In a nutshell:

• Public health experts largely agree that Michigan has done a good job of responding to the ongoing pandemic, despite public health resource/personnel constraints and political disagreements.
• The response has been characterized by many shortcomings, but also provides numerous causes for optimism and opportunities for growth.
• COVID-19 may be the final wake-up call for Michigan (and the United States) to take public health more seriously.

Last Thursday, a panel of public health experts weighed in on Michigan’s response to COVID-19 during a virtual policy event hosted by the Citizens Research Council of Michigan. Despite coming from very diverse backgrounds and perspectives, the panelists found many points of agreement.

Public health has been a major focus of the Citizens Research Council in recent years, and our 2018 report on public health found that Michigan had long neglected and disinvested in public health infrastructure and personnel.

In that report, we wrote:

“[Pandemics] remain an ever-present threat to human health and safety. Infectious diseases are now emerging in greater numbers and spreading more quickly than at any time in human history. Advances in mobility mean that an epidemic in one part of the world is just a few hours of travel away from threatening other parts of the globe…

While years of public health activities have worked to suppress and mitigate infectious diseases, they remain a significant threat to human health that require robust public health systems and emergency planning and preparedness to manage.“

As cases again trend upwards throughout Michigan and across the nation, COVID-19 reminds us of the importance of government’s public health responsibilities. Public health not only promotes citizens’ wellbeing and longevity, it is critical for many other core activities in society—from commerce and education to ensuring that all citizens have access to vote in safe, fair and open elections.

With the stage set, our diverse panel of experts shared numerous key insights.

Michigan’s Pandemic Preparedness

Panelists responded with a consistent ambivalence when asked whether Michigan was prepared in the face of a pandemic. A consensus emerged that Michigan’s state and local public health agencies did the best they could given resource limitations.

Dr. Renee Branch Canady, CEO of the Michigan Public Health Institute, began the discussion by quoting Benjamin Franklin, saying that “failing to plan is planning to fail.”

Dennis Paradis, Executive Director Emeritus of the Michigan Health Policy Forum, characterized Michigan’s efforts in confronting the pandemic as “heroic,” but conceded that the state was absolutely not as prepared as we would have liked, largely because of the decades of disinvestment and neglect of public health.

Marianne Udow-Phillips, Founding Executive Director of the Center for Health & Research Transformation, concurred with the assessment given by Paradis and went further to point out the lack of preparedness nationwide (noting that just 3 percent of U.S. health sector spending goes to public health – far lower than any of our peer nations). She echoed other panelists in praising the “phenomenal” efforts Michigan’s public health leaders and Chief Medical Executive, Dr. Joneigh Khaldun, but said they are working without enough resources and personnel to do contact tracing and to disseminate information to the public, especially given unprecedented public backlash and inconsistent policies at different levels of government.

Dr. Phyllis D. Meadows, Senior Fellow in the Health Program – The Kresge Foundation, noted that Michigan’s public health departments and workforce do a good job of delivering the various mandatory services for which they are responsible, but that there is plenty of room to do more when it comes to other issues that require a public health response (such as a pandemic). 

Paradis noted that public health tends to draw funding during a crisis, but then gets defunded immediately afterward, limiting the capacity of public health agencies and professionals to address not only pandemics, but a variety of important issues.

State Representative Hank Vaupel (Chair of the House Health Policy Committee and a Doctor of Veterinary Medicine) noted that, beyond the resource constraints identified by other panelists, there was no clear plan to follow. He further noted the important roles public health plays in keeping people healthy (promoting nutrition, exercise, and tobacco cessation, for instance) and resilient and in delivering health education so that people understand the importance of behaviors like wearing a mask and maintaining physical distance.

Reflecting on Successes and Failures

We asked the panelists to reflect on Michigan’s response to the pandemic thus far. 

Representative Vaupel noted that Michigan was successful in “flattening the curve” early in the pandemic. Canady noted that, not only did Michigan flatten the curve, but it has also actively worked to reduce (or even eliminate) health disparities associated with COVID-19.

