Who the Health Cares? with Prof Michael Sparer – Details, episodes & analysis

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.

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.

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.

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. Chapter Markers 00:00 Biden's COVID Mandate and the Court 01:15 Introducing Who the Health Cares 02:40 1787: The Constitutional Convention 03:57 Hamilton vs Jefferson: Federal Power 05:10 Jefferson's Vision: State Control 06:52 Local Police Power and Social Welfare 08:17 Fighting Epidemics in Early America 09:41 The Medical Revolution of the 1860s 11:17 NYC's First Board of Health 12:53 Why Local Health Departments Matter 14:44 Who the Health Cares? We All Should 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.

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.

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.

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.

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.