Learning from History: It’s Time to Invest in Public Health

This month marks the grim two-year anniversary of the COVID-19 pandemic changing life as we knew it. New York emerged as the original epicenter of the pandemic in the U.S.

To date, New York State has had nearly 5 million confirmed COVID cases and more than 67,000 deaths. Those numbers are chilling and behind them are real New Yorkers: family members, friends, coworkers, neighbors.

Certain images and memories from the early days of the pandemic are indelible. Here in New York City, the normal intense energy and hustle-bustle turned into an eerie ghost town. Zoom calls were punctuated by ambulance sirens wailing in the background. A field hospital was set up in the middle of Central Park. A front-page photo revealed health care workers wearing plastic garbage bags as gowns. A Navy hospital ship docked on the western piers of Manhattan, though it went almost entirely unused.

As painful as those memories are, we can’t forget them. Spanish philosopher George Santayana is credited with the aphorism, “Those who cannot remember the past are condemned to repeat it,” which he wrote in 1905. In a 1948 speech to the House of Commons, Winston Churchill paraphrased, “those who fail to learn from history are condemned to repeat it.” She’s not a famous statesman, but a friend of mine said recently, “At a minimum, can we at least make new mistakes instead of the same old ones?”

Santayana, Churchill, and my friend all had it right. We need to learn our lessons from past mistakes.

The main lesson: our public health infrastructure was woefully unprepared. For decades, we as a nation and as a State had disinvested in public health. In 2018, only 2.9% of total U.S. health spending went toward public health and preventive services. When COVID hit, we paid a terrible price for that neglect. We lacked adequate epidemiological surveillance. We lacked testing capacity. We lacked contact tracing. We lacked adequate supplies of personal protective equipment like masks and gowns. We lacked clear and coordinated public messaging. These are all elements of public health 101 — bread and butter functions that are essential to any outbreak of infectious disease. But we weren’t ready.

Despite the obvious and unnecessary devastation from that lack of preparedness, we keep repeating the same mistakes. When the Omicron variant first raced through the U.S. in December 2021, it was nearly impossible to find tests or high-quality masks. Just last week, Congress failed to approve additional pandemic funding that would have given the federal government the resources to invest in more testing, vaccines, and therapeutics. Nearly 1 million Americans are dead from COVID; have we learned nothing?

With COVID cases and deaths again trending upward in Asia and Europe, it’s clear that the pandemic is not over. We are all tired of it, but COVID isn’t done with us. We need adequate tools and resources to fight the ongoing pandemic. And we must prepare for the next inevitable public health emergency.

Here at home, we are making a bit of progress. A new report by Trust for America’s Health examines states’ performance on emergency preparedness. New York State’s overall performance improved between 2020 and 2021; we’re now in the middle of the pack of states and have moved up from the lowest tier.

We still have a long way to go. According to the New York State Association of County Health Officials (NYSACHO), budget cuts across all of New York State’s 58 local health departments over the past decade add up to more than $150 million. As a result, public health departments were stretched thin even before the pandemic. Between 2015 and 2020, local health department staff decreased by 7% while New York State’s population grew by 3%. Even more alarming, nearly 25% of local health department leaders have retired or left their jobs since February 2020. According to NYSACHO, 90% of local health departments in New York State don’t have enough staff to address basic community health needs. More than 1,000 additional full-time staff are needed across New York to provide adequate services.

I’m encouraged that New York may rise to the challenge. Recent budget proposals by the Governor and legislature all include additional funding for public health. That boost in funding could support increases in State aid for local health departments’ core work; health care worker retention bonuses and nurse loan repayment programs that could shore up the public health workforce; and additional resources for prenatal and postpartum care, mental health supports, and substance use treatment.

When it’s functioning well, public health can be almost invisible. Too often in the U.S., we take for granted that we have safe drinking water, that our kids are protected from lead poisoning, that disease outbreaks can be monitored and contained. But protecting public health requires careful planning and preparation, it requires money, and it requires a robust and skilled workforce.

On this anniversary of the pandemic, one way to honor those who’ve died from COVID is to learn from history. Stop repeating the same mistakes over and over. Don’t neglect public health — because we will surely regret it. Instead, let’s invest in public health and be better prepared the next time. We’ve learned things the hard way and we can do better.

