Beginning today and over the next two years, we should collectively assemble a comprehensive plan for the next American administration to restore the country’s public health system and its role in global health leadership [ see note 1 ] . In other words, we should be creating the ‘Health Recovery Plan’ now rather than wait for a hectic transition period in 2020/2021.
The damage done to our health infrastructure, and to our citizens’ faith in fact-based, evidence-driven health practices, will be difficult to put right. The next administration will face a difficult task simply bringing the nation’s health back to the level it was in 2016, let alone moving it forward. But a detailed and reasoned plan could speed the process and guide new leadership. In addition, America must vigorously re-engage with global health programs, addressing everything from famine and disaster relief to water security, containment of highly-infectious diseases like Ebola, and treatment of endemic challenges like TB and malaria.
How Should We Do This?
Very broadly, here’s how this might happen.
Create a Collection Mechanism and Curate the Entries
The first step might be simply crowd-sourcing as many details as we can, noting changes in laws, regulations, and agency policies. The breadth of the damage done is beyond the scope of any one person’s understanding, so allowing as many people as possible to contribute will be helpful.
The easiest way to do this is probably to set up a website to collect and house the knowledge of hundreds, if not thousands, of like-minded, concerned citizens, practitioners, government workers, and others. There should be an option to collect these notes anonymously, to avoid any possibility of retaliation or harassment.
The organization hosting the website should provide some degree of curation, storing entries according topic. This will help clear out duplicate information and structure what remains in a way that will make it more useful to those writing Plan chapters later (see below).
Define Scope and Constitute Panels
Based on the information received in Step One, the major sections of the Plan will be defined. For example, there should probably be one for Environmental Health, one for Global Health, for Indian Healthcare, for Medicare, for Medicaid, the ACA (Affordable Care Act), and more. Defining some of these chapters by existing federal programs will make it easier later to assemble legislative proposals.
With the sections defined, panels of experts should convene, one for each section, to debate and outline their chapter of the Plan. A group with organizational acumen and high standing in the healthcare community (like Devex or the Gates Foundation) [ 2 ] could solicit nominations for the panels, extend invitations, and provide necessary administrative support.
Write the Plan
The organizing entity would provide each panel with a structural requirements document as well as drafting assistance, as needed. These required sub-sections might be something like Policy, Rulemaking, Legislation, Executive Orders, and so on.
The chapters, and therefore the entire Plan, should be available online in draft form for comment, refining, and updates up until the new administration takes office.
Write the Plan to be Read by Everyone
Not only should the Plan be readily available online (and possibly in print) but it should also be written in the clearest and most accessible language possible, so every American can understand what changes are being proposed –and why. That probably means engaging a seasoned editor or author; someone like Stephanie L. Kaplan or Alice Falk, the Managing Editor and Editor, respectively, of the 9/11 Commission Report [ 3 ] or Laurie Garrett, author of Betrayal of Trust: The Collapse of Global Public Health.
Use a Broad Definition of Health
Many aspects of our health are affected by decisions taken far afield of healthcare itself. The Plan should acknowledge this and document non-healthcare-specific changes made by the Trump administration that are having an adverse affect on public health and need to be reversed. Examples include EPA’s rollback of the Clean Power Plan [ 4 ], FDA’s delay in implementing new food nutrition labels [ 5 ], and Labor’s delay in enforcing standards for use of cancer-causing agents [ 6 ], among many, many others.
Integrate the Recommendations
By its wholesale rollback or corrosion of many aspect of our healthcare system, the Trump Administration has inadvertently provided an opportunity to do the rebuilding in a highly strategic and integrative fashion. The panels should therefore avoid recommendation silos and instead seek to coordinate with each other. For instance, the Department of Labor’s decision on who is a contractor and who is an employee (especially for lower-paid workers in industries like fast-food) will affect the number of enrollees in the Affordable Care Act, which in turn will affect Medicare, Social Security, and many other programs. The Plan should be written to take such dependencies into account, aiming to achieve the overall best solutions across all government programs.
We should commit to reengage with our partner nations and organizations around the world, acknowledging once again that the health ecosystem is global, dynamic, and facing increasing pressures from climate change and other forces, both natural and human-made.
And if the Unthinkable Should Happen…
If the administration is given a second term, the Plan will still have great utility. It can serve as a map showing what lines should be drawn and what fights should be engaged. It will help keep like-minded organization from working at cross-purposes and it will give every citizen a guide to what should be advocated to their representatives.
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[ 1 ] By ‘leadership’ I mean not the bullying and arrogant behavior we’ve seen recently, but instead a cooperative and expansive approach to raise health conditions for people everywhere, and acting as an example and shouldering a load proportionate to our good fortune.
[ 2 ] It may be difficult to find a sponsor/administrator with both deep pockets and standing in the health field, if only because no matter how carefully the Plan focuses only on health needs, it will no doubt be viewed as a political initiative and that sponsor/administrator will bear the brunt of partisan blowback.
[ 3 ] The 9/11 Commission report is remarkably clear and readable. Even though each chapter was written by different researchers and investigators, the report reads seamlessly, as if drafted by a single author. A few years ago, I spoke with Kaplan, hoping to get a copy of whatever writers’ guidance she had given to all of the contributors, only to be told that there was no such guidance, only a reliance on the writing talents of the Commission staff. And while I suspect Kaplan was downplaying her (and Falk’s) role in achieving that consistency and clarity, the report remains a high standard for public documents. The report can be read online here: https://www.9-11commission.gov/report/911Report.pdf.
[ 4 ] EPA’s rollback of the Clean Power Plan. “The administration’s own analysis, however, revealed on Tuesday that the new rules could also lead to as many as 1,400 premature deaths annually by 2030 from an increase in the extremely fine particulate matter that is linked to heart and lung disease, up to 15,000 new cases of upper respiratory problems, a rise in bronchitis, and tens of thousands of missed school days.” https://www.nytimes.com/2018/08/21/climate/epa-coal-pollution-deaths.html
[ 5 ] FDA’s delay in implementing new food nutrition labels. “The FDA extended the compliance dates for the Nutrition Facts and Supplement Facts label final rule and the Serving Size final rule, from July 26, 2018 to January 1, 2020, for manufacturers with $10 million or more in annual food sales. Manufacturers with less than $10 million in annual food sales would receive an extra year to comply – until January 1, 2021.”
[ 6 ] Labor’s delay in enforcing standards for cancer-causing agents. “The Department of Labor (DOL) in June delayed enforcement of a rule that limits workers’ exposure to beryllium, which causes lung cancer and other respiratory diseases. In April the department delayed another rule that would lower the acceptable levels of crystalline silica in the construction industry, which employs nearly 7 million. Crystalline silica causes lung cancer and other lung diseases if breathed in in high levels.”