National Public Health Week is April 5 to April 11. This is the first in a series of articles about public health from the Harford County Health Department that will appear in the Aegis on Wednesdays in April.
My piano teacher unlocked the world of chords when C E G became a tonic C. Music binds scattered notes into chords and phrases that express what our souls long to say about life. Much of art’s beauty lies in diversity that is unified.
Abraham Lincoln expressed this in his first inaugural speech when he appealed to “mystic chords of memory” that all Americans shared in the prior 80-odd years of the patriotism required to start the world’s first modern democracy. The American chord that has always unified us through countless trials is our identity as fellow citizens dedicated to a proposition. The Constitution that we ratified and amended and all or our subsequent laws have been ongoing experiments meant to unify diverse Americans in our shared proposition — that all are free and all are equal. Necessary compromises to freedom and equality require profound existential justification. History is filled with un-freedoms and inequalities that were foisted on Americans at times of unjustified fear or for the gain of the powerful.
The SARS-CoV-2 virus has tested our unity because it demands a trade-off about how much freedom we are willing to give up to protect each other. There is a range of sacrifices that have been called for. Some have been asked only to wear a mask, wash their hands and stay 6 feet apart. Some have been asked to abandon their livelihood, their homes, their loves. This spring and summer, everyone is called to become a student of facts about COVID vaccines, to judge data about efficacy and safety. Our personal choices need to include both the substantial personal benefit from avoiding a disease that kills and disables at any age as well as the benefit of knowing that we won’t be the one who spreads disease to our friends and family.
When we started these personal sacrifices over a year ago, it wasn’t clear whose lives we were saving. Now after half a million funerals, we know. So many of these deaths were casualties to disunity and poor choices. The public heath tools that we entered 2020 with were demonstrably inadequate. After decades of slashed budgets, the public health departments of America were skeletons. The public health “muscles” that were once so strong in tracking health threats and marshaling a community to take action are shrunken and flabby. Although on paper the U.S. spends $90 billion a year on public health, my research has shown that half of that money is actually local health departments keeping the lights on by providing clinical services and collecting fees and block grants. Former armies of visiting public health staff and epidemiologists have dissipated.
The greatest superpower of public health comes from unifying people and local governments to take action against identified threats to health. In some parts of the U.S., counties had kept these skills in order. A few small U.S. counties were able to coordinate their citizens and local agencies to conform to well-known COVID control measures in testing, tracking and vaccine acceptance. We must learn how they did this, because most of America’s health departments have lost their ability to convene, unify and dialogue with citizens about the sacrifices needed to protect each other.
As we head into the second summer of COVID-19, the mystic chords of memory are recent memories of the funerals of over half a million sons, daughters, brothers sisters, cousins and grandparents. These memories beg to unify us and call forth the better angels of our nature. After this pandemic we need to stay unified and recognize that public health is not that thing that happens in that brick building on South Hays Street in Bel Air. Public health is the work of all of us. Being considerate to each other keeps us alive and requires a constant conversation about the tension between life and liberty.
Dr. David Bishai is the Harford County health officer, a practicing physician at the emergency department of the University of Maryland St. Joseph’s Medical Center in Towson, and a professor at the Johns Hopkins Bloomberg School of Public Health.