By David Sandman, President and CEO, New York Health Foundation
Published in Medium on March 17, 2022

Photo: The U.S. Navy hospital ship USNS Comfort sails into New York Harbor as part of COVID-19 pandemic relief efforts in New York City in March 2020. Photo credit: nycshooter

HPV Vaccination Rates Have Increased Among New York State Adolescents

Contact: Stephany Fong, fong@nyhealthfoundation.org

March 16, 2022 – A new analysis from the New York Health Foundation (NYHealth) found that vaccination coverage for the human papillomavirus (HPV) increased among New York State adolescents between 2018 and 2020. In a reversal of trends for other vaccinations, Hispanic and Black adolescents had the highest rates of HPV vaccination. Coverage improved across all racial and ethnic groups over the study period. Wide variation across counties in the State was also found, with vaccination rates ranging from 9.9% to 40.8%.

The analysis is based on data from the New York State Immunization Information System for the 57 counties outside of New York City. (Data on New York City immunizations are maintained by a separate system and were not made available to the report authors.) It assesses the percentage of 13-year-olds who completed the two-dose HPV vaccine before their 13th birthday.

“HPV is the single most common sexually transmitted infection in America and can lead to serious health consequences like cervical cancer,” said David Sandman, Ph.D., President and CEO of NYHealth. “HPV vaccines are highly effective and safe. It’s especially encouraging that Black and Hispanic New Yorkers, who fare worse on many health outcomes, have the highest rates of HPV vaccination coverage.”

From 2013–2017, an average of 2,730 New Yorkers were diagnosed with an HPV-related cancer each year. The HPV vaccine prevents the development of more than 90% of these cancers, making it one of only two vaccines that prevent cancer. The Centers for Disease Control and Prevention recommends that adolescents receive two doses of the HPV vaccine when they are ages 11–12 years.

Among the report’s findings:

  • Adolescent HPV vaccination coverage increased in New York State from 2018 to 2020. In 2020, 24.5% of 13-year-olds had received both shots of the HPV vaccine series by age 13, compared with 20.1% in 2018.
  • Contrary to trends for many other vaccinations, Hispanic or Latino and Black or African-American adolescents had the highest rates of HPV vaccination coverage over the study period. The coverage rate increased for all races and ethnicities from 2018–2020, but remained consistently lower for Asian and white adolescents.
  • Both girls and boys experienced an increase in HPV vaccination coverage over the study period. While the gap between genders decreased slightly over time, a difference of 2.5 percentage points in vaccination coverage remained between 13-year-old girls (25.9%) and boys (23.4%) in 2020.
  • Most counties experienced increases in vaccination coverage over the study period, but there was vast geographic variation in HPV vaccination coverage. Only two counties (Cortland and Niagara) met the State’s Prevention Agenda goal of 37.4% coverage among 13-year-olds by 2024. The 2020 coverage rate in the county with the lowest rate, Jefferson, was less than one-quarter as high as the county with the highest rate, Cortland (9.9% compared with 40.8%).
  • The lowest regional rates of HPV vaccination coverage were consistently found in the Lower Hudson and Long Island regions (in 2020, 20.5% and 20.9%, respectively). These regions also had the lowest vaccination coverage for other pediatric vaccinations, studied in an earlier NYHealth report here.

“New York State is making progress when it comes to HPV vaccination, but coverage is uneven and we’re still falling far short of our goals,” said Avital Havusha, Vice President of Programs at NYHealth. “We must sustain and build on these gains, particularly given the recent explosion of vaccine misinformation and hesitancy.”

Factors that may have contributed to the recent increase in vaccination coverage include improving provider communication strategies about HPV with parents, expanding adolescent self-consent policies, and using school-based health centers as HPV vaccinators. To further increase vaccination rates, New York State could consider additional policies, including requiring the HPV vaccine for school attendance and studying the potential of pharmacists to administer the HPV vaccine to young people.

The full report, “Making Progress on HPV Vaccination in New York State,” is available here.


The New York Health Foundation (NYHealth) is a private, statewide foundation dedicated to improving the health of all New Yorkers, especially the most vulnerable. The Foundation is committed to making grants, informing health policy and practice, spreading effective programs to improve the health care system and the health of New Yorkers, serving as a convener of health leaders across the State, and providing technical assistance to its grantees and partners.

