The rapid emergence of COVID-19 reminds us of the importance of the public health system. Local health departments (LHDs) play a central role in emergency preparedness and response. Effective epidemic response rests on the performance of the essential public health activities— assessment, policy development, and assurance—by LHDs.
Evidence suggests that LHDs can improve population health by reducing substance use-related and suicide-related emergency department visits, hospital admissions, readmissions, costs, and preventable deaths. In a study published in Medical Care in 2018, we demonstrated that LHDs are critical to coordinate and tailor care and promote health equity. However, LHDs receive only about 3% of total healthcare costs in the US.
We see three urgent areas for action to position LHDs to adequately promote population health and respond to epidemics.
First, LHDs need adequate and sustainable funding. In 2016, 22% of LHDs reported budget cuts and anticipated cuts in the upcoming year. Meanwhile, 93% of LHDs perform epidemiological surveillance activities. While the emergency spending bill enacted earlier this month transfers funds to states and municipalities for COVID-19 activities, it does not enable LHDs to improve overall population health. Emergency funding may have allowed states like Florida to temporarily hire 100 new epidemiologists, but longer-term systemic changes are needed to ensure that LHDs can provide the maximum benefit to the communities they serve. With adequate and sustainable funding LHDs can focusing on integrating their services within hospitals and health systems. They can also encourage other social service agencies to do the same. This would allow health systems to deliver more whole-person care.
Second, it is urgent that we strengthen care coordination to promote the integration of LHD services with the medical care system. Ongoing policy reforms encourage hospitals to partner with LHDs in various ways. These policies include: Accountable Care Organizations, pay-for-performance, and non-profit hospitals tax laws requiring a community benefit. Our prior research suggests that the care coordination and wellness promotion activities conducted by LHDs can make a meaningful improvement in population-level health.
Third, LHDs need to improve the use of information technology. This would allow them to integrate service delivery alongside medical providers. However, health-related information technologies are designed to meet the need of healthcare providers in hospitals and medical offices. Most health IT systems do not support real-time population health monitoring and reporting. Information technologies for LHDs need to be standards-based (e.g., FHIR) in order to enable the transfer of data and provide a workflow that is responsive to the needs of public health practitioners.
The COVID-19 pandemic has elevated preparedness and response on the policy agenda.
While hospitals are treating patients with COVID-19, LHDs have the lead role in controlling the pandemic. LHDs are the hub for data collection and dissemination. They provide linkages between public health laboratories, hospitals, and the Centers for Disease Control. They also conduct all contact tracing and communicate with the public about the risk of COVID-19. Thus, now is the time to act to ensure that LHDs have adequate funding for staff and technology. This will improve their response to emerging threats like COVID-19 other novel epidemics that are yet to come.
Priscilla Novak
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Ivy Benjenk
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Jie Chen