(C) Daily Yonder - Keep it Rural
This story was originally published by Daily Yonder - Keep it Rural and is unaltered.
. . . . . . . . . .
Commentary: Public Health Has More to Worry about Than RFK Jr. [1]
['Edward Strickler Jr.', 'The Daily Yonder', '.Wp-Block-Co-Authors-Plus-Coauthors.Is-Layout-Flow', 'Class', 'Wp-Block-Co-Authors-Plus', 'Display Inline', '.Wp-Block-Co-Authors-Plus-Avatar', 'Where Img', 'Height Auto Max-Width', 'Vertical-Align Bottom .Wp-Block-Co-Authors-Plus-Coauthors.Is-Layout-Flow .Wp-Block-Co-Authors-Plus-Avatar']
Date: 2025-01-09
Public health is worried about the nomination of Robert F. Kennedy Jr. to head the federal Department of Health and Human Services.
But public health is always worried. Is the water supply safe? Does the salad bar harbor deadly bacteria? Is there an outbreak of communicable disease at a daycare center or school?
There are a seemingly endless number and variety of worrisome things the public forgets, or does not even know to worry about. So the field of public health worries for us.
The public-health sector is a network of hundreds of local, state and federal agencies, offices, and tens of thousands of professionals who work to protect and improve the health of people and their communities. We need to support local public-health institutions unless we want more infant disability and death from syphilis, mass casualties from food poisoning or water contamination, growing clusters of cancer deaths, undetected abuse and neglect in nursing homes, and many more fearsome things.
As if these were not enough worries, public health has new worries. Health Affairs, a prestigious health policy journal, describes a public-health workforce that has been poorly funded and declining since about 2008 with steep decline projected by 2025. Public health will lose about 57% of its workforce, with most of this decline coming in local services, like county health offices and clinics and rural regional agencies and services.
Local public-health workforces are stretched to breaking in rural areas at the same time that many rural hospitals, primary-care clinics, emergency services, mother-and-child clinics, mental health supports, and other professional services have closed. A 2024 report found that 700 additional rural hospitals are at risk for closure.
How can a declining local public-health workforce in rural areas fill these huge gaps? Research has consistently found a “rural mortality penalty” — that living in a rural area confers likelihood of poorer health across many different health conditions. Public-health science and policy have discussed rural contexts of poorer health infrastructure, for example that rural communities suffered a higher death rate from Covid-19 resulting from lack of locally accessible hospital and clinic care and lack of reliable transportation to get to any care ).
Another set of conditions called “social determinants of health” or “macrosocial determinants of health ” can harm rural community health. These include things such as declining quality of education, loss of employment, and lack of investment.
Research has also discovered that trust and trustworthiness are key social determinants of health . Throughout the Covid pandemic emergency, trust in and trustworthiness of public-health institutions steeply declined. Sadly some of this was public-health elites’ own doing. (See, for example, the competing perspectives of the Great Barrington Declaration and the John Snow Memorandum.) Ideological partisanship found these fractures within public-health elites’ and weaponized them. Social media, legacy media, cultural “Influencers” of both the right and left quickly found ways to capitalize and make money from partisan and cultural fractures. Public-health elites too often failed to resist these powerful political and economic incentives. They did not find a common ground quickly enough, and they were perceived to be ideologically twisting scientific findings and not listening to urgent questions rising from local experiences during the pandemic. Many rural and other working-class communities felt particularly ignored or criticized by these elites. The problem was worsened because these groups have had less access to trusted health communicators in local communities.
Discussion about how to restore trust and trustworthiness has various streams of opinion, some compatible, some competing. These include improve communications, ensuring ethical norms of transparency and democratic norms of accountability, sustaining or expanding public-health authority (because that authority is under threat), and aiming for health equity. One significant article in Health Affairs links restoring confidence in public health with supporting a “national public health system that is accessible, equitable, and people-centric at every phase and step of the process.”
Issues of public-health authority are more problematic, with state and federal lawmakers taking power away from public-health institutions and giving it to themselves. But rural communities, particularly, know that distant, elite authority – whoever commands it – decides without asking them and often rules against rural and working-class interests. During the Progressive Era of the early-20th century, the disproved theories of eugenics and scientific racism used public-health authority to hurt rural and other working-class households and communities, including stripping them of property and rights, detaining thousands in carceral conditions (in Virginia they were called “colonies”), and coercively sterilizing as many as 70,000 Americans. Universities, public health agencies, and philanthropic foundations called this “social hygiene”: improving society by removing the unfit and the inferior. Bad ideas have a way of returning.
Rural and other working-class communities have often been targets of public-health authority and control. I fear that currently in academic ivory towers, foundation suites, think tanks, and in their related conferences and publications, some of these bad ideas are returning. A recent piece published in American Journal of Public Health uses rural stereotypes to argue that rural communities are suffering poor health because of individualism, mistrust, and racial resentment. Do these attitudes exist in rural communities? Yes, sometimes. But they also exist in non-rural communities, don’t they? Moreover, contrary to the authors’ selective prejudicial stereotyping, solidarity and community building, generosity and social care, and stewardship of creation are prominent values in rural communities. I asked the authors and the journal about this but have no satisfactory response from either yet. Selective prejudicial stereotyping is part of the eugenics/scientific racism model. We must not return to these bad ideas.
We don’t know whether Kennedy would support rural health effectively if he is put in charge of the Department of Health and Human Services. But local, rural public health that is accessible, equitable, and people-centric would be a good defense against a host of bad ideas that might be devised by academic and governmental elites, billionaire overlords, and their ilk.
Edward Strickler Jr., MA, MA, MPH, is a member of the Ethics Section of the American Public Health Association and a retired programs coordinator for the Institute of Law, Psychiatry and Public Policy at the University of Virginia School of Medicine. He lives in rural Virginia.
Related
Republish This Story Republish our articles for free, online or in print, under a Creative Commons license.
[END]
---
[1] Url:
https://dailyyonder.com/commentary-public-health-has-more-to-worry-about-than-rfk-jr/2025/01/09/
Published and (C) by Daily Yonder - Keep it Rural
Content appears here under this condition or license: Creative Commons CC BY-ND 4.0 International.
via Magical.Fish Gopher News Feeds:
gopher://magical.fish/1/feeds/news/dailyyonder/