NYHealth Testimony on New York City Veterans

On March 7, 2022, the New York City Council Committee on Veterans held a budget and oversight hearing. NYHealth President and CEO David Sandman presented the following testimony highlighting opportunities to prevent veteran suicide and address veterans’ mental health and food security needs:

Thank you, Chairperson Holden and members of the Committee for the opportunity to testify today about the health needs of veterans in New York City.

I am Dr. David Sandman, President and CEO of the New York Health Foundation. The Foundation is a private, independent, and statewide charitable organization dedicated to improving the health of all New Yorkers—including the 700,000 or so veterans who call New York home.

We have used grants, policy analysis, convenings, and advocacy to profile New York’s veterans, create universal access to Veterans Treatment Courts, build a robust network of community-based services, and prepare health care providers to understand veteran culture and meet their unique needs.

First and foremost, we are working with partners to reduce the tragedy of veteran suicide. In 2019, veterans in New York were nearly twice as likely as the State’s general population to die by suicide.[1] Particularly concerning is the increasing rate of suicide among New York’s youngest veterans, even as rates among older veterans have declined.[2]

Tackling this problem requires a multi-faceted approach, including restricting access to guns. Firearms are by far the most lethal method of suicide. You can learn more about all this work and more by visiting our website, www.nyhealthfoundation.org.

New York’s Veterans
Our veteran population has become increasingly diverse. Racial and ethnic minorities now make up 23% of New York’s veteran population, with that proportion expected to reach nearly 30% by 2030. The share of women veterans is also growing quickly; women are expected to make up 10% of New York’s veteran population by 2025.[3]

I also want to dispel the notion that veterans are “broken” or violent. Many veterans return from deployments and transition to civilian life relatively smoothly; they’re healthy, ready to work or go to school, and eager to settle into their communities.

But for some, the adjustment isn’t so easy. They may struggle with physical injuries and disabilities, and they may also be dealing with the invisible wounds of war: mental health issues including PTSD, suicidal ideation, and substance use. They may also be challenged by food insecurity, lack of employment, or homelessness.

Improving Mental Health and Addressing Veteran Suicide
Meeting veterans’ mental health needs and preventing veteran suicide must remain top priorities. My colleague (and Marine veteran) Derek Coy previously testified before this committee on the mental health needs of New York City veterans during the COVID-19 pandemic.

The New York Health Foundation has been proud to support the expansion of the Stop Soldier Suicide program; so far, it has connected more than 140 New York City veterans at risk of suicide to high-quality, specialized care.

We are also supporting a partnership between New York Cares and the New York City Department of Veterans’ Services (DVS) to continue the Mission: VetCheck program, which is working to provide “buddy checks,” peer-to-peer support, and referrals to 17,000 veterans across New York City who are at a high risk of suicide.

New York City’s Department of Veterans’ Services
DVS has been a key partner. As recently as 2015, the Mayor’s Office of Veterans Affairs had a meager budget and almost no staff. Thanks to the leadership of the City Council, DVS was elevated to a full-fledged agency led by a Commissioner in 2016. That move immediately increased its size and expanded its role.

This includes an enhanced portfolio of work that includes benefits enrollment, employment and housing assistance, mental health outreach, and referrals to mental health resources and food and nutrition programs. For example, DVS was a key partner, alongside the New York State Division of Veterans’ Services and community-based organizations, to deliver hundreds of thousands of meals to veterans facing food insecurity across the City.

These are just a few examples among many. A robustly funded, high-performing DVS is beyond essential. Thanking veterans for their service means nothing if we don’t back up those words with the first-class services and supports they need and deserve.

We respect and share the Council’s commitment to New York City’s veterans. I hope you will look to the New York Health Foundation as a resource for your important work. Thank you.

Watch video of the hearing here (Dr. Sandman’s testimony begins at 2:00:23).


[1] New York Health Foundation, “New York’s Veterans: An In-depth Profile,” October 2021, https://nyhealthfoundation.org/resource/new-yorks-veterans-an-in-depth-profile-2/.

[2] New York Health Foundation, “Issue Brief: Veteran Suicide in New York State,” January 2020, https://nyhealthfoundation.org/resource/veteran-suicide-in-new-york-state/.

[3] More information on New York State’s veteran population—including statistics on factors affecting veterans’ health such as employment status, income, and food security—is available at https://nyhealthfoundation.org/resource/new-yorks-veterans-an-in-depth-profile-2/.