32: Federal Debt Limit Alert

ROBERT JOHNSON:

This is Public Health Review Morning Edition for Thursday, September 23rd, 2021. I'm Robert Johnson.

Here's today's news from the Association of State and Territorial Health Officials.

Developing this morning: money to fund wildfire and hurricane response and recovery efforts as part of a bill passed in the U.S. House to extend the federal debt limit through next year. The proposal also would continue the current federal funding match for Medicaid programs in the U.S. territories through early December, avoiding a September 30th deadline.

It's not a done deal, however—Senate Republicans have opposed the extension.

ASTHO issued a legislative alert on the bill this week, the government relations team saying a federal shutdown cannot be ruled out. Look for a link to the alert in the show notes.

Preparedness has been highlighted during the COVID-19 response and vital to planning for the next pandemic.

Ray Barishansky is the deputy secretary for health preparedness and community protection at the Pennsylvania Department of Health. He's thinking about the 20 years that have passed since 9/11 and the lessons that apply to future crisis events.

It's today's morning conversation.

Preparedness is generally well-funded during or following an emergency—people are willing to put money into these issues when there's a crisis; and you could say right now that public health is in a boom funding cycle because of the pandemic.

What can states and territories draw from 20 years of history to avoid finding themselves in another bust cycle once this pandemic ends?

RAY BARISHANSKY:

It's interesting that you ask that because I often refer to that boom and bust cycle as a disease du jour approach to funding public health preparedness, and I think that that's a mistake.

When you fund public health preparedness based on a specific disease—whether that's COVID, or H1N1, or Zika—what you're doing is you're not funding public health preparedness infrastructure, and that's a necessity.

So, I would tell anybody who's looking to not find themselves in another boom-and-bust cycle to advocate, advocate, advocate.

We recognize that after this specific public health emergency—i.e., COVID—we'll be seeing a lot of funding to help address this response.

But I would tell people to look at the fact that if we would have invested even a fraction of that amount over the last 10 years, we would have had more personnel, we would have had better systems, we would have had better equipment, and we would have been more prepared by maintaining a higher level of public health infrastructure.

JOHNSON:

What's the best way, then, for ASTHO members to make that case?

BARISHANSKY:

That's a great question, and I think it's about crafting the right message for the right audience.

So, whether you're dealing with local state or even federal decision-makers, you have to frame the issue as the fact that sustained investments in public health will benefit different people in different ways. So, you could message the fact that sustained investment or infrastructure investment means that, during non-pandemic times, we have more public health resiliency, and we can provide better care and support to our population.

But at the same time, you would also say that this will pay off during our next big public health emergency—because, remember, public health preparedness has both what I can call a war time and a peace time mission.

So, even when there is no public health emergency, there is still so much in public health that's operating behind the scenes.

JOHNSON:

In the article that you co-authored with Mike Fraser and Jim Blumenstock, the three of you say a state of complete and total preparedness for all public health emergencies may not be a realistic goal.

What should be our preparedness objective coming out of the pandemic?

BARISHANSKY:

So, I was once describing an emergency plan to my health officer, and he looked at me and said, "Would you say it's 100% done?"

And I said, "I don't think any emergency plan is 100% done.” It might be in the 90 percentages, but then we have to use every opportunity to get better. And I think that's what Mike, Jim, and myself were trying to say.

We have to use everything we can—whether that's in regard to the investments that are now being pushed out to us for COVID—we have to use our after-action reports, we have to apply the lessons learned, we have to have a holistic approach to making public health preparedness better.

But even then, we need to understand that we have both internal and external stakeholders who are going to help us as we come out of this pandemic to make public health preparedness a stronger entity in totality.

JOHNSON:

Also today, parents watching news reports of progress developing COVID-19 vaccines for kids need constant communication as they navigate the perils of the virus.

That insight from Dr. Joshua Starr, CEO of PDK International, an education nonprofit and sponsor of a poll that has surveyed America's attitudes toward education for 53 years.

JOSHUA STARR:

I think that, from what I've seen over the last year and a half, the schools and leaders that are doing this best—even if they're in states where the governor hasn't provided leadership, or the state legislature is being problematic—the ones that are doing the best are the ones that continuously communicate with their families, with their kids, and are just, you know, as the old line was, “Seven times, seven ways of communication,” just regularly communicating.

People tend to trust teachers. They tend to trust principals—the more you communicate, tell them what's happening, even if you don't have definitive answers, you know, I think the better off that the public will feel and the more confidence they'll feel that the school has it under control.

JOHNSON:

Even though his work is focused on education, Starr says the feedback from parents also can be helpful to public health teams, especially when talking about masks and vaccines in schools.

Finally this morning, pharmacies have been strong partners during the pandemic and a new ASTHO blog article says they also should be part of the conversation about future crisis response.

The article, written by Joanne Roth from the Pennsylvania Department of Health, outlines the state's experience working with pharmacists, noting they've become important educators, immunizers, and partners in the neighborhoods they serve.

There's a link to the article along with links to other resources mentioned today in the show notes.

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Join us tomorrow morning for more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition.