Who is Protecting America's Health?

Release date October 26. Subscribe on Apple Podcasts, Spotify, and YouTube.

Key Takeaways

• The abrupt loss of roughly $100 million in federal infectious disease funding to New York City — with only hours' notice — shows how directly federal cuts translate into lost disease progression surveillance, vaccination, and outbreak response capacity at the local level.
• This year's measles resurgence isn't an isolated event. Dr. Morse frames it as a signal that the systems meant to protect public health are struggling or failing — made even more sobering by the fact that the U.S. had achieved measles elimination more than two decades ago, a public-health achievement that is now at risk.
• The "Make America Healthy Again" movement is, in Dr. Morse's view, internally inconsistent: cutting SNAP and Medicaid while claiming to champion nutrition, and letting the vaping industry expand instead of confronting it the way public health once confronted the tobacco industry.
• Morse's work dismantling the race-based eGFR kidney test revealed how deeply racism can be embedded in tools assumed to be objective — and how uneven the fix has been, even after professional societies changed the standard.
• Rebuilding trust starts locally. Dr. Morse points to community health workers, city and state public health collaboratives, and renewed ties to global health institutions as the path forward, drawing directly on what she learned working with Partners in Health in Haiti and Rwanda.

A System Under Strain

Measles was declared eliminated in the United States more than 25 years ago. This year alone, the country has recorded more than 4,000 cases — the most in three decades. Dr. Thoại Ngô opened his conversation with Dr. Michelle Morse, who recently transitioned out as New York City's acting health commissioner, by naming the moment plainly: food safety threats, declining trust in vaccines, and a federal health workforce in upheaval all at once.

Dr. Morse, who spent five and a half years at the New York City Health Department, described this as more than a string of unrelated crises. "Public health disasters are kind of a canary in the coal mine for societal disruption," she said. What's happening now, in her view, is a signal that systems built to protect people are struggling or failing — and that failure is especially painful given how much privilege the U.S. has enjoyed in making diseases like measles and polio exceedingly rare, even as health systems in places like Haiti and Gaza still struggle to protect children from vaccine-preventable diseases.

What Haiti Taught Her

Long before New York City, Dr. Morse spent years with Partners in Health and its Haitian sister organization, Zanmi Lasante, work she credits with reshaping her entire understanding of what health care delivery should look like. Rather than expecting patients to come to a hospital, the model brought care directly to rural communities — a deliberate inversion of a system, in the U.S. and elsewhere, that Dr. Morse says has historically been built around who can pay.

She pointed to a human rights declaration written by Haitian patients and community health workers demanding access to HIV treatment as one of the documents that shaped her most. "It helped me understand a very different paradigm for access to care and health care as a right, not a privilege," she said. That framework, she argued, is exactly what's being tested now in the U.S. — including in the ongoing termination of Temporary Protected Status for Haitian immigrants, more than 21,000 of whom work as caregivers and nursing assistants serving an estimated 77,000 patients nationwide.

A Movement of Contradictions

Turning to the "Make America Healthy Again" movement, Dr. Ngô pressed Dr. Morse on what it gets right and where it falls short. Dr. Morse didn't dismiss its stated goals. "I want to make America healthy again — of course I do," she said. But she described the coalition behind it as incoherent in practice, pointing to tobacco policy as the clearest example: after decades of public health successfully taking on the tobacco industry, she'd expect a health-focused movement to extend that fight to vaping. Instead, she said, regulators have allowed vapes to proliferate.

The same contradiction shows up around food security, she argued. Roughly three in four American adults now live with at least one chronic condition, and at least one in four adults in every state has obesity — yet cuts to SNAP, which serves roughly one in eight Americans, are landing hardest on the same families the movement claims to want healthier. "To remove access to food for people who do not have reliable food access is deadly," Dr. Morse said. "There's no other word for it."

Objectivity Was Never Neutral

One of the conversation's most pointed threads was Dr. Morse's work leading New York City's Coalition to End Racism in Clinical Algorithms. She described a widely used kidney-function test that, until recently, applied a race-based correction making Black patients' kidneys appear healthier than they were — a calculation that led to later diagnoses and worse outcomes for kidney disease that depends on early detection.

Even after professional societies changed the recommended standard, Dr. Morse said implementation has been uneven: individual hospitals and clinicians still decide which formula to use. She connected the pattern directly to a bigger concern about artificial intelligence in health care, noting that AI systems trained on data reflecting structural racism risk repeating the same embedded bias at a larger scale.

Investing Locally, Connecting Globally

Asked what happens after the loss of institutional knowledge inside CDC, FDA, and HHS, Dr. Morse turned to what she believes will actually rebuild the system: people. She pointed to New York City's Public Health Corps, a $100 million investment in community-based organizations deploying community health workers into the neighborhoods hit hardest by COVID, as proof that trusted, local messengers can move accurate information faster than misinformation spreads.

She also described joining a new Northeast states' public health collaborative and making New York City the first local health department to join the WHO's Global Outbreak Alert and Response Network — steps she sees as evidence that federal leadership isn't the only voice that can speak for American public health.

Asked what still gives her hope after everything she's seen, Dr. Morse turned to family. Her 97-year-old grandmother, born in 1929 in a segregated town in Virginia and barred as a child from her hometown's library and college, has watched the country change dramatically over her lifetime. Those conversations, Dr. Morse said, along with her own ongoing commitment to learning, are what keep her at the table. "I continue to learn and be challenged every hour of every day," she said. "That gives me hope."

PopTalks is a podcast from Dr. Thoại Ngô and Columbia's Department of Population and Family Health. New episodes release every two weeks.

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