Who the Health Cares?
A Podcast With Host Michael Sparer
Politics, Public Health, and You
America has 3,300 local health departments. Agencies most of us never think about until there's a crisis. They respond to disease outbreaks, inspect restaurants, ensure safe drinking water, and coordinate emergency responses. Yet their work remains invisible, their budgets perpetually squeezed, and their authority increasingly questioned.
"Who the Health Cares?" explores how the United States built this public health system, why it struggles for resources and trust, and what it would take to strengthen it. Host Michael Sparer traces the origins of American public health from 1866 garbage collection and Constitutional debates to today's vaccine controversies, revealing the hidden infrastructure your community's health depends on.
Understanding public health isn't about politics—it's about understanding the systems that protect us all. From keeping food safe to preventing epidemics, these 3,300 departments do work that matters.
Who the health cares? We all should.
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The Host
Michael Sparer, JD, PHD
Director, Center for Public Health Systems
Dr. Sparer 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 directs the Center for Public Health Systems, which examines how America's fragmented public healt
rastructure functions and how it can better serve communities.
Who the Health Cares?--Series Trailer
Listen to the trailer now, and subscribe so you don't miss the first episode dropping mid-November. Find us on Apple Podcasts, Spotify, or wherever you listen.
Season 1 Episodes
Episode 1: Jefferson, Hamilton, and Your Local Health Department
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.
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Episode 2: Five Trillion on Medical Care, Pennies on Public Health
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
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Episode 3: Who Knew? What Health Departments Do
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 four 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. It's even better when they can prove their efficacy, quantify the return on investment, and explain why they take actions that might well be unpopular.
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