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David N. Sundwall: Restoring confidence in public health. It’s a crisis of trust.

(Francisco Kjolseth | The Salt Lake Tribune) A group faces the House chambers at the Utah Capitolon Monday, Jan, 28, 2019, on the first day of the Legislative session to rally in support of protecting Proposition 3, the Medicaid Expansion law recently passed by voters.

The COVID-19 pandemic has changed the world, and in some unexpected and surprising ways. I have always thought of “public health” as providing essential services to keep us safe and healthy, and those involved in such efforts as heroes, e.g. Dr. Albert Schweitzer, the well-known physician/theologian as a medical missionary in Africa.

I think most people have also a positive view of public health in general, knowing that some government programs “have their backs,” are assuring the safety of the food we eat, the water we drink, informing us of risks to our health, and protecting us with vaccines, etc.

Yet, over the past several months, public health efforts and officials have been maligned and considered by some as having caused the worldwide economic downturn and dire consequences for employment, education and mental health. In my opinion, this is somewhat akin to “shooting the messenger,” to blaming the bearer of bad news for the consequences of the pandemic.

We have experienced the unfolding of a “novel virus,” a new threat to our health that has posed challenges beyond anything those of living have known, and we are learning more about it as it has spread throughout the world. Our situation was well characterized by U.S. Surgeon General Jerome Adams, who spoke last fall to a virtual conference hosted here in Utah, when he said, “We are building the plane as we fly it.”

He acknowledged that there was lots we didn’t yet know about this particular virus, and that policies and guidance would need to change and evolve over time as we learned more. Of course this is what has happened, and early on recommendations were made re: shutting down entire communities, broad stay-at-home orders and closing schools based on the information available at the time. We now know that some of these polices were very likely an overreaction to the threat posed, and that our efforts to limit the spread of the virus need to be more targeted to those at risk.

I was pleased to learn that in our state our new governor, Spencer Cox, acting as the state’s lead on the COVID response last fall, included representatives from the business community and economists in their deliberations and planning. He described in a recent radio interview that public health experts are now working hand in glove with those who better understand the potential economic impact of restrictions on businesses and the general public. Together they have developed a three-phased plan for economic recovery that will reflect more careful and prudent use of government regulations.

But misgivings about our public health response to the pandemic, on the part of some citizens and legislators, have led to consideration of wholesale restructuring of the Utah Department of Health. Legislation has been drafted that would take the Medicaid program out of this department and place in it the Department of Workforce Services. Why? What does this have to do with the pandemic?

While we should always be striving for more efficiency and to reduce duplication of effort, Medicaid is a health insurance program, not an employment program, and this would be bad move. Better, in my opinion, would be to consolidate all Medicaid services in the UDOH. I understand some have also considered parsing public health functions and responsibilities out to other agencies, and if so, why?

I recommended to Cox’s transition team that before any structural or organizational changes are made to the UDOH, that these issues should be carefully considered, that a task force or commission on the “Future of Public Health in Utah” be established to study these important issues and to make recommendations on how best to organize our state’s public health entities, including not only the UDOH, but also our 13 local health departments. The goal should be to have a robust, effective and efficient public health enterprise throughout our state – one in which we can all have confidence and trust.

Utah has a proud tradition of accomplishments in public health and has always ranked highly on most measures of health status. During this pandemic, let’s do all we can to strengthen and support public health in our state, to be better prepared to address future public health challenges.

David N. Sundwall, M.D.

David N. Sundwall, M.D., is emeritus professor of public health at the University of Utah School of Medicine and chief medical officer of Rocky Mountain Care.

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