What the American Rescue Plan means for public health

Experts discuss implications of the historic bill and its impact on health equity issues, local health departments, and schools of public health

President Joe Biden and Vice President Kamala Harris wearing masks

Image caption: President Joe Biden and Vice President Kamala Harris leave the White House Rose Garden after announcing the American Rescue Plan, which aims to help Americans recover from the economic and public health impacts of the coronavirus pandemic

Credit: The White House / Wikimedia Commons

For public health workers strained beyond reason during the COVID-19 pandemic, a new lifeline has emerged with the $1.9 trillion American Rescue Plan, signed into law by President Joe Biden on March 11. With its mission to spur recovery in the U.S. from both the health crisis and the economic recession caused by the coronavirus pandemic, the bill includes a historic $100 billion-plus investment in a broad sweep of public health measures, including COVID-19 vaccination efforts, expansion of jobs and training, and preparations for future infectious disease outbreaks.

Of all the government relief measures during the pandemic, the ARP represents "certainly the biggest and most comprehensive and substantial" investment in public health, said Joshua Sharfstein, vice dean for public health practice and engagement at the Johns Hopkins Bloomberg School of Public Health, during a webinar Thursday.

For perspectives on the implications of the landmark bill, the Bloomberg School hosted public health experts representing a variety of critical stakeholders and interests, including scholars of health equity, schools of public health, and state and local health departments. Below are some of the insights they shared.

The bill includes a historic $100 billion-plus investment in a broad sweep of public health measures, including COVID-19 vaccination efforts, expansion of jobs and training, and preparations for future infectious disease outbreaks.

Lisa Cooper, executive director of the Johns Hopkins Center for Health Equity, expressed hope that low-income communities and communities of color will benefit from the bill's provisions to alleviate childhood poverty—including investments in child care and early-childhood development programs and increased funds for SNAP (the Supplemental Nutrition Assistance Program). She also pointed to promising measures to expand insurance coverage and affordability, close gaps in access to medical care, and increase support for mental health and substance abuse programming.

Targeting funds directly toward local grassroots organizations in vulnerable neighborhoods will be critical, Cooper said. "They're the ones who have the trust of the community," she said. Already, community leaders have helped bolster confidence in the COVID-19 vaccines, she said, with up to 70% of Black citizens now expressing willingness to get immunized—comparable to numbers among white populations. "Now the issue is going to be … making sure that there's access," Cooper said.

One concern with the ARP, Cooper said, is that many provisions expire within two years. "Once this drops off, what's going to happen to all of these people who are going to be depending on a lot of these resources?" she asked, adding that the problem is exacerbated by the fact that bipartisan support for many aspects of the bill has been lacking.

As with the funds to pull American children out of poverty, ARP's infusion of funds into the public health workforce cannot just be a stopgap, said Chrissie Juliano, executive director of the Big Cities Health Coalition. "We have a real opportunity, thinking about sustainability, to make sure that we're not just hiring a hundred thousand public health workers for five minutes, then just going back to where we were," she said. "We need to make sure that we can recruit, retain, and retrain."

Juliano said she was encouraged that many funds within ARP came without a time restriction to spend them: "This flexibility is important, and it may allow health departments to keep people on staff longer."

Funds from the ARP will affect 130 public health schools and programs, doling out about $40 billion for higher education–related efforts, according to Tony Mazzaschi, chief advocacy officer of the Association of Schools and Programs of Public Health, who called the legislation's trajectory "a revolution from where we have been in the last four years."

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He noted that applicant numbers at public health schools have been "through the roof" during the pandemic—up about 40%, including "astronomical increases" in the number of applicants who are people of color. For recent and upcoming graduates, he said, the ARP signifies that "the employment field is going to expand. There's no doubt about it."

But one of the disappointments in the bill, Mazzaschi said, is that "there's very little research side," with no direct funds going toward the National Institutes of Health. "The research community is continuing to work hard to try to get additional resources."

While the ARP makes unprecedented investments at the federal levels, Carolyn Mullen, chief of governmental affairs and public relations for the Association of State and Territorial Health Officials, noted that the bill lacks specificity on how much will trickle down to state and local health departments—which are relying on the Centers for Disease Control and Prevention to disburse funds.

State health departments should use the funds to modernize their data systems, Mullen said, so that future outbreaks of infectious disease are easier to spot—and contain. "What I would like to see is … the ability for us to get warning signals when a disease crashes upon our shores, for the state health departments to communicate not via fax, and for us to be able to have the data and information we need to make informed decisions in real time."

The full video of Thursday's discussion is available here.