When Chae Li Yong entered college, she planned to pursue a medical degree. However, after dealing with her own medical challenges, she became disillusioned with a system that fails to provide affordable health care including medications to everyone. She began to search for alternate but complementary careers to medicine. When she stumbled into her first public health class, Chae Li knew she had found her niche.
As an undergraduate student of Community Health Education, Chae Li interned at a local health department. Prior to her internship, she knew she wanted to be an epidemiologist, which would take additional education. During her internship, Chae Li shadowed several public health professionals which only cemented her desire to be an epidemiologist. Alongside the staff, she collected mosquitoes, set pest traps, watched staff administer tuberculosis meds and inspected restaurants. She observed staff respectfully closing the pool of an upscale hotel, trying to find homes for strays scheduled to be euthanized, and interviewing someone diagnosed with HIV. She never forgot the courage and empathy workers demonstrated as they taught her how to safely search for patients in high crime neighborhoods or how to conduct impartial interviews of patients in prison.
After graduation, Chae Li worked as a community health educator at a local health department. It was in that position that she had her first encounter with the reality of limited budgets and the constraints they impose on public health departments. It would not be her last. Indeed, social workers in most fields would identify with Chae Li’s principal frustration in public health—trying to do more, always, with fewer resources.
For 5 years, Chae Li worked on a state-funded grant where she taught children about injury prevention and parents about child passenger vehicular safety. As long as she met her grant requirements, she was allowed to do other public health activities such as teaching smoking prevention and cessation. While still working full time at the health department, Chae Li returned to school to complete dual graduate degrees in social work (MSW) and public health (MPH). Within a year she accepted the epidemiologist position generated from the state’s bioterrorism grant. She recognized then what she has witnessed repeatedly in her career—public health issues can seldom be addressed without taking concerns from the social environment into account. A single mother struggling to find affordable childcare may not be concerned with lead abatement, and a father trying to feed his family may not have the foresight to consider childhood obesity. Chae Li is equipped with the technical knowledge of behavioral change and public health along with social work’s relational skills and systems thinking. She has worked not only the high-profile events of national foodborne outbreaks and H1N1 but also the field’s more routine support of the foundation of population health.
Over her 24-year career, Chae Li has been on the front lines for some of public health’s essential services. On September 9, 2020, a revised 10 Essential Public Health Services was released.
1. Assess and monitor population health status and factors that influence health. While collecting death data, Chae Li observed a trend in a specific subset of the population. She consulted other professionals including a social worker about an increase in infant deaths due, in part, to a unique cultural practice.
2. Investigate, diagnose, and address health problems and hazards affecting the population. Using bioterrorism funding, Chae Li set up a surveillance system which consisted of both active and passive surveillance. Even after funding ended, her community partners continued to send in data. This is why Chae Li and her partners were confident of two things. From August through November 2019, there were reports of an unidentified organism making working people ill enough to go to urgent cares but not acutely ill enough to go to emergency departments. Surveillance data indicated the illness was affecting the working population, not the young nor the old. The final confirmation that the illness was not COVID-19 was the lack of hospitalizations and deaths.
3. Communicate effectively to inform and educate people about health and the factors that influence it. In looking back at the federal response to COVID-19, it is obvious public health had the capability of creating one united message. Employers and employees knew to stay home if they tested positive or exhibited any symptoms. Unfortunately, the risk communication messages were not forthcoming at the federal level.
4. Strengthen, support, and mobilize communities and partnerships to improve health. Chae Li was involved in a project that trained people in the proper use of child passenger seats to reduce the number of children who are injured or die because they are improperly restrained in a car. The relationships forged through this work ensured that, after public health funding for the project ended, community partners—hospitals, police, fire departments, social service agencies, and private businesses—continued to check car seats and educate families on proper installation.
5. Create, champion, and implement policies, plans, and laws that impact health.
Public health disseminates information to help people make informed decisions. Social media campaigns can make health information readily available, but also complicates efforts to provide only accurate, quality resources. One casualty of this limitation has been childhood immunizations; as some parents have declined to vaccinate their children after reading unscientific and alarming media, certain vaccine-preventable diseases that had been almost eradicated are now on the rise. Closing the loopholes which allow nonreligious people to claim religious exemption for vaccine refusal can only be done through policy changes.
6. Utilize legal and regulatory actions designed to improve and protect the public’s health. While Chae Li has had to familiarize herself with the scientific background behind various grant-funded projects, she readily admits that the most challenging parts of her projects are often better handled by social work’s domain—the political, financial, and emotional fallout of public health decisions. Enforcing regulations that keep communities safe can be difficult, as the public often misunderstands food safety restrictions or an institution resists public health recommendations that might cost thousands of dollars to implement. When someone is restricted from working in an industry because they continue to pose a risk of infection, or when religious and/or cultural issues make transmission more likely, social workers have the cultural competency and interpersonal skills to broker workable solutions.
7. Assure an effective system that enables equitable access to the individual services and care needed to be healthy. Chae Li worked on a committee that was asked to help fund socks for needy children identified by the schools while another organization paid for the shoes. The schools provided transportation to and from the school and the shoe store. Consumers struggle to find health care due to lack of insurance or other holes in the health care safety net. The growing older adult population’s need for long-term care is of particular concern. Chae Li experienced this firsthand while seeking services for her ailing grandparents. The reality is that many people who need respite, in-home, or institutional care in later life cannot afford or, sometimes, even find these resources. Public health struggles to fulfill its mission when the health care system is fragmented, complicated, and often incomplete.
8. Build and support a diverse and skilled public health workforce. Prior to hiring temporary contact tracers, Chae Li’s health department had less than 40 employees serving a population of over 250,000 people. Those employees worked the pandemic for months before contact tracing staff was hired. During a brief respite in the pandemic where numbers were lower, several regular staff members retired or resigned. For insights into the public health workforce crisis, read Len Strazewski’s article, “Inside COVID-19’s overlooked toll on the public health workforce” (www.ama-assn.org/delivering-care/public-health/inside-covid-19-s-overlooked-toll-public-health-workforce).
9. Improve and innovate public health functions through ongoing evaluation, research and continuous quality improvement. A strong public health system is a pillar of community well-being. Because local health departments are usually understaffed and overwhelmed, they must focus the majority of their efforts on evaluating and improving grant funded projects.
10. Build and maintain a strong organizational infrastructure for public health. Over the last several years, the loss of experienced public health workers has greatly weakened the overall public health infrastructure and put additional strain on public health professionals. When there is a change in political leadership, new health directors are appointed to federal, state, and local public health agencies. Those directors may also replace experienced staff with inexperienced staff.
As the country grapples with evolving health concerns, rapidly changing technology, and a political context of mistrust, public health should emphasize evidence-based practice while responding to crises and preparing for public health emergencies. Public health leaders need to endeavor to be politically neutral but ethnically sound when they offer recommendations. Most of the time, public health leaders ignored many of the preventive and curative claims that were being made. Even after numerous studies were performed to disprove the preventive or curative claims, people refused to believe. Public health leaders need to be just as charismatic and compelling as those making false claims; most are not even close. As a trained public epidemiologist, Chae Li tracks trends. As a social worker, Chae Li considers the real-world and ethical implications of those trends.