Conservative Misunderstanding of Public Health

In some circles, the blame for our current troubles as a nation is all government, all the time.  The notion of government is synonymous with waste, fraud and abuse.  Every government employee, no matter how highly trained or hard working is reduced to "government bureaucrat."  There is also the widely held belief that government workers are more highly paid than private sector employees.  However, when factors such as education and experience are taken into account, it is not so clear that there is a disparity.  In fact, the pay disparity may be in the other direction - highly trained government employees are paid less than equivalent workers in private companies.  Since most of public health effort takes place in government, these attitudes and stereotypes matter.

Last week I had the privilege of interacting with a group of employees at the U.S. Centers for Disease Control.  I was there providing a training workshop, serving a group of about 50 civil servants in various specialties of public health.  I found them to be eager learners who are sincere about making an impact with their endeavors.  They were not unlike hundreds of public health workers I've either taught or otherwise associated with over the last three decades.  These are people who go to work every day, trying to contribute to the public welfare by decreasing tobacco exposure, diminishing community violence, protecting people against environmental toxins, and reducing the toll of infectious diseases.  At CDC as well as countless local and state public health settings, I have not found pikers sitting around trying to avoid real work until they can retire.

The facilities in which the training took place were not opulent, but in fact quite ordinary and basic.  That is also what I've found in hundreds of state and local public health offices and settings.  In fact, comparing my observations of these public sector facilities with my experiences in the private sector, such as in hospitals, insurance companies, and various corporations, the private sector sites have uniformly been better appointed, more spacious and well endowed.  While not all private facilities are luxurious either, it is just not true that public agencies are spendthrift for personnel or places of work.

Are there waste and abuse in government, including public health?  Most certainly.  Can you find public health workers who are unproductive, not serving the public good?  Without doubt.  But these things don't only occur in government.  There are workers in the private sector, including employees not in unions, who don't serve their employers well.  There is waste in every workplace, not just in government.  That is not to accept this as a good thing, but it is to reject the conservative narrative that fraud and abuse are unique to government. 

Public health agencies have a responsibility to be good stewards of the public's dollars.  Managers should expect evaluation of functions and accountability from employees.  This is good practice in every organization.  It is not hard to find examples of government services that are not very effective, and we need to always be trying to be better.  But, does anyone feel well served by insurance companies and banks?  Painting public health workers, as all government employees, as illegitimate is unfair, based on a lack of information.  There is the old expression, "What you're not up on, you're down on."  Because people don't understand public health, it makes an easy target.


And so I want to express my thanks to those mostly invisible public health workers who go about doing their jobs, trying to make healthier communities today and going forward into the future.  Those CDC professionals I met last week are a proxy for the public health workforce.  Many people don't know what they do, but those of us who do, must stand in their defense, with appreciation and support.