As the world focuses on Olympic medal counts, there is one race we do not want to win. Unfortunately, the U.S. is on pace to be the first nation to reach the 1 million COVID-related death mark. And, if you pause long enough to consider our health as a nation, this is not surprising at all. Life expectancy in the U.S. is a full five years less than in other high-income nations.
Vaccine hesitancy is not the only reason that the pandemic has hammered the U.S. The problems go deeper, to higher rates of obesity, substance misuse, cancer and high blood pressure. Worse still, there are major disparities in diseases and death with Black, Indigenous and people of color bearing a higher burden of COVID and many chronic diseases. We are the sickest wealthy nation in the world.
There’s a federal agency charged with protecting and preserving Americans’ health: the Centers for Disease Control and Prevention (CDC). It’s finally time we gave this agency the resources, authority and mandate to improve the nation’s health. A major overhaul is needed.
Our current public health system is threadbare, a fragmented patchwork of local, state, and federal health agencies with insufficient staffing, laboratories, disease tracking systems and public health interventions, leaving us with highly variable levels of protection and health disparities from one zip code to the next. Funding restraints and leadership limitations prevent public health agencies, including the CDC, from addressing the leading causes of premature and preventable death and illness.
The CDC’s weaknesses are not shared by other federal agencies. U.S. Department of Agriculture (USDA) food inspectors are charged with keeping diseased animals, rodents and bacteria out of our hamburgers. They have the power to stop meatpacking operations if necessary. Subpar meats get labeled with poor grades, and the public is informed. But if the CDC shows up at that same facility, the investigative team can only make suggestions. The company isn’t obligated to follow the guidance and the public will never know.
Compare how we track and tackle pollution versus diseases. The Environmental Protection Agency (EPA) mandates that every industrial facility report and control specific substances, providing regular measurements so that it can monitor compliance and reduce harmful exposures. In comparison, the CDC cannot order states or hospitals to track the primary diseases that kill us or shorten our lives. For COVID, some states refuse to provide any data and others choose not to report race or demographics, which hide disparities. Others had every hospital fax hand-calculated numbers. Not one state worked from a uniform definition.
This chaos is the norm. Asthma, the number one cause of childhood emergency room visits, is not tracked around the country. Huge disparities, hot spots and preventable cases go undetected. If a child is shot on a playground, the police investigate. Yet no disease detectives are assigned to investigate a pediatric asthma death because there is no data or mandate.
We faced a similar vacuum 50 years ago. The Cuyahoga River in Cleveland caught fire, Los Angeles was enveloped in smog, and New Jersey and Louisiana were known as industrial cancer alleys. To address the crisis, the EPA and its state counterparts were created using public health agency staff and energized with new laws, authorities and funding. The EPA sets basic standards for every state on drinking water, clean air and clean-up rules for dangerous spills and industrial hazards. As a result, every American, regardless of where they live, work, or play, has a realistic expectation to be protected from dangerous toxins. When these protections fail, as with the drinking water in Flint, Mich., scandal erupts.
We need to do the same for dangerous diseases, no matter how common. We do not have a uniform disease tracking system. The CDC does not have regulatory authority; it can only use funding and moral imperatives to cajole and encourage states to perform basic public health duties. Nor does it have ready-to-go surge capacity. We need more disease detectives and resourced laboratories in every state and city to tackle risks from anthrax to asthma and assure our rates of death, disease and wellbeing do not vary between neighborhoods.
It’s become easy to blame the CDC for shortcomings in the COVID response. The big picture, however, is that we cannot hold the CDC accountable when it lacks basic capacity.
Bipartisan legislative bills have been introduced in Congress to ramp up the public health workforce and pandemic response. The new Center for Forecasting and Outbreak Analytics will improve the agency’s predictive capabilities, but the gaps in real, everyday data will remain. These are all important first steps but dance around the edges. We need a new game plan — a bigger, bolder overhaul from the ground up with an emphasis on reporting and regulatory mandates.
Let’s fully revitalize the CDC so that we can become a contender in the quest to be the world’s healthiest nation.
Shelley Hearne, DrPH is the Deans Sommer and Klag Professor and directs the Lerner Center for Public Health Advocacy at the Johns Hopkins Bloomberg School of Public Health