Public health is one of the most basic responsibilities of government at every level. And while plagues historically have decimated populations the world over, the advent of antibiotics and vaccines allowed the developed world to go through decades of relative safety protected from infectious diseases. But it begs the question: why after 41 years of HIV and the onslaught of COVID, why can't we seem to improve, at least here in Los Angeles County? I personally remember lining up for the polio vaccine at school in New York. It was as simple as ABC.
From the polio vaccine in the '50s until HIV in the '80s, there were no mass infectious killers in the United States. As a result, the public health system withered. Now, one disease after another is afflicting us, currently with COVID and monkeypox, and our defenses against them at every level are defective. It is time we stop talking about repairing the public health system and actually begin the renovation.
Los Angeles is the largest county in the nation, with more than 10 million residents, which places a tremendous burden on its public health department. A burden they have repeatedly demonstrated they cannot meet. It falls on local leaders to chart a new course for the future rather than patching up a system that cannot meet the challenge. Yet there is no one at any level of government that has sounded that alarm and put forward a comprehensive plan.
Three basic problems plague public health efforts in Los Angeles County:
- the department is underfunded;
- it is overly bureaucratic;
- and it does not believe in partnering with the community.
They forget that public health is just that – “public.” It relies entirely on the understanding and cooperation of the public. The best way to gain that support is through trusted representatives of communities. Instead, the department treats community institutions as supplicants and uses the club of its funding to keep them in line.
If we are to build a new public health system that can truly protect us, it must start at the community level. The county should convene public hearings at the community level where they listen and engage with religious institutions, community clinics, business groups, professional associations, and neighborhood groups.
Whenever we go to the county to point out the yawning gaps in services, they always try to shift responsibility to the state and the feds. However, the county is the healthcare provider of last resort and has the local responsibility for public health. Whether it is the epidemic of STDs, monkeypox or COVID, it cannot always shift the responsibility to the federal government. L.A. County has a $38-billion budget, which is larger than the GDP of entire nations. If the L.A. Board of Supervisors doesn’t invest in public health, then that is on them. L.A. lags badly behind other major metro areas in disease control.
A top-to-bottom analysis and reorganization of the Los Angeles public health system is long overdue. Is it too big? Should the city of Los Angeles have its own health department - which it had until 1965, as do Long Beach and Pasadena? Are there standards for community engagement? Are there set goals for bringing down infection rates? Is the management accountable for meeting these disease control goals?
Most importantly, how will the community be engaged? Public health at its best is based on maximum persuasion and minimum coercion. A robust public debate is dangerously overdue.
Let’s start it today.