Who the Health Cares? with Prof Michael Sparer

This week, Professor Sparer is joined by Columbia Mailman professor and political scientist Larry Brown for a conversation about whether public health can ever truly be separated from politics. They discuss why local leadership is essential to rebuilding public trust, the potential impact of the midterm elections, and what the next generation of public health professionals needs to know about navigating the political realities of their work.

Welcome to season three of Who the Health Cares from the Center for Public Health Implementation at Columbia University.

In this episode, Former CDC Director Dr. Mandy Cohen joins Professor Sparer to reflect on how the public health, healthcare, and social services sectors can work together more effectively. They explore lessons from Cohen's time leading the CDC and North Carolina's Health and Human Services agency, discuss the role of politics in public health policymaking, and consider how public health leaders can make a stronger case for their work.

Read more about the Healthy Opportunities Pilot here.

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 l...

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 Te...

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 a...

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 pub...

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...

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 cou...

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 he...

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.

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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...

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.

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