To reopen the economy for good, invest in a preventive health workforce
As COVID-19 cases worldwide soar past the 2 million mark, every health leader is calling for the same three things: increased testing, contact tracing and quarantining of those who’ve been exposed. Alongside their clear necessity for reducing disease spread, these steps are critical to our ability to reopen the economy and keep it open once we do.
But one key question remains unanswered: Who is going to put this plan into action?
Costly errors were made in this administration’s response to COVID-19, but the U.S.’s underinvestment in public health dates back decades. And as Congress takes up a fourth stimulus package, strengthening our public health infrastructure — including the human infrastructure — should be a priority.
Doing so would not only create hundreds of thousands of jobs at a time of unprecedented layoffs, it would vastly expand our capacity to contain this pandemic and prepare for the next. Thousands of new graduates are about to enter a bleak economy, adding to the millions who are newly unemployed. The time is right for making bold investments in the preventive health workforce.
So what would that look like? The solution is two-fold: First, get more people into public health jobs. Second, ensure they can afford to stay there.
To address the first, we should invest in a national cohort of health workers who can roll out each element of the national COVID-19 strategy — let’s call it the Preventive Health Corps. From helping those who are quarantined meet their basic needs to undertaking noninvasive contact tracing to facilitating widespread testing, the Preventive Health Corps would fill an urgent resource need while also providing a much-needed job stimulus. The corps could build on existing service job models, like AmeriCorps, while paying the prevailing wage and providing full benefits.
The costs would be not only reasonable but far outweighed by the benefits. Even if we scaled up to 500,000 corps members, their compensation would amount to just a tiny fraction of the total stimulus spending, while yielding dividends for years to come. Moreover, these costs would be offset initially by savings from reduced unemployment claims.
Further, while COVID-19 represents the most urgent need, even in the absence of a pandemic, the U.S. sees well over 100,000 preventable deaths each year. A dedicated and comprehensive preventive health workforce — including direct service providers, educators, policy analysts and others — could powerfully reduce these numbers. And we wouldn’t be starting from scratch — existing institutions could host corps members, increasing their capacity to deliver tried and tested services and education.
To support the preventive health corps long-term, we should accelerate and simplify loan forgiveness. Although many people desire to pursue public service, around 70 percent of those graduating with a master’s in an appropriate field have student loan debt that averages around $75,000; for some, the balance is far higher. Many go into private-sector jobs to pay off debt. An accessible loan forgiveness program would incentivize more people with backgrounds in public health, law, social work, urban studies or health sciences to get preventive health-related jobs and commit to them as careers.
The existing Public Service Loan Forgiveness program, which erases federal student loan debt after 10 years of public service work, should in theory cover most preventive health jobs. In practice, however, just 1 percent of applicants to the program have had their loans forgiven, a consequence of complex paperwork requirements, strict rules about qualifying payments and confusion about eligibility.
Providing forgiveness on an annual basis — that is, forgiving 15 percent of an individual’s loan balance each year — would provide immediate benefits to those pursuing preventive health careers while building confidence that loan forgiveness is actually attainable, rather than a risky gamble.
Politicians have compared the current crisis to a war, with some going so far as to propose a health care worker draft. Yet mandatory service is no more the answer for recovery from this health crisis than it is for the military.
Tuition reimbursement, adequate pay and a clear pathway for career advancement have strengthened our armed forces. So too would providing equivalent benefits to frontline preventive health workers, whose success will be profoundly important to our health and safety as a nation.
COVID-19 may be the greatest health and economic crisis of our lifetimes, and it’s easy to feel overwhelmed by the challenge. But the solutions are known and within our reach. If we invest now in the building and sustaining a preventive health workforce, that action will begin saving lives immediately and its benefits will continue well into the future.
Jody Heymann, M.D., Ph.D. is a distinguished professor of public policy, health policy and management and medicine at UCLA and former dean of UCLA Fielding School of Public Health.
Aleta Sprague, J.D., is a senior legal analyst at the WORLD Policy Analysis Center.