Policymakers Seek to Strengthen Public Health Infrastructure

The House Committee on Energy and Commerce recently met to discuss 13 bills aimed at rebuilding U.S. public health systems and modernizing the data collection of those systems.

“Our hollowed out public health system explains why we see COVID-19 cases tracked using fax machines, and COVID-19 vaccines recorded on little white paper cards. These antiquated methods are embarrassing for our country,” said Rep. Anna Eshoo, D-Calif. 

Since 2008, at least 38,000 state and local public health jobs have disappeared and since 2010 spending for state public health departments has dropped by 16% per capita, and for local health departments by 18% per capita, according to data presented by Eshoo. 

Eshoo pointed out that even before the COVID-19 pandemic there were inconsistencies in public health data collection and sharing, and that these issues, and others, have been raised repeatedly during subcommittee hearings.

One of the bills discussed at the hearing, known as the Health Statistics Act, seeks to direct the Centers for Disease Control and Prevention to develop uniform public health data standards for state and local health departments.

The act would require the CDC to establish a working group and develop uniform standards for reporting public health data and allow the Health and Human Services Department to award grants to entities that report public health data to support the adoption of uniform standards.

In addition, the Office of Management and Budget would be required to issue directives concerning federal health data collection that address, for example, the use of determinants of health data and access to data for evidence-building initiatives.

The act also would direct the National Center for Health Statistics to expand an existing program that links different federal datasets to facilitate statistical public health research, including the social determinants of health such as education or socioeconomic status. The program would require an assessment of the availability of datasets, use existing authorities to link these datasets, and support linkage to a specified database of death record information.

However, the 13 bills presented at hearing faced opposition from some congressional leaders. Rep. Michael Burgess, R-Texas, and Rep. Brett Gutherie, R-Ky., said bills like HR 778, which would establish new grant funding for COVID-19 content tracing for the CDC, or the HR 976 ETHIC Act, which would require states to report specific COVID-19 data to the CDC, are duplicative of existing public health policies, and that these bills only address COVID-19 data efforts and not all public health efforts. 

“Some of the bills presented today are too narrow in scope and duplicative of current efforts, in addition it does not seem there is a consensus on who needs to collect what data, how it will be used, who will have access to it, and how to do that in a way that doesn’t add more administrative expense,” said Burgess. 

That’s why in 2020, Burgess and 300 other congressional members signed a bipartisan legislation called HR 3969, to amend title XXVII of the Public Health Service Act to include activities to address social determinants of health in calculation of the medical loss ratios, which are the total losses paid out in medical claims plus adjusted expenses divided by the total earned premium. 

HR 3969 would allow spending on social determinants of health to be included in health insurance plans medical loss ratio calculation and encourage Medicare Advantage and Medicare Managed Care organizations to take further action to support the social determinants of health data analysis act,  which promotes practices that look beyond clinical care to address the social and structural factors that profoundly shape health status like poverty and access to stable housing.

The bill would also require the Government Accountability Office to report the actions taken by the Secretary of Health and Human Services to address social determinants of health. 

However, Rep. Frank Pallone, D-N.J., said that for Congress to move forward with any policy aimed at strengthening the public health infrastructure, a uniform federal strategic action plan, as well as data standards and data sharing policies, need to be established. 

“Insufficient funding, limited resources, inadequate training combined with differing state and county laws, and nonexistent data standardization procedures are several of the many factors that limit public health data,” said Pallone.

“With resources that Congress has provided through COVID-19 relief packages, including the CARES Act and the American Rescue Plan, we know that data modernization is underway. We must now continue that work to ensure that research labs, providers and public health departments are working with real-time, current data and have a better understanding of social determinants of health,” Pallone concluded.