Leadership in Public Health: 3 Challenges and Opportunities

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Public health workers see patients at a field clinic.

Public health affects us all. The most recent noteworthy example of the field’s importance is how public health officials organized to detect, prevent and treat COVID-19 and its many variants. A coordinated defense against an infectious disease doesn’t happen by accident. Leadership in public health is crucial to planning a response, ensuring that health care workers have the resources they need and keeping the public informed.

However, public health is about far more than responding to infectious disease outbreaks. It also involves promoting healthy lifestyles; performing research on disease and injury prevention; recommending health-positive policies; and implementing educational programs in schools, businesses and government facilities.

The field of public health faces many challenges. Some high-level examples are a lack of adequate staffing, a shortage of medical supplies and a deficit in funding. These three elements pose a significant threat to public health and its ability to function efficiently. An advanced education, along with years of experience, can help public health leadership develop the expertise needed to address the challenges facing the field.

Staffing Challenges and Opportunities

Staffing shortages remain a long-standing challenge that public health leaders must constantly problem-solve. Scott Becker, CEO of the Association of Public Health Laboratories (APHL), cited an aging workforce and the increasing complexity of skills required to do the job as two main reasons for the staffing shortages.

According to a 2021 research brief by the de Beaumont Foundation, government public health departments at the state and local levels need to increase their workforces by at least 80% (approximately 80,000 full-time equivalent positions) to provide the minimum level of public health services to the country.

The public health sector needs to grow its workforce significantly in a short amount of time to overcome this gap in employment. According to Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials (NACCHO), the key to retaining employees is securing emergency federal funding at the local level so that city and county public health workers can be retained despite losses in local tax revenue.

For example, in September 2021 APHL was awarded $282 million by the U.S. Centers for Disease Control and Prevention (CDC) via the American Rescue Plan. APHL used these funds to boost the public health workforce with qualified professionals to work in laboratories. The investment was also used to expand upon APHL’s fellowship program, enabling it to provide enhanced learning opportunities for students at all degree levels to improve their public health skills and knowledge. The intent is to help a new wave of qualified professionals join the public health workforce upon graduation.

Supply Challenges and Opportunities

The COVID-19 pandemic revealed just how fragile the supply chain is for pharmaceutical products and medications, according to the American Journal of Public Health. In addition to the shortage of anti-infectives used to treat COVID-19, other drugs and products used for general hospital management and intensive care were hard to come by. More than 100 drugs were on the shortage list at the beginning of the pandemic in January 2020, according to the U.S. Food and Drug Administration (FDA), due to the restriction of international and commercial trading channels.

A big part of the problem is that the U.S. is heavily reliant on other countries for its pharmaceuticals. India, China and Europe are among the main suppliers; however, the effects of the pandemic, export bans, staffing shortages, lockdowns and other factors contributed to supply challenges. Additionally, finding new sources was nearly impossible due to COVID-19 travel restrictions.

In addition to pharmaceutical supply chain issues, a lack of testing supplies for diseases and viruses was another public health hurdle. COVID-19 tests, sexually transmitted infection (STI) tests, routine bacteria tests, mycobacterial tests, routine parasite tests and fungal tests all experienced shortages, according to the American Society for Microbiology (ASM).

The pandemic also impacted frontline medical workers when supply chain failures resulted in a shortage of essential medical equipment as well as personal protective equipment (PPE) and hand sanitizers, according to Frontiers in Public Health. This compromised the health and safety of nurses and other medical workers, resulting in many providers contracting the very virus they were attempting to treat.

Public health leadership has always been challenged by supply chain issues, but the pandemic revealed weaknesses that the country wasn’t prepared for. Fortunately, solutions are in the works. Technologies such as artificial intelligence, big data analytics and blockchain are being applied to build a more reliable, robust supply chain by removing the bureaucracy and inefficiencies of the current one — effectively streamlining it.

Another solution that leaders in public health have promoted includes regional stockpiling of essential pharmaceuticals and medical equipment. However, this must be implemented in accordance with World Health Organization (WHO) regulations. Several principles of international human rights laws and general international laws must be followed, not to mention the principle of “no harm.” Stockpiling drugs has the potential to cause artificial shortages, meaning that those in need of essential medications may not have access to them.

