One image that most resonated with me throughout this pandemic: Sisyphus pushing a rock up the hill, knowing he might never make it to the top. It echoed how my colleagues and I on the front lines and beyond in the public health workforce felt. We would let ourselves take a breath and hope the worst was behind us, yet still brace for what we knew would come, carrying the weight on our shoulders.
This is how many of us have felt this year — maybe all of us. For me as an emergency physician and public health advocate, at times it felt like an unrelenting assault on every front with no escape or seeming end. And we just kept pushing — with work, kids, and isolation; with worry, sadness, and exhaustion.
A possible end to this pandemic is in sight. As cases continue to drop in the city and region and nearly 70% of Philadelphia’s adults receiving at least one vaccine shot, we are slowly returning to some normalcy. Exhausted as we may be, there are signs of hope. I believe with focus and learning from past missteps, the next year could be transformative for Philly’s health. Here are a few areas to start.
As someone who has long advocated for people marginalized by stigma — including those who use drugs, experience homelessness, or have mental illness — I, perhaps naively, believed that everyone would recognize that every life has value and is worth a helping hand in times of distress. This year made me realize that might not be the case.
When pre-pandemic national news and exploitative TV shows elevated the plight of Kensington, groups were quick to flood these neighborhoods, sharing what they did through tweets and Instagram posts for all to see. Yet the “backyards” in South Philly and other areas of the city where overdose was prevalent but not amplified were often ignored until they too approached crisis levels. A review of the latest overdose data from the Philadelphia Department of Public Health shows only three fewer people died in 2020 of unintentional overdose than the city’s worst year of 2017 (1,214 overdose deaths vs. 1,217). There was improvement specifically among non-Hispanic white individuals (a 10% drop). There was, however, a significant increase in deaths within non-Hispanic Black communities by nearly 30%.
Yet Philadelphia is fortunate to have a fierce network of quiet doers, who work to meet the needs of their communities regardless of barriers and limitations, including stigma and neglect. Groups like Angels in Motion, started by Carol Rostucher, have long addressed disparities and stigma around drug use and increasing access to care across the city; the north-central Philly-focused Urban Creators group is expanding harm-reduction services. On the pandemic front, Dr. Ala Stanford and the Black Doctors COVID-19 Consortium filled huge gaps in testing and vaccinations for the hardest-hit communities. All are perfect examples of local leaders addressing health inequities by building new systems where the existing failed.
Workers’ mental health
March 2020 marked historic departures of women from the U.S. workforce, seen across sectors and industries. It may reflect a forced coercion, where leaving children unattended could only be addressed by women caretakers leaving their jobs. Other workers, including many women in the frontline medical and nursing fields, were let go. I would have never imagined so many who had been deemed essential workers would find themselves fighting for their own survival — whether from being exposed to COVID-19 with limited PPE or through overall insecurity in finances, shelter, food, or safety.
“There is an unmistakable feeling of change afoot.”
But there is an unmistakable feeling of change afoot. Naomi Osaka demonstrated this when she withdrew from the French Open for the sake of her mental wellness. This struck a noteworthy contrast with the tragic opposite we saw just one year earlier, when Dr. Lorna Breen, a celebrated emergency physician in New York, died by suicide after overwork, exhaustion, and an unabating sense of obligation pushed her beyond what she could take.
Suicide continues to be a major issue within the world of medicine, driving some physicians to step away from the field entirely. Fortunately for physicians and other health-care professionals, there is hope on the horizon with the Dr. Lorna Breen Health Care Provider Protection Act, which aims to reduce and prevent suicide, burnout, and behavioral health challenges for our health-care workforce by funding training and promoting policy solutions. This first-of-its-kind legislation is on track for passage on the Senate floor.
The groundswell of support for protecting our wellness and values is one we should pursue in Philadelphia — not only in our “eds and meds” sectors but across professions. Supporting the workforce is key for our industries, and the region as a whole, to thrive.
This last year has shown us all how critical good leadership is to navigate through exceptionally difficult times. I cannot hide my profound disappointment with many who have stood above me — from the level of the former federal administration mishandling the pandemic, state legislators’ push to restrict reproductive health rights while expanding gun rights after supporting a coup, to heads of city agencies having to resign, on down.
The lesson for me has been that instead of assuming heroic and authentic leaders are “above” us, we must also look to ourselves and those beside us for true leadership. The problem solvers are all around but often have neither the spotlight nor the titles. That said, infatuation with self-proclaimed “disruptors” — such as Philly Fighting COVID, with whom the city eventually severed ties — above any of the highly trained people who have dedicated years to serving the communities of Philly undermines everyone. It’s time to recognize the tremendous experience, skill, and expertise we have in our region and encourage and support rising leaders, rather than overlook them for the flashy or stifle them for the old guard.
This has been a time of one existential crisis after another, but I have never been more hopeful than at this moment. Although our foundations have been shaken, we are standing — together. What had been foregone conclusions about what works in our city now must prove themselves. Philadelphia, and its army of thinkers, doers, and problem solvers, is uniquely poised for true, impactful, and sustainable change — with looming federal and state investment, driven by data and aligned with best practices, and the innovation of the next generation of leaders across our city. Now is when we step up.
Priya E. Mammen is an emergency physician and public health specialist. She is a fellow of the Lindy Institute of Urban Innovation and trustee of the College of Physicians of Philadelphia. She will write monthly for The Inquirer about the future of public health in Philly. @PEMammen