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Who the Health Cares? with Prof Michael Sparer: Daily Summaries Delivered
by Center for Public Health Systems
America has 3,300 local health departments. They are the backbone of our public health system, yet they are agencies most of us never think about. Until there's a crisis. They respond to disease outbreaks, inspect restaurants, ensure safe drinking water, and coordinate emergency responses. Yet their work remains invisible, their budgets are perpetually squeezed, and their authority is increasingly questioned. Host Michael Sparer traces how we built this fragmented public health infrastructure, from Constitutional debates to 1866 garbage collection to today's vaccine controversies. He examines why healthcare spending dwarfs public health investment, why public health agencies vary so dramatically from community to community, and why understanding this system matters for everyone. This isn't partisan politics. It's about the public health infrastructure that protects us every day. Who the health cares? We all should.
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- 3 days ago45 min
Public Health, Politics, and Money: Lessons from Kentucky and Indiana
Public health funding is often discussed as a matter of budgets and policy. But the real story is about politics, relationships and power. In the aftermath of the COVID-19 pandemic, states across the country received an unprecedented influx of federal dollars to strengthen their public health systems. But turning those investments into lasting change proved far more complicated than simply appropriating money. In this episode, Michael trades places with guest host Rebecca Sale to discuss his ongoing research tracking public health funding in five states. Focusing on Kentucky and Indiana, Michael explains how coalitions of public health leaders, legislators, local officials and community partners helped secure major new investments in local health departments. He also explores why Kentucky's reforms have largely endured while Indiana's funding was dramatically reduced, and what these contrasting experiences reveal about the challenges of demonstrating value, maintaining political support and building a sustainable public health system. The Center for Public Health Systems at Columbia's Mailman School of Public Health conducts needed research, facilitates public discussions, develops policy proposals and provides educational programs, all with the goal of encouraging a better, more efficient and more equitable public health system. This work builds on the recognition that the nation’s public health system is currently under-resourced, under-paid and under-valued, and that a stabilized and strengthened system would benefit all of us.
- 2 weeks ago25 min
Former Health Secretary Umair Shah on AI, MAHA and Leadership Lessons
Public health officials are navigating an increasingly complicated landscape defined by shrinking resources and political polarization. Meanwhile, artificial intelligence is transforming how health systems collect information, manage care and respond to community needs. The challenge for today’s public health leaders is figuring out how to adapt without losing the public’s trust or losing sight of their core mission: improving the health of the communities they serve. In this episode, Michael speaks with Dr. Umair Shah, former Secretary of Health for Washington State and former executive director of the Harris County health department in Texas. Drawing on his experience at both the local and state levels, Umair explains how health departments are responding to workforce shortages, shifting federal priorities and the need to function as a safety net provider. He also discusses the growing role of AI in health care and why he believes public health can still serve as a unifying force in a divided country. The Center for Public Health Systems at Columbia's Mailman School of Public Health conducts needed research, facilitates public discussions, develops policy proposals and provides educational programs, all with the goal of encouraging a better, more efficient and more equitable public health system. This work builds on the recognition that the nation’s public health system is currently under-resourced, under-paid and under-valued, and that a stabilized and strengthened system would benefit all of us.
- May 5, 202632 min
How Decisions Get Made During Public Health Disasters
The work of public health often becomes most visible when our systems are under the greatest strain. From hurricanes to pandemics, crises test not only our ability to respond, but also the strength, flexibility and fairness of the systems we rely on every day. In this episode, Michael sits down with Mitch Stripling, Director of the New York City Preparedness and Recovery Institute, to discuss the role of emergency preparedness and response within our public health system. Drawing on decades of experience responding to disasters across the country, Mitch explains how emergency response systems are supposed to work and why they sometimes fail. He also reflects on what the COVID-19 pandemic revealed about our leaders’ ability to respond under uncertainty and the risks and opportunities that come with emerging technologies like AI. The Center for Public Health Systems at Columbia's Mailman School of Public Health conducts needed research, facilitates public discussions, develops policy proposals and provides educational programs, all with the goal of encouraging a better, more efficient and more equitable public health system. This work builds on the recognition that the nation’s public health system is currently under-resourced, under-paid and under-valued, and that a stabilized and strengthened system would benefit all of us.