In response to the COVID-19 pandemic and its effects on health care workers, public health leadership has developed new protocols for managing patients. These new protocols were designed specifically to minimize the risk to both patients and health care workers. Perhaps the biggest change is the significant shift from in-person exams to telehealth medicine. Additionally, public health officials have worked with government agencies to secure critical medical equipment, testing supplies and PPE for nurses and other health care workers.

While these supply challenges are by no means solved, the reduced severity of the pandemic has allowed public health leadership to focus on replenishing medical supplies, increasing human resources, and working with the government and other organizations to find solutions.

Funding Challenges and Opportunities

Funding is the lifeblood of public health. It’s what enables public health departments to conduct research, employ workers, create educational programs and purchase equipment. Unfortunately, insufficient funding is one of the main hurdles that regularly challenges public health leadership. That lack of funding usually takes the form of budget cuts.

Years of state budget cuts and insufficient federal funding left several public health labs shorthanded when the first case of COVID-19 was discovered in the U.S., according to APM Reports. The problem with a lack of funding is that it hinders a lab’s ability to retain experienced scientists who are at the top of the field. Essentially, a lack of funding results in a lack of both quantity and quality of public health workers — not an ideal situation to be in when a worldwide pandemic breaks out.

Public health leadership has been able to find some solutions to overcome funding challenges, including lobbying government agencies for emergency funds so they can bring their staffing and equipment up to sufficient levels. During the pandemic, there hasn’t been much pushback on this. The challenge that lies ahead is maintaining sufficient funding so that public health departments are prepared and adequately staffed and funded for the next crisis. Public health leadership has emphasized the importance of being proactive rather than reactive.

Public Health Leadership Is Key to Facilitating Solutions

Public health leadership is essential in maintaining adequate staffing, overcoming supply chain shortages and securing funding to keep laboratories functioning at optimal levels. As the COVID-19 pandemic winds down, the onus will be on public health leadership to ensure that its workforce is adequately prepared and funded the next time a public health crisis breaks out.

For those interested in becoming a public health leader, investing in an advanced education is often the first step. The University of Nevada, Reno’s online Master of Public Health in Public Health Practice program includes courses such as Research Methods for Public Health, Epidemiology in Public Health and Health Policy that are critical for a successful career in the field. Additionally, the program is fully online with no residency requirement, making for a supremely flexible learning environment.

Start on the path to a career in public health with the University of Nevada, Reno.

Recommended Reading:

Benefits and Challenges of Telehealth in Rural Areas

How to Become a Public Health Nurse

Types of Social Support in Public Health

Example Sources:

American Journal of Public Health, “The Pandemic and the Supply Chain: Gaps in Pharmaceutical Production and Distribution”

American Society for Microbiology, “Supply Shortages Impacting COVID-19 and Non-COVID Testing”

APM Reports, “Public Health Labs Suffered Budget Cuts Prior to Coronavirus”

Association of Public Health Laboratories, “New Public Health Laboratory Workforce Pipeline Project Receives Historic and Much-Needed $282 Million Investment”

Association of Public Health Laboratories, “The Importance of Sustained Federal Funding for Public Health”

CDC Foundation, What Is Public Health?

De Beaumont Foundation, “Staffing Up: Workforce Levels Needed to Provide Basic Public Health Services for All Americans”

Frontiers in Public Health, “At the Epicenter of COVID-19 — The Tragic Failure of the Global Supply Chain for Medical Supplies”

The Milbank Quarterly, “COVID‐19 and Underinvestment in the Public Health Infrastructure of the United States”

Research in Social and Administrative Pharmacy, “Global Drug Shortages Due to COVID-19: Impact on Patient Care and Mitigation Strategies”

SAGE Journals, “The Public Health Funding Paradox: How Funding the Problem and Solution Impedes Public Health Progress”

STAT, “Expanding the Domestic Public Health Supply Chain Is a Matter of National Security”

The Nation’s Health, “Already-Strained U.S. Public Health Workforce Grapples with Covid-19: Despite Resource Gaps, Workers Fight On”