The dismantling of public health infrastructure – KevinMD.com

Public Health Infrastructure and Sustainable Development Goals: A Report on Communicable Disease Resurgence

Executive Summary

This report analyzes the recent resurgence of vaccine-preventable diseases, such as pertussis and measles, within the United States, contextualizing this public health crisis within the framework of the United Nations Sustainable Development Goals (SDGs). Drawing on testimony from retired developmental-behavioral pediatrician Dr. Ronald L. Lindsay, the report documents the systemic failures contributing to this trend, including the erosion of public health infrastructure and coordinated care models. The analysis highlights significant setbacks to SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 16 (Peace, Justice and Strong Institutions), and underscores the critical need for renewed investment in public health systems to meet global development targets.

Analysis of Public Health Decline and Impact on SDG 3

Statistical Evidence of Disease Resurgence

Recent data indicates a significant regression in the control of communicable diseases, directly undermining progress toward SDG 3. Key statistics reported include:

• An 81 percent increase in pertussis cases in Florida in one year, totaling over 1,300 cases.
• Over 1,500 confirmed measles cases in 2025, a disease declared eliminated in the U.S. in 2000.
• Three measles-related fatalities, the first such deaths in the United States in over a decade.

Setbacks to SDG 3: Good Health and Well-being

The resurgence of these diseases represents a direct failure to meet key targets within SDG 3. The observed trends contravene the following objectives:

1. Target 3.3: End the epidemics of communicable diseases. The rising case numbers for measles and pertussis indicate a reversal of decades of progress.
2. Target 3.8: Achieve universal health coverage, including access to quality essential health-care services and vaccines. The dismantling of public health programs and clinics reduces access for vulnerable populations.
3. Target 3.d: Strengthen capacity for early warning, risk reduction, and management of national health risks. The collapse of coordinated systems weakens the nation’s ability to respond to outbreaks.

Institutional Failures and Implications for SDG 10 and SDG 16

Erosion of Health Systems and Coordinated Care

According to expert testimony, the primary cause of this public health crisis is the systematic dismantling of established health infrastructure. This includes:

• The closure of clinics and defunding of essential public health programs.
• A retreat from coordinated care models, particularly those serving children with complex needs such as autism and ADHD.
• The erasure of institutional memory and expertise due to political and ideological shifts.

These actions have created a vacuum in public health, leaving communities unprotected and reversing progress made over 125 years of system-building. This institutional decay directly impacts SDG 16 (Peace, Justice and Strong Institutions) by weakening the effectiveness and accountability of public institutions responsible for citizen well-being.

Disproportionate Impact on Vulnerable Populations and SDG 10

The collapse of specialized health services has a disproportionate effect on vulnerable and marginalized communities, exacerbating inequalities and hindering progress on SDG 10 (Reduced Inequalities). Programs specifically designed to promote health equity have been compromised, including:

• The Ohio Rural DBP Clinic Initiative, which expanded access to care in underserved counties.
• Joint Base Lewis-McChord (JBLM) CARES, a resource center for military families with children with autism.
• Medical homes established for children with complex developmental and behavioral needs.

The failure to sustain these programs undermines the goal of ensuring equal opportunity and access to essential services for all, regardless of geographic location, disability, or socioeconomic status.

Recommendations and Path Forward

A Call for Reinvestment and Advocacy

To realign with the Sustainable Development Goals, a renewed commitment to public health is imperative. Based on expert calls to action, the following steps are recommended:

1. Restore Coordinated Care: Re-establish and fund integrated care models that ensure comprehensive health services.
2. Promote Vaccine Vigilance: Implement robust, science-based public health messaging campaigns to restore confidence in and access to vaccinations.
3. Strengthen Public Health Institutions: Rebuild and protect public health infrastructure from political interference, ensuring its resilience and accountability in line with SDG 16.

