Public Health: Always the Bridesmaid

by Taylor Mitchell Carter

What seems like a decade ago, I was at a friend’s house for a movie night. My husband kept telling me to put my phone away, “keep work at work,” he advised. I just couldn’t help but check the COVID-19 National Data Dashboard by Johns Hopkins University, a tool that was sent to me in one of the many public health newsletters I subscribe to. As a current Master of Public Health student at the University of Kansas Medical Center, I simply argued “I can’t help it.” All I could do was hit refresh what seemed like every 30 seconds, just waiting anxiously for one of those little red dots to appear in my city.

The Venn Diagram of my MPHTC work and my employment are fortunately nearly overlapping. In January, my employer hinted that I could potentially be contracted to provide disease investigation support for the county’s local public health department. Honestly, as a first year epidemiology student, I saw this as an incredible opportunity to get my hands dirty in this very niche field during the pandemic of our era. It feels strange to admit, but I was really excited about it. Not only would I be able to do more than hit refresh on my phone, but I knew this would be an incredible opportunity that I would look back on some day. I envisioned myself telling future grandchildren that I was one of the public health rockstars who stepped up to the plate.

This work felt like baptism by fire at times, but I learned more about myself and this incredible field than any course could have ever taught me. These are my take-aways:

Public Health: A Buzzkill

Public health is a field dedicated to creating environments and conditions where people can achieve their best personal health. It’s a broad definition, but it allows public health professionals to approach health from so many different angles, which I think makes this field so unique. Public health is often confused with healthcare or health insurance, but it’s so much more than that. Unlike medical care, public health doesn’t directly work to make you, the individual, feel better. The field is designed to use evidence-based practices to improve the health of the overall population. It’s a little known fact that public health interventions are largely responsible for the increase in life expectancy we’ve seen over the past two centuries, and at the center of it all is evidence based practice.
This work is not flashy, and it’s largely done behind the scenes, outside the eye of public view. As a byproduct, public health is always the bridesmaid. Even in the midst of this public health crisis, it STILL isn’t the bride. It’s seen as the buzzkill parent who grounds you from even going to the wedding. Nobody likes being told what to do, but these efforts aren’t done to “punish” anyone – they are done to keep the public as healthy as we can.

Kansas Public Health is Balling on a Budget

Kansas state public health funding for Kansas Local Health Departments has remained level since 1992. That’s the year Bill Clinton was elected into office. If that’s not enough – I wasn’t even born yet. Kansas’ spot on America’s Health Rankings has plummeted over the past three decades, and further decline is expected. Almost two-thirds of Kansas counties receive just $7,000 each year from the State Formula Grant. The bottom line is that pandemic or otherwise, a lack of public health funding is an issue for the health of Kansans.

Aside from myself, who, again, is not yet an epidemiologist, the epidemiology team at the health department consists of a variety of public health professionals, many of whom are also not epidemiologists. While the health department is fortunate to employ several epidemiologists, there is a lot more to it than disease investigation. A large bulk of the process relates to symptom monitoring, which is conducted by a team of public health professionals who have entirely different day jobs. For example, my partner in crime is a medical aid for the health department’s tuberculosis control program. Not only is she conducting virtual and physical site visits with patients, but she is in charge of contacting all of my cases and their close contacts almost every day to assess symptoms, send appropriate documentation, answer questions, and release them from quarantine/isolation.

Truth be told, if public health was adequately funded, the health department may not have needed to contract outside of their organization. It’s not entirely the current administration’s fault, but it certainly has not helped. Which brings me to my next point.

Politics and Public Health are Like Eyebrows

Bear with me here – have you ever heard the phrase “eyebrows should look like sisters, but not twins”? Well, public health and politics are like eyebrows. They are eerily similar, but there are a few distinctions that make them just different enough to not be exactly the same. Additionally, it would look rather strange if you only had one eyebrow right? Politics and public health heavily rely on each other. The purpose of political action is to shape the environmental, social, and economic conditions and systems within a community. This directly impacts the health of community members, which is where public health professionals step in.

Like sisters, politics and public health often quarrel. While the United States grappled with the controversial decisions made by the current administration, Kansas politics and public health were having a battle of their own. During the weeks and days leading up to Easter Sunday, it was determined that 25% of Kansas COVID-19 cases were linked directly to church services or funerals. In an effort to combat the spread of the virus, Governor Laura Kelly decided to use her power to ban large gatherings – an unpopular decision made by a democratic governor in a notoriously conservative state. On the day Kansas reported its largest single day of COVID-19 deaths, Kansas Republican Leadership revoked her executive order banning large gatherings.

These political actions impact the behaviors of the population, which in turn impacts population health. For example, the refusal to wear a mask in public has become a political statement of sorts. Businesses and corporations such as Costco are being challenged by unwilling customers who refuse to abide by face mask regulations in an effort to exercise their freedoms. Anti-mask movements were popular during the 1918 Spanish influenza as well, yet another example of how history has a funny way of repeating itself.

Misinformation Spreads Faster than Any Virus

As if learning disease investigation on the go wasn’t enough of a challenge, misinformation on social media made my day to day life even more difficult both inside and outside of the health department walls. Discussing isolation and/or quarantine parameters with cases/contacts can be a struggle, but it’s even more difficult to have those conversations only to be challenged with “well I saw on facebook ___” or “the news said ___”. Everyone is entitled to their own opinion, but misguided theories (like injecting cleaning products), snake-oil “cures” (cough cough injecting cleaning products), and sketchy advice (do I even need to say it again) are dangerous. This is true especially when the person making those claims is the leader of the free world.

People like certainty, consensus, and consistency. Misinformation and disinformation (i.e. the “Plandemic” “documentary”) muddy the waters. If the authorities can’t agree, who can the people really trust?

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