In the wake of the COVID-19 pandemic, the Commonwealth Fund Commission on a National Public System has issued a series of recommendations for Congress and the Department of Health and Human Services (HHS) to transform public health in the United States.

The commission’s findings and recommendations are based by what it described as the nation’s “splintered” and often ineffective COVID-19 response, with problems compounded by stark health inequities and high rates of chronic illness that led to many unnecessary deaths.

“The United States needs a strong and effective national public health system that can improve health outcomes, advance equity, and respond to emergencies. Right now, we have a system with many cracks through which millions of Americans fall each year,” said Margaret A. Hamburg, M.D., former commissioner of the U.S. Food and Drug Administration, who chaired the nonpartisan commission. 

“With a stronger system in place, we can improve health outcomes overall, reduce inequities, and ensure a stronger response to some of our major problems, like the addiction and overdose epidemic and maternal mortality, as well as other emergencies that arise.”

The commission recommended:

  • The creation of a new position—undersecretary for public health—who would serve as a focal point at HHS for building a public health infrastructure.
  • Reliable funding from Congress for state, local, tribal, and territorial health departments. The commission estimated it would cost $8 billion a year to build a public health workforce and modernized public health information system.
  • The health care system work more closely with the public health system by regularly sharing data during both emergency and nonemergency periods. This coordination would build on some of the successful collaborations between the health care and public health systems seen during the pandemic.
  • Public health leaders work to build public trust through enhanced community engagement and shared decision-making. The commission also encourages broad support for community-based organizations and improved communication efforts to address health literacy, misinformation, and disinformation, as well as a commitment to improved integrity and transparency in decision-making.

“The recommended spending is significant, but it pales next to the cost of continued inaction, including the trillions of dollars and a million lives lost because the pandemic response was so inadequate despite heroic frontline efforts,” Julie Gerberding, M.D., M.P.H., former director of the U.S. Centers for Disease Control and Prevention, who serves on the commission, said in the announcement.

For more information, click here for the full report.