The advocacy efforts of health care professionals, including Dr. Lindsay’s extensive publications and media testimony, exemplify the critical role of civil society and expert partnerships (SDG 17) in holding institutions accountable and driving policy coherence for sustainable development.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The entire article is centered on public health, specifically the resurgence of vaccine-preventable diseases like pertussis and measles. It discusses the direct health consequences, including a significant increase in cases and fatalities (“Over 1,500 confirmed measles cases in 2025. Three deaths…”). The author’s call for “vaccine vigilance” and “coordinated care” directly aligns with the goal of ensuring healthy lives and promoting well-being for all.
2. SDG 10: Reduced Inequalities
   • The article highlights the impact of dismantling healthcare systems on vulnerable populations. The author mentions his work in creating “medical homes for children with autism, ADHD, and complex developmental needs” and the “Ohio Rural DBP Clinic Initiative” to expand access in “underserved counties.” The collapse of these systems exacerbates health inequalities, leaving specific groups without the specialized and equitable care they need.
3. SDG 16: Peace, Justice and Strong Institutions
   • The author critiques the “dismantling of public health” and the “retreat from public health infrastructure.” This points to a weakening of effective and accountable institutions responsible for public welfare. The article frames the problem as a failure of governance (“political indifference and ideological rigidity”) and calls for rebuilding the systems (“We need to remember what worked”), which is a core tenet of SDG 16.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Under SDG 3: Good Health and Well-being
   • Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
     • The article directly addresses this target by focusing on the alarming increase in communicable diseases like pertussis and measles, which were previously under control. The statement, “We thought we eliminated measles in 2000. Not so. This administration brought the scourge back,” shows a direct regression from this target.
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
     • The article’s emphasis on “vaccination campaigns” and the consequences of their failure speaks to the need for universal access to vaccines. The dismantling of “coordinated care models” and the shuttering of clinics represent a direct attack on providing access to quality essential healthcare services.
   • Target 3.d: Strengthen the capacity of all countries… for early warning, risk reduction and management of national and global health risks.
     • The author describes himself as a “witness to the dismantling of public health,” which is the very system responsible for managing national health risks. The entire article serves as a warning about the consequences of weakening this capacity, as evidenced by the uncontrolled outbreaks.
2. Under SDG 10: Reduced Inequalities
   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
     • The author’s work to create “medical homes for children with autism, ADHD, and complex developmental needs” and establish clinics in “underserved counties” are concrete examples of initiatives aimed at ensuring health inclusion for people with disabilities and those in rural areas. The dismantling of these programs represents a setback for this target.
3. Under SDG 16: Peace, Justice and Strong Institutions
   • Target 16.6: Develop effective, accountable and transparent institutions at all levels.
     • The article is a testament to the failure of this target. The author describes how a robust public health system, built over 125 years, was dismantled, leading to a loss of effectiveness. The phrases “systems retreat” and “institutional memory erased” directly point to the degradation of a key public institution.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. For SDG 3 Targets:
   • Incidence of communicable diseases: The article provides explicit data points that serve as indicators.
     • “Florida has seen over 1,300 pertussis cases this year, an 81 percent increase from 2024.”
     • “Over 1,500 confirmed measles cases in 2025.”
   • Mortality rate from vaccine-preventable diseases: The article mentions a specific mortality indicator.
     • “Three deaths, the first measles-related fatalities in the U.S. in over a decade.”
   • Coverage of essential health services: The article implies a negative trend in this indicator through descriptive statements.
     • “Clinics shuttered. Programs defunded.” This suggests a reduction in the availability and coverage of healthcare services.
2. For SDG 10 Targets:
   • Access to healthcare for vulnerable groups: The existence and funding of specialized programs serve as an indicator.
     • The article mentions the creation of “Joint Base Lewis-McChord (JBLM) CARES, a $10 million autism resource center for military families” and the “Ohio Rural DBP Clinic Initiative.” The status (funded or defunded) of such programs is a direct measure of progress toward reducing inequalities in healthcare access.
3. For SDG 16 Targets:
   • Effectiveness of public institutions: While not a quantitative number, the article uses the resurgence of eliminated diseases as a powerful qualitative indicator of institutional failure.
     • The fact that measles, considered eliminated in 2000, has returned and caused deaths is a stark indicator of the public health system’s diminished effectiveness.

4. Summary Table of SDGs, Targets, and Indicators

Source: kevinmd.com