Revitalizing policy is desperately needed to overcome the social, economic and health disparities in the U.S. that have been magnified by the COVID-19 pandemic and outcries over racial injustice, according to the new APHA Press book Public Health Under Siege: Improving Policy in Turbulent Times.
As COVID and other crises have made clear, everyone must recognize that public health is political. Such recognition is necessary to explore pathways for change, such as overcoming racism.
“Our inability to curtail COVID-19’s impact stems from an abysmal partisan response and decades of harmful policies and unaddressed health inequities,” write co-editors Grace Guerrero Ramirez, MSPH, former fellow of the Association of Schools and Programs of Public Health, and Grace Castillo, MPH, program associate at the de Beaumont Foundation.
“These inequities have been created and exacerbated by racist and oppressive policies sponsored by governments and corporate interests – these policies are working exactly as they were designed,” they write. They add that public health practitioners need to be “bold, loud and creative” to sustain a unified movement for health equity and pursue justice.
The de Beaumont Foundation and the American Public Health Association collaborated on the book, which details the critical role of policy across a wide spectrum of issues related to the social determinants of health.
Featuring the voices of public health professionals and advocates who have worked with community and political stakeholders to address challenges, the book outlines policy victories such as: funding for improved data infrastructure; sound gun safety legislation; and advancing policies for racial justice.
It also documents vast inequities, from struggling schools to unsafe neighborhoods, that must be overcome through policy change.
“It’s been like a sinking ship,” said Brian C. Castrucci, DrPH, president and CEO of the de Beaumont Foundation, of the current health care system that focuses on access and insurance, too often ignoring prevention of illness.
“Bailing only lasts so long before the boat sinks,” Castrucci said. “That’s like our health care and its broken policies. We have to revamp our policies to fix what’s wrong.”
The book shows how individuals, community groups and other advocates can work with state and federal governments to develop innovative policies to effect change.
“We are at a crucial point in time, not only dealing with a pandemic but many other preventable health emergencies. These challenges require policy solutions that address the root causes of poor health and inequality,” said APHA Executive Director Georges C. Benjamin, MD. “This book is a handbook for policymakers at all levels to better understand the critical links between policy and health and how they can take actions to improve our health.”
The U.S. spends $3.6 trillion — more than any other nation — on medical care, but ranks 37th in overall health performance, reflecting decades of neglected social policies that contributed to the environment where the virus could thrive, according to Benjamin and Castrucci.
Far less money is spent on education and to address unemployment, poverty, environmental exposures and community safety, the book shows. Health inequities can be addressed when policymakers at all levels of government increase opportunities for people to make healthy choices, the authors state. The book calls for policies that give all people the opportunity to achieve good health, such as access to nutritious food, early education and green spaces.
A consistent message in the book is the significance of public health, and how advocacy for laws and regulations must continually be initiated to improve public health, not undermine it.
“We haven’t seen public health fully supported on the policy level,” said APHA Associate Executive Director Susan Polan, PhD, who writes in the book about APHA’s Speak for Health advocacy campaign. “We can’t let up because that must change.”
