Accepting this grim reality, and reorienting around it, has proven challenging. While all doctors must meet the exacting standards of their licensing boards, the nitty-gritty of public health work is often learned on the job. In Dean’s case, she was finishing up a residency in internal medicine when she was asked to consider a role as a health officer for Santa Barbara County—a low-paying position she could afford to take because her husband was a highly paid physician in his own right. Intrigued, Dean read the law and discovered that California gave extraordinary latitude to its public health officers, each of whom can declare a health emergency and then take any “preventive measure” they deem appropriate. Armed with the health and safety code, Dean began hunting down cases of meningitis, tuberculosis, hepatitis, and more in order to contain the infectious agents before they could spread.
Angell, by contrast, began her career as a physician in a community clinic. She went on to become the founding director of New York City’s cardiovascular disease prevention program, where she restricted trans fats in local restaurants. Later, Angell moved to the CDC’s Global Noncommunicable Disease Unit, where she worked on heart disease, cancer, lung disease, and diabetes. That’s ultimately why Newsom tapped her for the top job in California in 2019: Heart disease is and remains the leading cause of death in the U.S. and a leading public health priority. But Covid-19 came knocking.
Having Dean and Angell, two of the brightest minds in their respective fields, at the helm of California public health should have set the state up for success. They could have led their own teams to combat the virus and other, ongoing issues simultaneously. But the current structure of public health departments—a single, underfunded entity in each community, responsible for tracking, preventing, and containing diseases of all types—is one in a list of dozens of factors that hampered the pandemic response in California and across the country.
It’s had terrible results for chronic illness outcomes, too. In October 2021, more than 220 local public health departments told The New York Times they had been forced to “temporarily or permanently abandon” other initiatives, like their response to the opioid crisis, to focus exclusively on the pandemic. Social distancing policies that delayed routine screenings and “nonessential” surgeries will likely lead to a surge in advanced cancers. Long Covid, a wide range of health issues that occur in some people who are infected with Covid-19 and never completely recover, is already creating a “tsunami of disability.” And it’s possible that some people who had an acute Covid-19 infection and got better will still be more likely to develop other chronic conditions down the line.