- Apr 21, 202630 min
Public Health, Lost in Translation
The work of the U.S. public health system is invisible to many of us. That’s why public health guidance is often misunderstood – and ultimately mistrusted – by Americans on both sides of the political aisle. And in times of uncertainty, when clear guidance matters most, the gap between perception and reality is especially costly. In this episode, Michael speaks with Chelsea Cipriano, Managing Director of the Common Health Coalition. Drawing on her experience at the federal, state and local levels, Chelsea explains how mixed messaging, pandemic-era missteps and a lack of clear storytelling have eroded trust in public health. She also highlights what leaders can do to rebuild trust and find new ways to fund the work that keeps communities healthy. The Center for Public Health Systems at Columbia's Mailman School of Public Health conducts needed research, facilitates public discussions, develops policy proposals and provides educational programs, all with the goal of encouraging a better, more efficient and more equitable public health system. This work builds on the recognition that the nation’s public health system is currently under-resourced, under-paid and under-valued, and that a stabilized and strengthened system would benefit all of us.
- Apr 7, 202630 min
Public Health Finds a New Beat
Getting public health messaging right isn’t easy. With trust in institutions on the decline and misinformation on the rise, even life-saving information often fails to reach the people who need it most. So what kinds of messages actually get through? In this episode, Michael sits down with Dr. Jide Williams, a neurologist and Vice Dean of Community Health at Columbia University. After watching stroke patients arrive too late for effective treatment, Jide partnered with hip hop artist Doug E. Fresh to create a music-driven approach to stroke education. That effort grew into Hip Hop Public Health, a broader model that uses music and storytelling to teach kids about everything from healthy eating habits to the importance of cancer screenings. Jide also explains why music is such a powerful learning tool and what it takes for doctors to rebuild trust with the communities they serve. The Center for Public Health Systems at Columbia's Mailman School of Public Health conducts needed research, facilitates public discussions, develops policy proposals and provides educational programs, all with the goal of encouraging a better, more efficient and more equitable public health system. This work builds on the recognition that the nation’s public health system is currently under-resourced, under-paid and under-valued, and that a stabilized and strengthened system would benefit all of us.
- Mar 26, 202623 min
The Hidden Cost of Cutting Medicaid
Medicaid was never intended to be the backbone of the U.S. public health system. But what started in 1965 as a limited health insurance option for a small group of low-income Americans has grown into a $900 billion program that funds everything from hospital care to housing support. In this episode, Michael Sparer and Rebecca Sale trace the history of Medicaid and unpack the sweeping changes coming to the program under the “One Big Beautiful Bill.” The result won’t just be fewer people with insurance. It could also mean unexpected and harmful cuts to the country’s already fragile public health system. They also discuss whether a small, unexpected provision for rural health investment could point toward a better model for the future. Michael S. Sparer, J.D., Ph.D. is the William Henry Welch Professor of Public Health Systems at Columbia University's Mailman School of Public Health, where he has taught for over 30 years. He also directs the Center for Public Health Systems, which examines how America's fragmented public health infrastructure functions and how it can better serve communities. Professor Sparer’s research examines how policy shapes politics both in health insurance systems and in local health departments. He is particularly expert in Medicaid policy and in the inter-governmental dynamics that have shaped the evolution of that program. His work on public health has also focused on federalism and on the ways in which local health departments respond to changing political and fiscal environments. Before his academic career, he spent seven years as a litigator for the New York City Law Department. He is a three-time recipient of Columbia teaching excellence awards and former editor of the Journal of Health Politics, Policy and Law. The Center for Public Health Systems at Columbia's Mailman School of Public Health conducts needed research, facilitates public discussions, develops policy proposals, and provides educational programs, all with the goal of encouraging a better, more efficient, and more equitable public health system. This work builds on the recognition that the nation’s public health system is currently under-resourced, under-paid, and under-valued and that a stabilized and strengthened system would benefit all of us.
