. In subsequent years, that role has largely diminished.

There are two disturbing observations I would make that are even more obvious with the light cast by the coronavirus crisis.

First, there has been a significant reduction in resources for public health. Let’s be clear. These reductions are much broader than Duval County and have been significant, if not drastic, across the state. Between 2010 and 2018, Florida cut funding for county health departments by over 10% and the number of positions funded by the state shriveled by a dramatic 27%. A Florida International University study found that state public health funding was cut by 35% over a six-year period on a per capita basis. There has been a 50% decline in local positions since the early 2000’s.  These funding cuts are clearly shortsighted.

Second, but related, is that the public health infrastructure has been dismantled. In the past, there was a decentralized network of local health departments to address local public health issues.  Now with centralization in Tallahassee, county health departments function as state offices in each county but with dramatically less funding. Even the name has been changed to the “Florida Department of Health- Duval County.” I would argue that public health is largely local.  

These changes have occurred gradually over time and largely unrealized by the public. In the past, the director of the local health department would be a visible member of the mayor’s response team. Public health expertise would be brought to bear on our local response to the pandemic. This is another lesson learned from this current crisis and one that should not be missed by our state legislators.  Restoration of funding of public health should commence now. Restoring the authority and the autonomy of local public health leadership is needed. The current health crisis will not be the last. The local public health organization is essential to help with disaster preparedness, whether a hurricane or a pandemic. Public health brings important expertise, and should play a key coordinating role, in our local community response to whatever crisis lies ahead in the future.