Creating a Public Health System that can Better Respond to a Crisis

The public health system needs a lot of work, and there are so many different ways to improve it. I've mentioned improving practices in the past, but now I'd like to focus on how the public health system responds, or fails to respond, to crises, and how we can improve the system as a whole. Some of these ideas will be easy to implement, while others could take years, or even generations, but we need to start somewhere. While there are many areas of interest for reform, a large portion of this article focuses on improving efficiency.

Dealing with Optimization

One of the problems with creating a public health system that can respond to any crisis is that it would require an infinite amount of researches. That statement seems like a no brainer, and in many ways it is, but we have to recognize that we're dealing with an optimization problem. Take standard patient capacity and emergency capacity. Because emergency capacity is above the average capacity, emergency resources are generally not put to use. Most of the time, they are wasted resources.

3D Printers

3D printers are probably one of the most powerful ways to add flexibility without losing much efficiency. While it might not make sense to have a massive supply of ventilators, PPEs (personal protective equipment), and so on, because for the most part, they would go unused, 3D printers could always be in use. During our recent medical crisis in 2020, people with access to 3D printers, from hobbyists to students with access to 3D printers as part of art and engineering programs at colleges, worked together to design and print needed materials for the public health system. 

Every major hospital should have a significantly ward dedicated to 3D printing. This ward can be active at all times. There are so many different applications for 3D printers in medicine that there is always a use for these printers. Moreover, these printers are general purpose, which means that they can very quickly be switched over to creating a specific set of medical products that are needed for a given crisis.

A General Response System

For years, I have wanted to promote the idea of a militia that focused on first response, including emergency engineering services and medical services. I've wanted to leverage the latest technology to bring help to where it is needed most. I've been idling for a while, but with recent events, I think it is well past time that we need this system.

General Idea

Militias are powerful tools to help defend a society. But militias are often focused on military style defense. While such defense is important, disaster relief requires a different skill set. The Army Corps of Engineers focuses on civil projects, rather than military defense. A militia version of this system can and should be implemented.

Members would be trained on basic engineering and disaster relief practice, emergency medical care, amateur radio communications, and other topics that are important during times of disaster, whether they are environmental or health related.

Mobile Response

A key component of the idea that I've been working on is a mobile response system. We have 3D printers and we have global communication systems. We have a lot of technology that can be used to take ideas from a central command and put them into practice immediately. As I've already explained, more and more, 3D printing technology allows for the on the fly printing of medical tools, casts, and other needed materials. A mobile unit that is equipped with 3D printers, connected to a central command, can do a lot to create materials that people need, where they need them.

Home Base

What good is a mobile response system without a "home base?" With modern technology, we can create a network of experts in a variety of fields, that can work together to take information being collected by the mobile units, create solutions, and send those solutions right to the mobile response units. The home base will act as a foundation for the rest of the infrastructure, and can perform general R&D, analyze numerous disaster scenarios, and adapt on the fly.

The Longer Term Problem of Sprawl

Going back to optimization, one of the greatest issues we're facing is a highly inefficient distribution of the population. Obviously that issue isn't something that we can address overnight. We can't pick everyone up and move them. In order to solve this issue, we first have to understand how it happened in the first place. 

In other articles, I've mentioned how subsidies generate sprawl. Subsidies for roads, power grids, and other infrastructure, while useful for many people, also make it cheaper to move further and further away from each other. Easing back on infrastructure spending, reducing the amount by which cities subsidizing rural living, and promoting city living, are all ways in which we can improve efficiencies in distribution of population.

However, in the shorter term, we find ways of better allocating hospital resources, in order to ensure that some hospitals do not become overburdened while others have empty beds. Big data, artificial intelligence, and other technologies can help solve part of this issue, but we would also need services that could safely move patients from one region to another. 

Hospital Ships and Trains

Hospital ships and trains are a useful option in many cases, if there is a way to get them to where they need to be. These resources can be coupled with the mobile units that I mentioned earlier in this article. And while they are far more expensive to produce and maintain, they offer the ability to handle larger tasks, and can work in unison with the mobile units and the home base, and can also act as substations.

Limited Throughways

There are a number of these units in operation, some of which are government operated, and some of which are privately operated. The US Navy operates two hospital ships, each with a capacity of 1,000 beds (Wikipedia). However, there are some issues that need to be addressed.

Access however is a problem. I oppose government subsidization of infrastructure, because it artificially decreases the price of sprawl. However, I'm not opposed to the creation or use of infrastructure as a whole. There are two areas of infrastructure that are really important for medical units, aside from roads. Ships need waterways, and trains need railways.

Above is a map of the canal system in the United States. While the East Coast has a substantial canal network, in part because canals were popular during the period in which the East Coast was developing, there are few canal systems on the West Coast. Further revitalization and expansion of canal systems could give medical ships greater access to areas in need.

However, as the above map of class I (large scale) railroads shows, there is greater interconnectivity through rail, than there is by waterways. Therefore while medical ships may be very useful in some areas, an emphasis on medical trains may be practical.

Creating General Purpose Units

That being said, having a large reserve system in place isn't all that efficient. Building medical ships and trains is costly and time consuming, and these units would largely sit unused for long periods of time. Medical ships can be used more efficiently, because they could travel around the world to where they are needed, but trains would be more limited. 

It is for this reason that units like these should be less focused on medical needs, and more focused on general needs. Once again, 3D printing technologies, and other technologies which are highly adaptable, can be useful in makings sure that these units could be quickly re-purposed to handle whatever issue arises, whether it is a weather related natural disaster, or a health related matter.

Final Thoughts

Overall, there's a lot that we can do to improve future to better respond to natural disasters, pandemics, and other unexpected crises. And we need to do a much better job than we're doing. The key is balance. The more adaptable we can be, without sacrificing efficiency, the better. Perhaps a focus on efficiency might sound cruel, but if we have too many resources that are sitting around being wasted, and that are only used in times of crises, we're not using those resources to better the world during the rest of the time, and that's a problem.

Further Reading

I'm a huge fan of guilds, and other forms of member owned cooperatives. While there are some regulatory challenges, the conversion of at least some hospitals into guilds offers many benefits.

I've written many articles on public health in general. While I still don't have an index page available on Vocal, I do have one on Medium.