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US public health system alarmingly neglected

As we witness the global spread of the Ebola virus we are relearning an important lesson: Public health matters.

Public health matters not only in how we track down and trace the index cases for this disease, but also in preparing our communities to face such threats. What few of us realize, however, is that our public health system has been eroded and compromised, calling into question our ability to address future outbreak events.

To remind ourselves how far we have come, we need only to recall when tuberculosis was the scourge of this country a mere century ago.

In the early 1900s, nearly every family was affected. As with Ebola, there was no cure. To face this threat, our nation mobilized, birthing the modern-day public health system out of the work of small local chapters of the Anti-Tuberculosis League.

Public health nurses were educated to perform gumshoe assessment and surveillance for TB and fight for clean water and better nutrition to increase survival rates. These most basic of measures promoted by public health nurses effectively prevented tuberculosis transmission and abated the epidemic long before Isoniazid, the cure, was discovered.

Since the end of the TB epidemic in the United States, the public health system has continued to monitor and prevent the rapid spread of infectious diseases in our communities. A prime example in recent times was the cessation of the 2012 pertussis (whooping cough) epidemic in infants and children in Washington. Our public health system matters when outbreaks happen.

Despite efforts to address Ebola, pertussis and other disease outbreaks, the current public health system has been alarmingly undercut by seemly indifferent political brinksmanship from both sides of the aisle.

The short-term interests of budget sequestrations have dramatically eroded our national and local public health systems. Most alarming from our perspective as public health nurse educators has been the precipitous drop in the proportion of nurses trained to practice public health, declining from 39 percent in 1980 to a shocking 2 percent of the total nursing workforce in 2012.

Without an awareness in politicians that public health matters, this risky loss of nurses as vital components of our prevention system is not expected to end.

As educators of the next generation of nurses, we are committed and confident that we are equipping our students with the very best skills for public health nursing. Yet when we look around the country, we see a rapidly shrinking public health system.

To stay strong as a nation we must be ever ready for the next disease threat, and that means maintaining our commitment to a strong and resilient system.

Robin Evans-Agnew and David Reyes are assistant professors who teach nursing and health care leadership at the University of Washington Tacoma.

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