The future of public health: trends, issues and outliers
Written by Frederick Johnson
|From tracking trends in disease and illness to organizing efforts that promote a longer and higher quality of life, individuals working within public health have large goals that deal very specifically with individual people.|
One of the most fascinating aspects of public health is the ways in which it changes over time. The concerns of the early part of the 20th century are quite dissimilar to the concerns of the 21st, but the goals of those studying and working in the field are the same: better health for more people. Many of the challenges facing public health workers are substantial. Here is a look at the trends and issues facing today’s public health worker, from dealing with budget cuts to continuing to add to their education.Changes in Surveillance
One aspect of public health that is markedly different than it was even ten years ago is that of surveillance. Electronic data collection systems, the analytic muscle of big data, the ability of an interdisciplinary approach — all this has made public health surveillance more extensive and more complex, and while it may be tempting to believe that our technological prowess can mitigate health threats, human expertise is still essential in the diagnosis of disease, data interpretation, communication and more to ensure that the public’s health is protected. To that end, may disciplines must come together in surveillance, including:
· CoronersBudget Cuts
The economic downturn of 2008 coupled with budgetary showdowns and shutdowns in Congress have created a public health system that has suffered extensively from cuts. As a result, most organizations within the public health sector find themselves in a transition time that looks to remain. State and federal budget cuts affect everything from the implementation of laws that affect public health to the accreditation of public health agencies. Many public health positions have been eliminated entirely due to budgetary constraints, so many public health workers find themselves working in nontraditional settings outside government.Workforce Shortages
Numerous workforce shortages exist and look to continue, both due to budgetary pressures and waning involvement. Areas that deal with surveillance, nursing, lab work, environmental health and the like all need more workers. In fact, The Association of Schools of Public Health predicts that approximately 250,000 more public health workers will need to enter the field by 2020 to maintain current rates of public health officials.Education
As technology continues to evolve at an almost breathless pace, the educational needs of public health workers evolve, too. From staying abreast of surveillance trends to utilizing new software to gather, analyze and interpret data, technology is seeing a regular uptick in a need for continuing education within the entire public health sector.
It isn’t just technology’s advance that makes ongoing education so vital for public health. Research continually changes what we know about medicine, and public health officials need to keep up with it. Additionally, as laws change, enforcement shifts as well. Ongoing education is a necessary and difficult-to-meet challenge both right now and in the future.Infrastructure Needs
Without a properly understood, functioning and executed infrastructure, public health officials cannot hope to deal with the vast health needs at the national, state and local levels. Both acute and ongoing threats must constantly be evaluated and responded to. Infrastructure is how the work of public health gets accomplished. Due mostly to budgetary cuts, the infrastructure of the United States’ public health system is under duress. The need for a well-qualified, educated and capable workforce, the necessity of an up-to-date data gathering and analyzing system and operational agencies that assess public health needs and provide solutions are all part of what makes the public health system run, and these three areas are in transition, or in danger of being so underfunded that they are effectively eliminated.
Public Health is an area of ongoing need whose struggles to meet those needs are different than those of days past. From the stress budget cuts place on workforces and infrastructure to the continual demands that technology places on educational needs, the future of public health will need to become more flexible and thrifty, especially if it hopes to remain vital.
About the Author: Frederick Johnson is a contributing writer and public health administrator in a high-need community.
NHS staff face severe impact on mental health due to COVID
The decision to drop COVID-19 restrictions in England this month alarmed doctors in the National Health Service (NHS) while hospitalisations are on the rise. At the same time, hospitals have started cancelling operations again adding to the existing backlog of operations, which estimates say could take a year to clear.
Dr James Gilleen of the University of Roehampton and his Covida Project team are warning of the ongoing risks to the mental health of NHS staff, many of whom are traumatised from the first wave of infections. “As the UK continues to see COVID-19 infection numbers rise at a similarly alarming rate as those seen during the country’s second wave, it’s combined with a renewed strain on the NHS and its staff" he said.
The Covida Project is a digital tool created to assess the psychological impact of the COVID-19 pandemic on frontline workers including NHS staff, the police and carers.
“Healthcare workers are already exhausted and burnt-out; they are traumatised from their experiences of working during the pandemic. During the first wave in May 2020, a study from the Covida Project found an unprecedented quadrupling of the number of NHS staff with high levels of anxiety, depression and post-traumatic stress disorder (PTSD) compared to before Covid-19" Gilleen said.
"Having the most severe levels of these symptoms was statistically linked to four key factors - insufficient access or pressure to reuse Personal Protective Equipment (PPE), insufficient workplace preparation, insufficient training and communications, and a higher workload. Staff aren’t just anxious, depressed and traumatised from being over-worked – it is from feeling unsafe and at risk."
The Covida Project found that almost a third of healthcare workers reported moderate to severe levels of anxiety and depression. The number reporting very high symptoms was four times higher than before the pandemic.
Gilleen adds, “With COVID-19 restrictions now fully removed in England, NHS staff face the daunting triple-threat of rising Covid-19 hospitalisations, huge backlogs of medical operations to clear, and the added expectation of large increases in winter flu, which is already being seen even now in summer.
"These difficulties are present at a time when the NHS is already under-resourced, impacted by sickness and/or staff being ‘pinged’ to self-isolate through the government’s track and trace app, and staff continuing to fear the daily risk of infecting family and friends.
"Together these are considerable psychological burdens and create a perfect storm for the mental health and well-being of NHS staff."
Gilleen says there may be worse to come, especially if new, more transmissible variants develop. "Previous research after other pandemics such as SARS has shown that residual mental health symptoms like PTSD can continue for years, so the impact of repeated waves over the long-term will be potentially catastrophic for the mental health of NHS staff.
He has some clear recommendations to protect the wellbeing of frontline healthcare workers. “To protect the mental health of NHS staff they must feel they are less at risk or in danger, have access to the required level of PPE, not be continuously over-worked, with better staffing, more opportunities for rest and space to share their stress.
"Despite this and similar findings from other studies, still not enough is being done to protect NHS staff mental health and wellbeing and we fear it will continue to suffer in the months to come. With this comes the real risk that large numbers of staff will burn out or even quit the NHS.”