As Missouri’s state health authority, I’m often asked, what are the big takeaways from the COVID response? This novel infectious disease tested every aspect of our society and starkly exposed our public health workforce and infrastructure as chronically under-resourced and thus inadequately positioned to efficiently and expeditiously surge to fully meet the expectations of the people we serve. 

This novel infectious disease revealed the integral interdependency our entire healthcare, behavioral health, and public health systems have upon each other. This was a lesson affirmed for our public health and healthcare delivery systems. No hospital or healthcare system, regardless of size, has the capacity to absorb the medical surge that would present to their doors without the work that public health performs daily, ensuring safe drinking water and food sources, investigating outbreaks large and small, of known and less known diseases, promoting and educating people of the impact of their individual and community choices on their own personal health, such as the use of tobacco, addressing food deserts and working to assure the availability of fruits and vegetables or safe walking and exercise options in communities. 

This is perhaps increasingly true as we approach 2030, when we anticipate the population of individuals residing in the U.S. over the age of 65 will outnumber the number of individuals age 18 and under—a time in our lives when we all typically encounter more health concerns and barriers to healthy living.  

In Missouri, our public health partners believe our public health system needs to change, and we understand our policy makers and citizenry believe likewise. We are using CDC’s historical public health workforce and infrastructure funds to robustly embrace and take steps to enhance public health capacity in our state. 

In a recent survey, our 115 autonomous local public health agencies identified that over half of them did not have the capacity to fully perform basic public health functions, such as promoting maternal and child health, addressing environmental public health, conducting chronic disease, communicable disease, or injury prevention activities. 

Missouri has historically been under-resourced in comparison to other states, and we believe that is reflected in this self-analysis of our local public health agencies. 

From a practical perspective, we are using the CDC infrastructure funds mentioned earlier to conduct a cost analysis of the necessary investment commitment to assure all citizens have access to a fully functional public health system in every community statewide, as well as an accountability measures initiative to set appropriate performance measures should policymakers in Missouri determined to increase investment in our public health system. 

We have collectively as a local, state public health system, committed to move toward assuring each community and citizen in our state has access to all components of a public health system. We believe none of us are safe and protected until all of us are safe and protected.  

When people are asked what they believe the role of government should be? One answer often received is to protect the health and safety of citizens. 

In America, we’ve often translated that as assuring we are prepared domestically to face a foreign adversary, and we’ve invested heavily in defense, appropriately so.  

Heartbreakingly, we lose approximately 650,000 American citizens to heart disease every year, and another 605,000 to cancer every year—the two leading causes of death in America and in Missouri—together accounting for seven of 10 deaths nationally. That’s roughly 1.3 million per year to those two chronic diseases alone, and doesn’t account for the recent scourge of opioid misuse, infectious disease, and injuries. Compare that to the unfortunate loss of 1.1 million American lives in all wars, beginning with and including the Civil War.  

So just think of that 1.1 million lives lost in all battles. Nearly 1.3 million lives lost to just two chronic diseases every year. Shamefully, we’ve almost become hardened to and accept as inevitable the number of deaths by chronic disease that in a war or an act of bioterrorism would be widely publicized as unacceptable losses and would result in congressional hearings, heightened media attention, and a public outcry for action. 

COVID laid bare for us the fact that our economy, the future of our children and their education, our ability to provide for our families and indeed our very lives, and the health to enjoy our lives is dependent upon a strong, viable, and functional public health system.  

We should value our public health system on the same par as our defense system because they are two sides to the same coin of protecting our citizens. We should invest in our citizens their health and their very lives by investing in our public health system and protecting that funding as vehemently as we protect domestic funding for defense.