I began my career in San Francisco at the Department of Public Health, where I engaged in many activities, including dressing up as a giant condom in our city’s vanguard efforts to conquer an emerging crisis called AIDS. Back then, when I tried to explain to my mother what I did, she was often confused. I wasn’t treating patients, or prescribing medication. How could research, educational literature, or a condom costume make people healthier? 

Much like my mother, most of us don’t know what public health is, or pay attention to public health, until we need it. And sometimes, by then, it is too late.


It is because of the day in-day out work of public health that we live relatively healthy lives, and see few major outbreaks. And it is because public health does its job so well that our work is virtually invisible: we don’t see the epidemic quelled because of vaccination campaigns; we don’t witness the salmonella outbreak that was prevented because of food inspection and regulation; we don’t notice the devastating diseases rendered asymptomatic or cured thanks to research that takes years (and funding) to complete.

But that out of sight, out of mind mentality is also why public health is often the first to get cut in budgets and why the infrastructure of public health has been so eroded over the past decade.  And why today, in the crisis of Ebola, we wonder if we have the capacity to respond.

Back in 2013, through something called the sequester, a series of cuts were made as part of a federal plan to institute ‘fiscal responsibility.’ Those cuts included: almost one billion from the Centers for Disease Control (compared to 2012); 1.5 billion from the National Institutes of Health, the fount of our country’s medical research; and a reduction of $411 million to global health programs plus an additional cut of $289 million to USAID. These cuts came on top of many reductions made to state and local health departments over the past decade. Together, they have caused the safety net of public health in the US and globally to be extremely stretched—and in some cases frayed. 

The Ebola crisis is a real threat across the world. It has killed thousands and could kill millions. In the shadow of Ebola lie other existing and emerging health concerns: influenza, MERS, tuberculosis, diabetes and HIV.

Some of these issues may not feel like a crisis—but some have silently killed many more than Ebola, and without the work of public health, they will continue to kill many more.

Ron Klain’s appointment to oversee Ebola efforts is an important one, but a leader needs resources and personnel to marshal. We would never send our army into a battlezone without gear, without backup, without weapons, but that is what we have done for our frontline defense workers against public health emergencies, both here and abroad. We have left them with gutted infrastructure, with no money for research, with limited capacity to study methods of transmission or to develop treatment options.

This week Mark Zuckerberg and Dr. Priscilla Chan’s donated $25 million to fight Ebola, a welcome and needed investment. I challenge them and other philanthropists to make an equal investment in California’s public health infrastructure so we can be prepared to fight continued and emerging challenges. We need to strengthen our entire public health and health care here at home, including hospitals, clinics, non-profits, local health departments and local community groups. We need to understand that infrastructure and health in developing countries are not an extravagance in our globalized world--they are an investment in everyone’s wellbeing.

Ignoring public health is ignoring the public’s health.  We can’t afford to wait.

Pittman is president and CEO of the Public Health Institute.