"I'm Scared to See The Ending"

The Erasure of Public Health

A few weeks after the election, my father asked me what was most concerning, what was keeping me up at night. I immediately responded by saying —

“I fear that my profession, the field of public health, will be erased by Trump.”

That fear was realized today when 10,000 of my colleagues (some friends, former students, and past coworkers) were fired from their jobs at CDC, HHS, FDA, and CMS. According to STATNews —

“Layoff notices began arriving early Tuesday for thousands of employees of the sprawling Department of Health and Human Services and its subsidiary agencies, with as many 10,000 workers potentially expected to be hit by the cuts, including some of the country’s top health officials.”

My heart is breaking — for those who lost their jobs.

My heart is ALSO breaking for you, your friends and family, and the communities you call home — because today’s decisions by the Trump Administration will result in all of us being less healthy. My heart is breaking for my children, who are growing up in communities with decreased access to care and fewer protections in place to ensure their health and safety. As a result of the continued dismantling of public health, people are going to die (people already have).

The lyrics from Taylor Swift’s song The Story of Us have been swirling in my head —

I'm scared to see the ending
Why are we pretending this is nothing?
I'd tell you I miss you, but I don't know how
I've never heard silence quite this loud

I’m scared of the ending — the result of the dismantling of public health — because it is going to be catastrophic. Without public health, there will be disease and suffering. There will be fear and a lack of information. Without public health, there will be no prevention, no new diagnostic tests, no new screening tests, and no new safe and effective treatments.

We will likely fail to identify the pathogen responsible for the next pandemic, which will result in increased mortality as well as financial, educational, social, and community losses.

In case you have forgotten or someone hasn’t told you —

Public health professionals and the health departments/agencies we work for, including where 10,000 employees were fired today, are responsible for (among other things) —

1. Preventing the spread of communicable (aka infectious diseases)

2. Ensuring that all communities have safe food, water, and air

3. Supporting maternal and child health

4. Improving access to clinical service (so that everyone has access to a healthcare provider/quarterback)

5. Preventing chronic diseases and injuries

6. Investigating disease outbreaks and alerting you to recalls when food has been contaminated

7. Conducting clinical trials to find new treatments for cancer, diabetes, heart disease, and Alzheimers

To do this work, public health professionals have been trained in epidemiology, statistics, environmental health, behavioral health, assessment and surveillance, community partnership development, health equity, organizational competencies, policy development, emergency preparedness and response, and communications.

Public health works so that you, your family, and your community can lead healthy, happy, and productive lives.

Public health blocks infectious agents from entering our food and water supplies through the creation of policies and regulations. We also are responsible for the creation of sanitation systems and surveillance systems to monitor community health through sewage. Public health prevents car crashes by requiring seatbelts and car seats/boosters and enforcing speed limits. We educate and communicate. We assess population health through data collection, analysis, distribution, and action. We work tirelessly to create healthy communities for all.

Public health knows from the start that (as Dr. Bill Foege says) —

“No one will thank you (a public health professional) for the disease they didn’t get.”

Public health is a collaborative team of hard-working individuals who are passionate about and committed to creating healthy communities for all. We focus on prevention and know that no one will thank us for a disease they didn’t get.

I want to bring attention to the work of public health and the unique training of public health officials. I want our elected officials to recognize that if we dismantle public health, our healthcare system will fail. People will die. We will see more disease, more suffering, more death, and more misinformation.

Each of us is healthy because an entire team of public health professionals has been working to create the environments, policies, educational programs, programs, assessments/evaluations, surveillance systems, and more to ensure that every community is safe and healthy. To ensure that we have healthy environments, health policies, access to care, preventive medicine, screening programs, and more need to be prioritized.

Dismantling public health will lead to catastrophic health problems.

It is time we recognize and fully support what public health does.

That’s where we are going to start.

As I said in my Death By 1000 Cuts presentation last week,¹ the work that we have ahead of us is a marathon (not a sprint). I do not have all the answers or an action plan tonight. Tonight is about being sad and recognizing the disastrous impact that dismantling the federal public health system will have on each of our lives.

I will be here with you weekly throughout the next four years.

To create healthy communities for all, I am committing to —

1. Using data/science to create public health (aka preventative health) programs, policies, and interventions to save lives and decrease suffering.

2. Fighting misinformation.

3. Inspiring others to understand the science to make healthy decisions and create healthy communities.

I will share the next steps — to advocate, fundraise, protest, create, support, or something else — as it becomes clear to me what we need to do in response to decisions and cuts to the federal public health system.

But tonight we recognize —

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Please do not forget to —

1. Click the “Like” button on the posts you enjoy. It’s a small thing, but it helps.

2. Share posts, either on social media or with your friends and family. Seriously, it has never been more important to share Epi(demiology) Matters.

3. And stay in touch — What questions do you have? What information do you need? concerns are keeping you awake? Let me know, and we can discuss them together.

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Epi(demiology) Matters is written by Dr. Becky Dawson, PhD MPH — an epidemiologist, teacher, mom, wife, and dedicated yogi. She is a tenured professor at Allegheny College, Research Director at a community hospital, and an exclusive contributor (all things health & medicine) at Erie News Now (NBC/CBS). Her goal is to create healthy communities for all. She writes Epi Matters — first & foremost because epidemiology does matter (to all of us) and she hopes that each post will help to educate and empower readers to be healthy and create healthy communities.

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Epi(demiology) Matters is free — because science, reports, news, updates, and alerts about health should NOT be behind a paywall. EVER. Everyone needs access to up-to-date health information in order to be healthy and create healthy communities for all.

1. Note: this is the link to the full/live presentation with the Q&A afterward.