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 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.

When the Supreme Court in 2022 struck down President Biden's COVID vaccine mandate, it wasn't really about vaccines—it was about who has the constitutional power to issue such a mandate.  As it turns out, the 10th amendment gives states—and by extension, local governments— the "police power" to regulate and oversee our public health system. This is why we have 3,300 state and local health departments instead of one national system. But here's the surprising part: when New York State created the nation's first municipal health department in 1866, they didn't fight disease with medicine. They fought it with garbage trucks. The city's streets were filled with rotting food, dead animals, and human waste and the germs that emerged were causing deadly epidemics. During the "Great Sanitary Awakening," reformers realized the solution was sanitation.   While the American public health system traces its roots to the unglamorous work of street cleaning, today the scope is much broader. This episode reviews this history and makes clear why it matters. 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.

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.  Join Michael Sparer from Columbia's Mailman School of Public Health as he explores how the US built this fragmented public health system, why it's struggling, and what we need to do to fix it. From Constitutional debates to garbage collection in 1866 New York to today's vaccine controversies, this podcast reveals the invisible infrastructure your health depends on. Who the health cares? We all should. Listen to the trailer now, then subscribe so you don't miss the first episode dropping mid-November. Find us on Apple Podcasts, Spotify, or wherever you listen.