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Quickly Noted: Discussion of Siloization and Infrastructure

January 27, 2009

tphThe Pump Handle is not the usual fare that I peddle around here, but they’ve got a great post up today.

They talk about how public health folks tend to fall into silos and not work together. In my work, there are different groups with specialized focuses. These are great people who do their job more tirelessly and with more vigor than their paycheck and the respect given to them deserves. Simply put, these folks are what makes public health work . And while they know each other socially, there is very little cross-pollination of their work or ideas that occurs. There is some definitely, but man, to see these folks work together — that’d be something else. It’s something we’ve simply got to work on.

The second part, though, is why I posted this here. Check these out:

Consider, for example, the meaning of the word “infrastructure.” There is a halo effect from the use of this word for bridges and roads and electrical grids but when applied to public health it doesn’t transfer easily. Infrastructure is the “structure” that is below our vision, the stuff we take for granted, don’t know is there or don’t understand  but that nevertheless makes many other things possible by supporting them. Infrastructure doesn’t produce anything but is part of society’s capital. 

If you try to stipulate what part of the public health or social service or any other system is infrastructure not everyone can agree. Bank of America is not infrastructure but the banking system is part of the economy’s infrastructure. A state public health laboratory is not part of the public health infrastructure but most of us consider the laboratory system to be an essential element of infrastructure. Similarly for our disease surveillance system, which provides us with the “situational awareness” we need to make decisions about disease outbreaks or resource allocation. It’s public health infrastructure.

I argue, time and again, that public health should benefit from preparedness monies and efforts. One of the reasons I don’t usually link to The Pump Handle and Effect Measure is because they tend to think that focusing on preparedness issues in public health contributes to the siloization of public health and continued ignoring of public health infrastructure. Admittedly, they might not be wrong in practice; but public health should realize that this is a once in a lifetime opportunity to boost public health spending and cross-pollinize ideas and resources. Preparedness folks should realize it and reach out. People who write RFPs should realize it. Infrastructure is something that preparedness can help build, but we need public health to help guide it. Otherwise you get five different biosurveillance programs that don’t talk or work together. You get Level A suits, but no surgical masks for clinics.

Longtime readers will notice a refrain, as if I’m beating a dead horse. I do this because I’m a peon. I make no decisions. But maybe somewhere someone who does make decisions will read this, and think that folks like those at The Pump Handle and me should work together. Not just them on my programs, but mine on theirs, too. We should be public health.

Image credit: The Pump Handle

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