A conversation on the future of public health practice

Learning from leaders in the field in a time of challenge

Consider a fairly ordinary day. Someone picks up dinner from a restaurant on the way home from work. A mother fills a glass of water from the kitchen tap and hands it to her child. A man collects a prescription from the pharmacy down the street. A toddler receives a routine vaccination at the local clinic. Over the weekend, a parent hears from a neighbor that a stomach bug went around the school but seemed to burn itself out before it spread.

None of these moments register as noteworthy. That is precisely the point.

Behind the meal that was picked up was a sanitarian who had inspected that kitchen, checked its refrigeration temperatures, reviewed its food handling practices, and certified it safe to serve the public. Behind the glass of water was a monitoring system that tests for contaminants, enforces safety standards, and ensures that what comes out of the tap will not make anyone sick. Behind the prescription was a regulatory apparatus that had reviewed that drug for safety and efficacy before it ever reached the pharmacy shelf. Behind the toddler’s vaccination was an immunization program run by a local health department, staffed by nurses who track coverage rates and follow up with families. And behind the stomach bug that did not become an outbreak was an epidemiologist — probably in a small office somewhere, probably underpaid — who noticed the cluster, investigated it, and made sure it stayed contained.

All of this happened in the background. None of it happened by accident.

Every one of these quiet interventions is the work of public health practice. The challenge in the moment that many recent cuts to public health threaten these fundamental core actions of public health.

I have not been able to stop thinking about this since a conversation I had earlier this week. We convened, at Washington University, the leaders of four organizations that collectively represent essentially all public health professional in this country: the American Public Health Association, the National Association of County and City Health Officials, the Association of State and Territorial Health Officials, and the Association of Schools and Programs of Public Health. What emerged was not a policy seminar. It was something closer to a reckoning—an honest accounting of what is being lost, and of how little the public understands about what it stands to lose.

The proposed federal budget for fiscal year 2026 would cut CDC funding by more than half. Over one hundred public health programs would be eliminated. Twelve billion dollars in previously approved grants have already been clawed back. And about half of local health department budgets come from federal sources. So, when federal spending on public health is cut, the implications of these cuts are largely felt throughout the country, not in the capital itself. It is the county health department in rural Alabama. The immunization clinic in Kansas City. The epidemiologist—the one tracking the stomach bug, the one ensuring it does not become something worse—in Milwaukee.

Georges Benjamin, who has led the American Public Health Association for more than two decades, drew a distinction that I found clarifying. He described the historical pattern of public health funding as “yo-yo funding”— crises arrive, money follows late, then vanishes too soon. That pattern, frustrating as it is, has at least had a rhythm to it. What is happening now, he argued, is different in kind. The word he used was indiscriminate. CDC is issuing funding allocations in fifteen-day increments. Organizations cannot plan. Staff do not know, from one Monday to the next, whether they will have jobs. That is not a funding cycle. That is institutional dissolution.

And here is where I think the conversation cut deepest. Because the case for public health funding assumes that the public values public health. And we have evidence that many people do not, or, more precisely, that they do not understand the work of public health enough, or the institutions behind it. I find it alarming that nearly sixty percent of Americans express some form of mistrust towards the CDC and the FDA. That number should trouble all of us. Importantly, that number predates the current political moment. There is no doubt that it is a challenge that was deepened by the pandemic; but it also is clear that it was not created by the pandemic. The pandemic sharpened underlying challenges that have led to a moment of public skepticism that has created space for the current cuts to public health practice to go largely unchallenged in the public space.

Scott Harris, the State Health Officer for Alabama, offered what I thought was the most honest observation of the afternoon. He admitted that when the pandemic arrived, he had been naive—he had assumed the science would speak for itself. It did not. “The messenger,” he said, “was more important than the message.” And then he said something that has stayed with me: people may not trust capital-P, capital-H Public Health as an abstraction. But in his state, people do trust the county health department nurse they have known since their children were small. Trust, in other words, is not a communications strategy. It is a relationship. It is local, personal, and accumulated over years of showing up. It is precisely the kind of thing that cannot be rebuilt quickly once it is lost. And it is being lost—not through some gradual drift, but through decisions made far from the communities that will bear the consequences.

I have written in this space about the perception, held by a significant portion of the public, that public health has become a partisan enterprise. I will not rehearse the full argument here, except to say that the implications are worth restating. If public health is seen as belonging to one side of a political divide, then defending it becomes a partisan act, and defunding it becomes a partisan act, and neither framing serves the actual purpose of the work. The way out—the only way out, I believe—is to return, relentlessly, to what public health actually does. Not what it says. Not what it believes. What it does. It creates a world where everyone has access to safe food, drinkable water, clean air. It ensures that we all have the opportunity to live a rich fulfilling life. Public health minimizes avoidable death and suffering. These are not ideological propositions. They are functions of a civilized society. And they are functions that indeed all of us—regardless of partisan stripe—can get behind.

Laura Magaña, who leads the Association of Schools and Programs of Public Health and who founded the Global Network for Academic Public Health, made a point that deserves more attention than it typically receives. She argued that public health literacy should begin not in graduate school but in primary school. If every citizen grew up understanding what public health is—understanding that it is the reason their drinking water is safe, the reason outbreaks are caught early—then the case for sustaining it would not need to be made in a crisis. It would already be understood. That is a long-term proposition, and we are in a short-term period of challenge. But the two are connected. The reason we find ourselves making the case for public health now, in a moment of acute strain, is precisely because we failed to make it in calmer times.

I want to close with something that happened at the end of our conversation. I asked each panelist what gives them hope. Laura said the young generation—their passion, their purpose. Lori Tremmel Freeman, who leads NACCHO, said she has unwavering faith in the people who run local health departments, who know what they have to do even in the hardest of times. Scott said that as long as people want things to be better, they are going to get better. And Georges said: “My grandkids. They are a pistol. And they do not let us get away with anything.” The room laughed. But I think he was making a serious point. The generation coming behind us is not sentimental about institutions that do not serve them. Their impatience is, in its own way, itself a form of hope.

During the conversation, someone called the people who do this work “the silent guardians of health.” I keep returning to that phrase. It captures something essential: public health works in the background so that the rest of us do not have to think about it. That is its great strength. It is also its great vulnerability. Because when something is silent, it is easy to forget it is there. And when it is forgotten, it is easy to cut.

Tonight, someone somewhere will pick up dinner on the way home without having to think about whether the kitchen was inspected. A mother will fill a glass of water from the tap and hand it to her child without thinking about whether it was tested. A toddler will receive a vaccination at a clinic that simply exists, as though it has always existed, as though it always will. That quiet confidence that manifests as not having to think about all these, and many others. The kind so deep we hardly even recognize it as trust, is to my mind one of the greatest achievements of public health. I would like us all to continue not having to think about these. That will require us to protect the system that makes such confidence possible, to insist that the health of the public is not a line item, not a partisan project, but a foundational obligation of a society that means what it says about caring for its people.

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Also this week

The conversation referenced above, “Public Health in Challenging Times: Finding a Way Forward,” took place on March 31, 2026, as part of the Assembly Series at Washington University in St. Louis. The panel featured Georges Benjamin (APHA), Lori Tremmel Freeman (NACCHO), Scott Harris (ASTHO), and Laura Magaña (ASPPH). Thank you to the panelists and to the many colleagues who made the event possible.

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Coming soon

On April 14, the WashU School of Public Health will host “Building for a New Era of Global Health,” the inaugural convening of WashU Public Health’s Global Health Futures research network. Learn more and register here.