How are public health students impacted by a weakened public health emergency preparedness system?

Support for, and trust in, public health is at a nadir. Recent accomplishments include the rapid development and approval of a safe and effective COVID-19 vaccine, effective mpox response, declines in opioid overdose deaths through harm reduction, and evidence-based public health initiatives addressing root causes of gun violence.

Despite these initiatives, which have significantly reduced the population-level impact of injury and illness, perceived missteps in the management of COVID-19, pervasive mis- and disinformation, increasing public distrust, and a lack of financial support have contributed to the deterioration of public health’s ability to respond to disasters and emergencies. The impact of false narratives and disinvestments interrupt the public health workforce pipeline, denying students opportunities to be trained for and participate in public health emergency preparedness activities.

In 2003, I began my career as a disaster epidemiologist conducting household interviews for rapid needs assessments being conducted by the US Centers for Disease Control and Prevention (CDC), the N.C. Division of Public Health, and the University of North Carolina following Hurricane Isabel.

For more than two decades, I deployed with students in partnership with local, state, and federal public health agencies to respond to disasters and collect data that contributed to both the immediate and long-term mitigation of the negative health impacts of disasters.

This work, conducted in communities across the United States, is only possible because of a community’s trust in public health agencies and individuals’ willingness to share their postdisaster needs with our interview teams, which typically include a public health student and a local resident.

The collection of perishable data in postdisaster contexts is challenging regardless of circumstance, and alterations have been made over time to ensure better representation of pregnant women, migrant workers, and rural populations in these postdisaster assessments. Yet, these assessments would not be possible at all without trusted connections between governmental agencies, academic public health, and disaster-affected communities.

Politicization threatens our ability to respond

Politicization of disaster response and disaster assistance, and the mis- and disinformation that has now become prevalent around it, make it more difficult to collect these data. Following Hurricane Helene, one of my public health students at the University of Delaware worked with the western North Carolina nonprofit Sustaining Essential and Rural Community Healthcare to conduct key informant interviews and a Community Assessment for Public Health Emergency Response community survey. Both officials and residents reported that misinformation took time and attention away from response activities and disinformation led residents to distrust the response and recovery.

After the pandemic, we have a dramatically under-resourced public health preparedness and response system, even in the face of more frequent and severe disasters and public health emergencies. These challenges will continue to mount as the Trump administration dismantles not only public health but also science more broadly. If the administration continues with their stated intent to dismantle the National Center for Atmospheric Research, this will further limit our ability to understand the human health impacts of extreme weather and weather-related hazards associated with climate change. This comes after significant damage to other federal agencies, including the CDC, the Environmental Protection Agency, and the Occupational Safety and Health Administration, all of whom monitor and collect data on disasters caused by natural, biological, and technological or industrial hazards and risks.

A weakened workforce pipeline

With the rapidly changing landscape, students are learning about “how things used to be,” with an asterisk next to almost all federal disaster and public health policies and legal frameworks noting that the material could be outdated quickly. However, it is important that students are aware of the mechanisms and functionalities that have existed before this most recent political upheaval.

For new public health professionals to help build back programs in more sustainable and resilient ways, it is vital that they have a comprehensive understanding of the policies that were dismantled, as well as their strengths and weaknesses. However, limited job opportunities and ongoing uncertainty will steer this generation of public health students away from governmental public health careers, leaving a long-term deficit of expertise.

The difference between an emergency and a disaster is that in an emergency, actions can be taken to avoid a disaster, which exceeds the capacity of an impacted community. The Federal Emergency Management Agency’s (FEMA’s) workforce is 20% smaller under the Trump administration, and mitigation grants through the Flood Mitigation Assistance and Building Resiliency Infrastructure and Communities programs have been eliminated. Reducing community capacity to manage social, systemic, and infrastructural risks through disaster risk reduction, mitigation, and anticipatory action will result in emergencies more frequently progressing into disasters.

Furthermore, without federal capacity to respond in agencies like FEMA or CDC, the risks that a given emergency will become a disaster also drastically increase simply because of the ways resources are allocated. Students will no longer have the opportunity to participate in fieldwork when there are no federally supported disaster responses or to learn about disaster epidemiology when there is no longer funding for academic programs that teach students public health in complex emergencies and disaster epidemiology concepts. A safety net that is frayed in nondisaster times will simply unravel during a public health emergency.

Overall, it is critical for both the current and future public health workforce to continue to work to identify and understand the social drivers of health and the ways in which the current regulatory, technological, and political moment is affecting public health in both the short and long term. Discussing the ongoing stress impacts of the “triple disaster” in Japan in 2011 (i.e., earthquake, tsunami, and nuclear accident at the Fukushima power plant), Adam highlighted the importance of identifying and understanding the impacts of new and unexpected stressors on population health.

A call to action

Borrowing from this framing, the next generation of public health professionals must now begin to engage in quantifying the public health impacts of these policies to generate the essential evidence base for the future reinvestment in, and reinvigoration of, public health emergency preparedness.

Current public health students can begin to actively capture the baseline state of public health, commit to ongoing active surveillance and measurement, and engage with both objective measures of health and self-reported perceptions to track how the human-made and unexpected stressors like artificial intelligence, climate change, and political polarization may affect us.

While being “political” has often been seen as a negative for public health officials, now is not the time for public health students to be insular or isolated. Although engaging with the political, legislative, legal, and business sectors as a public health student or professional may feel daunting, public health must now more than ever engage with a variety of new partners and tools for public health practice. We cannot respond to the current attacks on public health in isolation. Businesses must speak up regarding how important a healthy and safe workforce is to their success. Local officials must advocate for the health of their residents and communities.

The long-held sovereignty of local public health governance must give way to regional collaborations like the recently announced Northeast Public Health Collaborative, which brings together 10 states and New York City to work together on issues like vaccine policy, public health financing, and public health data collection, management, and analysis.

Public health has always had the impetus to protect previous achievements—vaccination, robust surveillance systems, workplace and environmental safety, maternal and child health, reducing health disparities—through monitoring and evaluation, education, regulatory enforcement, and other essential public health services. For public health students, now is the time to find your passion, engage with partners that can support you, and prepare to lead.