This piece was orginally published as a commentary in Politico.
The unfolding complexity of school reopening reflects a simple truth: Our state and local public health infrastructure is woefully inadequate to meet the moment.
While significant evidence affirms that children being physically present in school is the most optimal learning and developmental environment, there is a groundswell of legitimate apprehension from school staff, parents and students that going to school means walking into an unsafe environment. This sentiment has led 35 of the nation’s 50 largest school districts to begin the fall semester remotely, unsure how, or when, they can reopen for in-person instruction.
The challenge of safely returning staff and students to classrooms shouldn’t rest solely with district superintendents and school leaders. To think our educators can become public health experts on the fly is naive and dangerous.
The first resource educators should turn to are their state and local public health departments, whose job is to help crucial public institutions like schools navigate the complexities of the pandemic.
But there, they are often hitting a barrier.
Degraded by decades of underinvestment, shifting values, complacency and special interest politics, local public health departments, particularly those outside of major urban centers, are ill-equipped to support local education leaders working to return staff and students to schools safely.
For instance, the most basic measure to determine whether schools are safe enough to open for in-person instruction is the level of community spread of Covid-19. Yet the availability and accuracy of the data used to measure spread vary widely from state to state and locality to locality. In some states, the basic reproductive number, known as R-naught, is being collected at the local level; in other states, the number is not available at all.
Additionally, contact tracing, another locally managed public health activity that is central to controlling the pandemic, has been massively uneven across the country and within states. In California, for example, local public health departments have not hired nearly the number of contact tracers needed to keep up with the trajectory of the pandemic.
The deficiencies are not the fault of the hardworking, oftentimes underpaid, men and women who serve in these health departments. They are the legacy of flawed institutional decision-making, systemic inequity and short-termism. We have both observed this firsthand over the past decade from our vantage points in emergency rooms and classrooms; our public health departments, which should be in the vanguard of fighting this pandemic, are instead hobbled by disorder, inconsistent leadership, capacity constraints and insufficient funding.
Local public health systems didn’t always struggle. At one time, they were the vanguard of science-driven policymaking. Starting in the 19th century, two major developments — rapid advances in bacteriology and the "great sanitary awakening" that encouraged the social reforms necessary for improvements in public health — put public health officials out front in fighting and preventing disease. With deeper knowledge of germ theory and how disease spreads, society came to understand that, “not only public and individual restraint were needed to control infectious disease, but also state agency epidemiologists and their laboratories were needed to direct the way.” The first public health department was born as the New York City Department of Health in 1866.
The Sheppard-Towner Act of 1921 further accelerated the status and reach of local public health departments, providing administrative funding to states to implement autonomous programs to meet federal guidelines. The expansion continued through the 1960s with federally funded state and local public health departments expanding their roles into clinical care, family planning, immunization and reportable disease tracking.
Beginning in the 1970s, however, the explosive growth in U.S. health care expenditures led to significant increases in federal spending. To blunt this trend, lawmakers introduced cost containment measures, including a shift to block grant funding mechanisms and Medicaid restructuring that gave states greater control over their own spending.
These changes led to massively underfunded state and local public health systems. According to a KHN/Associated Press story, in the past decade alone, spending for state public health departments has dropped by 16 percent per capita, and spending for local public health departments decreased by 18 percent per capita.
The cuts have left agencies with far fewer resources. One striking example: 78 percent of local health departments do not have an epidemiologist on staff. It is foolish to think that the 2,800 local health departments across the country that have been decimated by disinvestment can support 13,800 school districts in dynamic back-to-school decision-making.
If the nation hopes to respond to the monumental challenges the Covid-19 crisis has presented schools, including improving student health outcomes and aiding a return to in-person instruction, Congress must step up to make local public health a long-term priority and support evidence-based interventions in schools. Although funding schools and public health departments is generally a state and local responsibility, a drop-off in local tax revenues and laws forbidding state governments from deficit spending even in an emergency means that only the federal government is currently able to appropriate and direct funding for these efforts.
It should do that by ensuring the next version of the CARES Act provides resources to:
- Rebuild the capacity of local public health departments by replacing the 51,000 local public health jobslost during the Great Recession and ensuring that anepidemiologist is available to support every school district in the country.
- Implement state-mandated safety protocols in schools, adequately test and trace school community stakeholders, sustain personal protective equipment supply chains, and undertake vaccine policy and planning.
- Double the number of school-based health centers and modernize facilities, upgrade equipment and technology and increase access to health services for children and families utilizing the existing 2,000 centers.
- Transition another 2,500 traditional public schools into so-called community schools that provide a range of student and family services under one roof, including medical care, through the Full-Service Community Schools grant program.
Unfortunately, Congress’ inability to advance another bill means that desperately needed resources will not reach schools before the start of the 2020-21 school year. But that doesn’t mean the resources won’t be needed. Given Covid-19’s resiliency, school leaders are going to require the support of stronger local public health departments next semester, next year, and for the next public health crisis.
Education policymakers and practitioners working to keep students and school staff safe face the daunting task of having to make school-opening and school-closing decisions in real time for the foreseeable future, as the level of community spread rises and falls and as therapeutics and vaccines emerge.
If they have any chance of making the best decisions in such a fast-changing environment, we must provide them the resources, tools and expertise they need. That begins with rebuilding our state and local public health departments
Ramires and Buher are managing directors of Opportunity Lab and FutureEd senior fellows.