Rebuilding Trust In Public Health Will Take Long-Term Investment, Expert Says

Rebuilding the nation's public health infrastructure will take committed effort long after the pandemic has passed, especially in communities of color, Dr. Sandro Galea said Wednesday on GBH's Greater Boston.

"We should have dealt with this five years ago," said Galea, who teaches at Boston University's School of Public Health. "Or at least if we're going to tackle it now, we should make sure it doesn't remain a problem five years from now. We have a system where we have under-invested in looking after people who are marginalized, looking after people of color, looking after people who have low incomes."

By most measures, public health spending in the U.S. has long been in decline. Per-capita spending on state and local public health departments has declined by 16% and 18%, respectively, since 2010, according to an analysis by Kaiser Health News and the Associated Press. The Milbank Memorial Fund found a $4.5 billion funding gap between where the U.S. is now and "a minimum standard of foundational public health capabilities."

Galeas said under-investment in public health has fed into hesitancy around COVID-19 vaccines in community of color, which have faced a history of mistreatment and ongoing racism from the medical community. Hesitancy still persists, data show, but it has declined dramatically as the vaccines have rolled out. A poll released by the Pew Reaserch Center this week found that 69% of the public either wants to get vaccinated or already has been. That includes 61% of Black Americans — up from 42% in November.

Throughout the pandemic, Indigenous, Black and Hispanic Americans have been more likely than their white, non-Hispanic counterparts to be hospitalized or die as a result of COVID-19, according to data collected by the Centers for Disease Control and Prevention.

The pandemic's disproportionate impact on communities of color was "entirely foreseeable," Galea told Greater Boston host Jim Braude.

"It seems to me like at the moment, what we need to do is make sure that we doubled down on our effort to make sure that nobody's left behind," Galea said. "And once this is over, to actually follow through on our commitments to make sure that we no longer have health have-nots."

Reinvesting in public health and rebuilding trust with communities that have faced medical racism will take years of work long after the current crisis has passed, the doctor said.

"What we are trying to do now is make sure that the vaccines are taken up so we can protect lives," he said. "But we are [also] going to commit to investing in rebuilding trust over the next year, five years, 10 years. Because you cannot manufacture trust — today, it's March 10 — by April 10 or by May 10. That's simply false."