Udow-Phillips also praised the state’s early response to the pandemic, commending Governor Whitmer for listening to epidemiologists and other scientists when Michigan was hit early by the pandemic and had little data and limited federal guidance. Meadows, Canady, and Paradis also praised the early, decisive actions by Governor Whitmer, Dr. Khaldun, and other state leaders.

Dr. Meadows pointed out that early focus on the healthcare response and issues of hospital capacity overshadowed the need for a public health response and public health capacity to engage in contact tracing and other activities that break the chain of viral transmission, prevent infections, and keep people out of the hospital. 

The pandemic is wearing on our workers. Dr. Canady pointed out that we have a weary, exhausted, and over-extended public health workforce that has gone over and above the call of duty in responding to the pandemic.

Representative Vaupel stressed that, for public health to be successful, the public must be part of the response—not just in their understanding and acceptance of guidance from officials, but also in their own behavior. Paradis noted that failures in communication may have contributed to ongoing problems (such as resistance against simple public recommendations like wearing a mask).  Dr. Meadows noted that misinformation and miscommunication at the national level may have contributed to these issues.

Dr. Canady highlighted the important role public health plays in using data and evidence to bridge the boundaries between personal responsibility and social responsibility, pointing out that it isn’t enough to just tell people what they should do to keep themselves and their communities healthy; public health also works to fulfil a societal responsibility to ensure that healthy, good choices are easily and readily available to all individuals.

Looking to the Future

Finally, we asked the panelists for lessons to guide future policy. 

Paradis suggested that federal, state, and local policymakers would benefit from teams of public health analysts to highlight the health impacts of proposed legislation and other policies much in the same way the Congressional Budget Office (or Michigan’s House and Senate Fiscal Agencies) assess the financial consequences of new policies. This novel idea would help support the Health in All Policies approach that the Citizens Research Council has previously promoted.

Rep. Vaupel highlighted the need to take health seriously, pointing out that a healthy society is less expensive in terms of healthcare. He stressed the need to spend dollars more efficiently by promoting healthy behaviors and addressing the tremendous scope of mental health issues facing the state and nation.

Udow-Phillips noted that all other countries invest more in social and human services. She pointed out that the legacy of underinvestment in safe housing, nutrition, and other social determinants of health have led to a higher prevalence of conditions (like diabetes) that have made many Americans more vulnerable to COVID-19. The consequences of this long-term underinvestment can be seen in our high rates of healthcare spending and poorer health as a nation.

Dr. Meadows pointed out that COVID-19 is just one of many public health issues that need the same level of attention, rigor, adaptability, creativity, and fiscal support. The adaptability and tenacity with which we’ve responded to COVID-19, she said, is cause for hope for the future of public health.

Udow-Phillips similarly said the growing awareness of public health due to the pandemic is cause for future optimism, as is the growing recognition of racism as a public health issue. “Public health is about having all of our citizens grow up with opportunity,” she said, “and the promise that they can achieve their full potential” without health-related barriers to living a healthy, happy, and productive life.

In closing, Dr. Canady reflected that we are a nation where we strive to embody the notion that everyone is created equally with a fair and just opportunity to be their best (and healthiest) self. This national value, she said, is at the core of the public health principle of health equity. The road to health equity, however, requires us to examine difficult issues like the causes of poverty or the residual effects of racism. 

She pointed out that public health serves to educate people and also uplift them. “We want to teach people how to eat well…how to stop smoking,” Canady said, “and we also want to say ‘OK, but what are the stressors that are causing people to smoke,” pointing out that many unhealthy behaviors are linked with mental health, stress, and social circumstances.

The science and professional discipline of public health allows us to identify the structural factors that get in the way of people’s health, often in disproportionate ways throughout society.

In Dr. Canady’s words: “Public health is not what we do to people; it is what we do with people.”