From the Dean: What Ebola Can Teach Us about Public Health

By Dean Bobbie Berkowitz, PhD, RN, FAAN

The global dimensions of the Ebola crisis have exposed many of the fault lines in our nation’s ability to act swiftly and decisively when confronted with an unforeseen threat from an infectious disease. The days following the death of Thomas Eric Duncan at Texas Health Presbyterian Hospital were filled with uncertainty and confusion. The absence of a protocol for clearly assessing the threat and formulating a policy response, coupled with the lack of a dependable channel of communication to the public, fueled an atmosphere of anxiety that lingered for weeks. I have a long history in public health, as a public health nurse, chief nurse executive, and Deputy Secretary of Health in state government, and I could not help but reflect on how well the  primary public health mission of assessment, policy development, and assurance (Institute of Medicine, The Future of Public Health, 1988) assisted us in the management of Ebola.    The  fundamentals of public health including the essential public health services were designed to prepare public health for just such a threat as Ebola because together the core functions and essential services provide a definition of public health and framework for the responsibilities of public health systems in this country.

For example, Essential Service #2 calls for developing systems to accurately diagnose and investigate health problems and hazards, while Essential Service #3 stipulates timely initiatives to inform and educate citizens about serious public health issues. Other essential services call for partnerships with local community-based organizations to assist in planning for and solving public health problems.

Infectious diseases such as Ebola, MRSA, SARS, bird flu, and influenza represent a threat to the health of the nation and are a reminder that our nation’s public health system and public health nurses have a significant role to play in mitigating their prevalence and capacity to harm.

For years, public health nurses have been the backbone of  local and state health departments whose focus has been on surveillance and response to communicable disease. Chronic conditions, such as heart disease, obesity, and diabetes have become a critical part of public health’s prevention agenda and the social determinates of these illnesses have been targeted for interventions by public health professionals including public health nurses. But as important as these issues are, systems put in place to address them did not transfer well to the Ebola crisis.

At the same time, hospitals and hospital systems have begun addressing population health, something public health nurses have understood and practiced for decades. Helping accelerate this transformation was the establishment of accountable care organizations, which are financially rewarded when they ascertain and manage the overall health of their patient population. As a result ACOs, hospitals, and hospital systems are all conducting health care assessments in the communities they serve, developing policies for tracking and managing infectious and chronic disease, and promoting educational and wellness programs in partnership with local agencies and grass-roots organizations. Often they work closely with public health departments. The alignment with the public health mission is clear.

As new resources are applied to bolster the surveillance, monitoring, and response to infectious disease as a result of the Ebola crisis, it would be advantageous for both fiscal and policy reasons to identify areas of correspondence in how health departments, ACOs and the hospital sector manage chronic as well as infectious disease. Better coordination and a sense of shared mission are necessary for effectively and efficiently protecting individual patients and entire communities.

Let me conclude by commending the outstanding efforts of the U.S. and global health institutions that are working diligently to contain the Ebola epidemic and also express my deep admiration of the courageous volunteers putting themselves at risk to help others. While it seems that the U.S. is, for now, at low risk for additional cases of Ebola infection, the contagion continues to decimate West Africa. There is an enormous amount of work that remains to be done before the countries of Sierra Leone, Liberia, and Guinea are free of the virus. We at  Columbia Nursing will continue to support these efforts.