A Dialogue on Standing Up for Public Health and Democracy
What’s happening, and how did we get here? A public conversation between two leaders in public health philanthropy and academia traced the historical origins of recent attacks on public health and democracy and shared their ideas on how to defend them for the future.
Richard Besser, president and CEO of the Robert Wood Johnson Foundation (RWJF), and Jelani Cobb, dean of the Columbia Journalism School, were the featured speakers of the 2025 Isidore I. Benrubi Lecture in the History and Ethics of Public Health at the Columbia Mailman School. Established in 2007, the annual lecture series addresses topics in history, science, policy, and ethics. Besser and Dean Cobb were introduced by Interim Dean Kathleen Sikkema and Merlin Chowkwanyun, co-director of the School’s Center for History and Ethics of Public Health.
Journalism is a common thread for Besser and Dean Cobb. Dean Cobb is a longtime contributor to the New Yorker magazine, where he writes on race, politics, history, and culture. Besser, a pediatrician by training, was chief health and medical editor at ABC News from 2009 to 2017. Previously, he worked at the Centers for Disease Control and Prevention (CDC); among other accomplishments, he led the agency’s response to the H1N1 influenza (swine flu) pandemic.
The conversation looked to history to explain the current political moment, including recent attacks on the independence of the CDC. It wasn’t long ago that public health enjoyed strong support across the political spectrum, Besser observed. While earlier criticism of public health priorities like water fluoridation was confined to the fringe, “the [recent] wholesale assault on the world’s best public health agency is unprecedented,” he said. To explain the shift, he pointed to the COVID pandemic. Public health became politicized as some Americans felt their liberties were being infringed by social distancing, masking, and vaccines. Public health leaders in the U.S. were laser-focused on policies to reduce the risk of mortality. Yet they often minimized the costs— “not factoring in the risk of isolation, the risk to the economy,” Besser explained.
During the 2009 H1N1 pandemic, Besser prioritized transparent communications; his team continually reminded the public that recommendations can change as new information comes in. “We wanted people to know what we knew when we knew it [and] what we didn’t know,” he recalled. Communications style is another consideration, Dean Cobb noted. “The people who are peddling quack cures know how to talk in a way that the establishment frequently does not.”
The irony of the MAHA movement is that its proponents already care deeply about health, Dean Cobb observed. “We have a public that is concerned about the poor quality of its own and somehow that concern has been siphoned off into every kind of quack cure you can imagine, every kind of conspiratorial idea about medical practice, about public health practice,” he said.
Of course, the problem wasn’t just a gap in communications. The high cost of health care and higher education may have fueled some of the anger seen in the 2024 election. “We have to be willing to look into our own backyards,” Dean Cobb said. “Tell me why [the public] should trust us. We have to be able to answer that question individually and collectively before we can start to make any kind of progress.”
Democracy, Health, and a Better Future
While public health is politicized as never before, some evidence-based health policies remain popular. In recent years, several states have expanded access to Medicaid and reproductive rights through ballot initiatives. In response, a number of states, including Florida, upped the threshold to win a ballot initiative to supermajorities of 60 percent. Last year, an abortion rights measure there fell short with 57 percent of the vote. In response, RWJF is supporting pro-democracy efforts. More than 30 RWJF grantees are now involved in court challenges. Already, they’ve seen wins in immigrant rights and access to federal research funding. The foundation also continues to support health equity in a political environment hostile to those goals. “As a foundation focused on health, we have to do all we can to preserve our democracy,” Besser said.
How bad is it? By some estimates, the current political climate is worse than the McCarthy period, Dean Cobb noted. Even so, there are reasons to be hopeful. Despite the chilling environment for journalism and free speech, he said journalists continue to “want to tell the stories that the public deserves to know,” and journalism students want to improve the craft as a tool to address societal problems. For his part, Besser pointed to the September 17 Congressional hearing on the firing of CDC director Susan Monarez as a good sign that Congress might do more to stand up for public health. He was also cheered by an enthusiastic reception to a report by the New Jersey Reparations Council, an RWJF grantee, launched this past Juneteenth.
Besser concluded with advice for public health students. “Don’t give up,” he told them. “The act of going into public health is an act of resistance. It’s an act of faith in a better world. Public health is a way to help ensure that people here and around the world can lead their healthiest lives. These are tough times, but the values that are embodied in the discipline of public health are going to survive.”
