Founded 20 years ago, the Commissioned Officers Foundation for the Advancement of Public Health supports educational, training, and research activities, with a special emphasis on the US Public Health Service and the USPHS Commissioned Corps. Among the Foundation’s strategic goals is advocacy for public health and public health leadership.

While we are still battling the COVID-19 pandemic, it’s not too early to recognize that when it comes to the public health system in the United States, many of the enhancements and reforms that we and other public health-focused organizations recommended and sought for so many years were not equal to the need, even if they had been implemented. Every aspect of the public health system must be reexamined, reconsidered, and rethought.

That is why we have crowdsourced ideas to improve the public health system.

Below are some of the many suggestions we received from current and retired officers. We cannot advocate for everything at once—we will have to focus on what is both the most necessary and the most practical, while recognizing that modest changes will not prepare us for the next pandemic or help us to solve the enduring public health problems that have made the US population less healthy than those of many other high-income countries.

  • Grow the Commissioned Corps to a total strength of at least 15,000 Regular Corps (active duty) officers with a Reserve Corps of at least 2,500. Officers would be assigned to every state health department and to some of the larger city and county health agencies, as well as to the National Health Service Corps to expand care for underserved populations, in both urban and rural communities.

  • Encourage service in the USPHS Commissioned Corps as an entry point to a career in public health. Offer student loan forgiveness and health professions scholarships in exchange for service in the Corps, including to all current as well as newly commissioned officers.

  • Expand training opportunities for health professionals in all agencies where commissioned officers serve.

  • Recruit health information technology professionals into the Commissioned Corps with training opportunities and scholarship programs.

  • Create a new structure from the eight operating divisions of the Department of Health and Human Services that currently constitute the USPHS, to be headed by the Surgeon General. Since these operating divisions account for less than 15% of the DHHS budget, DHHS is an insurance company (CMS) with a small public health presence. We need a new agency whose sole focus is health security, health promotion, disease prevention, and direct care for underserved populations, not just reimbursement policies. The new structure should include the Offices of the Assistant Secretary for Preparedness and Response and the National Coordinator for Health Information Technology.

  • Make the Surgeon General a cabinet level position with a four-star rank and a permanent seat on the National Security Council.

  • Coordinate national public health plans with states. We wouldn’t fight a war against a foreign adversary with each state and territory pursuing its own strategic war plan. Why are we fighting COVID-19, the opioid epidemic, hypertension, stroke and cardiovascular disease, asthma and respiratory diseases, obesity and poor nutrition, and other health priorities with over 50 different strategic plans?

  • Use fiscal policy at the Federal, state, and local levels, targeting activities and products that can be seen as “antihealth,” to generate revenue that will ensure a steady and adequate source of funding for public health agencies.

Please send your ideas and your feedback to [email protected], with the subject line “Future of Public Health.” We’ll follow-up in this column and on our website.