- Nov 25, 202514 min
Ep3-Who Knew? What Health Departments Do
A health department in Kentucky pays half your rent. Another in Oregon runs the county jail's medical system. A third in Iowa partners with businesses to raise wages for childcare workers. How did we end up with a public health system where one department operates comprehensive medical clinics while another struggles to conduct timely septic inspections? Let’s investigate the 4 categories of work that state and local health departments choose from when planning their activities: foundational services (disease response and restaurant inspections), clinical care for low-income residents, social determinants of health (housing and nutrition), and health strategy (coordinating all the pieces of a community's health infrastructure). Most local public health departments don't do all four. Some can barely manage one. The variation is staggering. Regardless, all public health agencies are better off when they find community-based partners to collaborate with and engage regularly with their residents… Even better when they can prove their efficacy, quantify the return on investment, and explain why they take actions that might well be unpopular. Chapter Markers 00:00 What Do Health Departments Actually Do? 01:51 Local Health Department Variation 03:33 Four Buckets of Foundational Services 05:17 Clinical Care and the Safety Net 07:05 Social Determinants of Health 09:20 Chief Health Strategist Role 10:53 Five Paths to Build Trust About Michael Sparer Michael S. Sparer, J.D., Ph.D. is Chair of the Department of Health Policy and Management at Columbia University's Mailman School of Public Health, where he has taught for over 30 years. He also directs the Center for Public Health Systems, which examines how America's fragmented public health infrastructure functions and how it can better serve communities. Professor Sparer’s research examines how policy shapes politics both in health insurance systems and in local health departments. He is particularly expert in Medicaid policy and in the inter-governmental dynamics that have shaped the evolution of that program. His work on public health has also focused on federalism and on the ways in which local health departments respond to changing political and fiscal environments. Before his academic career, he spent seven years as a litigator for the New York City Law Department. He is a three-time recipient of Columbia teaching excellence awards and former editor of the Journal of Health Politics, Policy and Law. About the Mailman School of Public Health, Center for Public Health SystemsThe Center for Public Health Systems at Columbia's Mailman School of Public Health conducts needed research, facilitates public discussions, develops policy proposals, and provides educational programs, all with the goal of encouraging a better, more efficient, and more equitable public health system. This work builds on the recognition that the nation’s public health system is currently under-resourced, under-paid, and under-valued and that a stabilized and strengthened system would benefit all of us.
- Nov 25, 202518 min
Ep2-Five Trillion on Medical Care, Pennies on Public Health
Why do public health departments have such little power, so few dollars, and are undervalued while their counterparts in the medical care system, especially physicians and hospitals, have influence, money, prestige, and respect There is no single or simple answer to these questions. But let’s start by looking back at three periods of American health care history: the emergence of the modern public health agency in the mid to late-19th century, the growing power of the American Medical Association in the early 20th century, and the Presidency of Harry Truman in the late 1940s. The review of these eras reveals a public health system run by government, in a society that has a bias in favor of the private sector and a public health system that must at times balance individual rights against community needs, in a society that is generally unhappy with perceived infringements on individual rights. The politics of public health are unlikely to change unless public health officials can persuade both policymakers and the public that its work is providing real value and real benefit in everyday life Chapter Markers 00:00 December 12th: Launch Day and Bagels 01:46 Medical Care Spending vs Public Health 03:47 The Great Sanitary Awakening 07:05 The Rise of the AMA 09:44 Harry Truman's Healthcare Vision 12:22 Why Medical Care Won 14:16 Six Reasons for Limited Influence About Michael Sparer Michael S. Sparer, J.D., Ph.D. is Chair of the Department of Health Policy and Management at Columbia University's Mailman School of Public Health, where he has taught for over 30 years. He also directs the Center for Public Health Systems, which examines how America's fragmented public health infrastructure functions and how it can better serve communities. Professor Sparer’s research examines how policy shapes politics both in health insurance systems and in local health departments. He is particularly expert in Medicaid policy and in the inter-governmental dynamics that have shaped the evolution of that program. His work on public health has also focused on federalism and on the ways in which local health departments respond to changing political and fiscal environments. Before his academic career, he spent seven years as a litigator for the New York City Law Department. He is a three-time recipient of Columbia teaching excellence awards and former editor of the Journal of Health Politics, Policy and Law. About the Mailman School of Public Health, Center for Public Health SystemsThe Center for Public Health Systems at Columbia's Mailman School of Public Health conducts needed research, facilitates public discussions, develops policy proposals, and provides educational programs, all with the goal of encouraging a better, more efficient, and more equitable public health system. This work builds on the recognition that the nation’s public health system is currently under-resourced, under-paid, and under-valued and that a stabilized and strengthened system would benefit all of us.
About Who the Health Cares? with Prof Michael Sparer
America has 3,300 local health departments. They are the backbone of our public health system, yet they are agencies most of us never think about. Until there's a crisis. They respond to disease outbreaks, inspect restaurants, ensure safe drinking water, and coordinate emergency responses. Yet their work remains invisible, their budgets are perpetually squeezed, and their authority is increasingly questioned. Host Michael Sparer traces how we built this fragmented public health infrastructure, from Constitutional debates to 1866 garbage collection to today's vaccine controversies. He examines why healthcare spending dwarfs public health investment, why public health agencies vary so dramatically from community to community, and why understanding this system matters for everyone. This isn't partisan politics. It's about the public health infrastructure that protects us every day. Who the health cares? We all should.
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