The going is getting tough when it comes to Colorado’s response to COVID-19.
Pandemic politics have come into sharp relief recently as school districts delayed in-person openings and Gov. Jared Polis admonished county leaders to do more to curb the spread of the virus.
Local press, including Colorado Public Radio’s investigation into the early steps in Colorado’s response, revealed frustrations among local leaders with the state public health department.
While there’s certainly a story to be told about these personal dynamics, they overlook the larger, systemic context.
The Colorado Health Institute specializes in studying fundamental issues that transcend personalities and politics, and we think it’s important to understand these big-picture problems so we can find our way out of this pandemic and prepare for the next emergency.
In particular:
- We are paying the price for decades of underfunding public health and ignoring upstream investments in health.
- We are relying heavily on unproven innovations and technological solutions.
- We are getting the government we designed.
- We are underestimating the impossibility of public health jobs.
When it comes to funding, public health has long been the neglected stepsister of Medicaid and health care delivery. It has suffered relatively poor funding for decades.
The Colorado Department of Public Health and Environment is about one-twentieth the size of the department that runs Medicaid. It gets only about $60 million a year from the state general fund, while about 90% of its funding comes from the federal government and taxes on tobacco and marijuana.
The department’s responsibility is vast. It oversees clean air, clean water, emergency medical services, hazardous materials and prevention of disease, violence and substance use. Responding to viral outbreaks is just one of its jobs.
For years, public health researchers have warned that many states — not just Colorado — would quickly become overwhelmed in a pandemic, lacking the resources to trace infections and isolate people who were exposed to a disease.
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COVID-19 is especially devastating for people with chronic diseases, such as high blood pressure or diabetes. It’s the work of public health to prevent these chronic diseases. Yet these illnesses grow in America year after year — evidence of our neglect of the prevention that public health provides.
Polis is a tech entrepreneur. It should come as no surprise that he gravitates toward tech-based solutions and tech-savvy people in his administration.
His Innovation Response Team originally paired private and public sector workgroups. In normal times, this could be a fascinating model: innovative thinkers working alongside subject matter experts to solve intractable problems. But given the urgency of the pandemic, we may question the timing of the model.
In hindsight, rather than a technology executive to solve Colorado’s challenge of COVID-19 testing, perhaps a veteran of medical supply chain procurement could have been a more astute pick. Was there an ideal pick? We’ll never know.
There is still hope for this approach. The recent selection of technology firm Dimagi to implement our contact tracing may be the saving grace for Colorado. We know from public health experts that good old-fashioned contact tracing seems too dated to handle this pandemic.
The disease is spreading too quickly, staffing is too expensive, and even if we solved for both those problems, people no longer pick up their phones when strangers call — a central dependency of contact tracing.
Media attention continually focuses on the lack of a federal response and the missed opportunities to combat the pandemic. While it is hard to disagree with this assessment, we should also examine local and state dynamics, because this too provides cause for concern.
Colorado prides itself on local control, especially when it comes to schools. Yet the pandemic has shined a bright light on local differences public health, such as the appetite for masking, business closings and government intervention writ large.
Local preferences and politics, usually celebrated, contrast with the need for regional, statewide or even national responses, which are needed to provide consistency in controlling COVID-19. Coloradans, particularly those in metro areas but even in rural swaths of the state, travel too much for individual counties’ orders to be effective. We know this from analyzing our commuting patterns and cell phone movements.
We also have made constitutional changes that promote turnover in our top posts within state agencies. Remember Amendment S from 2012? This measure, passed by Colorado voters, allows new governors to change out more top-level posts beyond traditional cabinet-level appointments.
Senior executives, who report to the governor’s cabinet members, also became political appointees. At least in 2012, we thought that new blood in government roles would help the government run more like a business and was an idea good enough to add to our constitution.
While this does not necessarily serve as an excuse for notable and recent departures at the state health department, it provides a larger context for our consideration.
Our government, the one that we have designed, encourages local control and invites new players to positions of political power; it just doesn’t serve us well during this pandemic.
In addition to the structure of our state government, it’s also worth remembering that Polis has brought a libertarian streak to the governor’s office. He’s a fan of local governance and pushes decision making to local districts, at least in the public health sector.
His threatened veto of last year’s immunization bill (revised and passed in 2020) was a case in point, as are his statements that public health is about convincing the hearts and minds of Coloradans.
The pandemic has brought unprecedented challenges. Many were foreseeable, but no one counted on the federal government abdicating most of its responsibilities or the scarcity of supplies or the challenges that caller ID brings to contact tracing.
This combination of factors suggests that the job to effectively and successfully fight the pandemic is impossible without the full support of government at all levels and society as a whole.
No matter who sits in the top post at local and state public health departments, the job and all its constraints may just be too much. Even the most talented leader could not manage this alone.
Instead of blaming personalities or politics, we must look to ourselves as personal contributors and community members. In the case of COVID-19, overcoming the long odds will take all of us.
The pandemic still runs rampant, not just in Colorado but in most states. The failures that led us to this point began years ago. If we pin them on one or two people, we will miss the lesson we must learn about improving our public health system.
And if we do not learn now, when the next pandemic arrives, we will have new names of scapegoats but the same failures.
Michele Lueck is president and CEO of the Colorado Health Institute, an independent health policy research group.
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