A Tale of Two Systems –
The shortchanging of public health
by Bob Hughes
We have two health systems in this country. One – our health care system – is anchored in medical treatment delivered one patient at a time. The other – our public health system – promotes health and prevents disease in our neighborhoods, communities, and nation. Both health care and public health are crucial to overall health, yet these two systems have followed sharply different trajectories over the past 50 years. Health care has thrived. It’s almost one-fifth of the economy despite its severe shortcomings in quality, cost, and access. Public health has struggled overall. Even with moments of shining success, the underlying infrastructure has been under-resourced and under-appreciated for years. 

The pandemic came along, and like a national stress test, it revealed our anemic public health system and put its weaknesses in stark relief – decades of disinvestment, inadequate staffing, outmoded equipment, copy machines masquerading as information systems, and a disjointed patchwork of financing and organizations.

I have been involved in public health throughout my career. My academic training was in public health. I worked on responding to toxic waste threats in Memphis and was involved in the aftermath of a closed U.S. Public Health Service Hospital in Seattle (yes, public health used to have its own hospitals). I was in San Francisco when the city developed a unique community-based system of care for patients with a new infectious disease, HIV. I was fortunate to join outstanding colleagues at Robert Wood Johnson Foundation on several public health issues – most notably reducing tobacco use. And I was a board member of a local public health agency in New Jersey. So, it is painful to see public health underperform at a time when it is most needed. 
Our building reopened on June 1. However, staff are free to continue working from home if they choose, and there are currently no visitors, meetings, or outside events allowed.

The fund was originally scheduled to discontinue at the end of 2020, but amidst the pandemic, we will no longer be supporting the use of gatherings in Missouri, regardless of size. This includes virtual events.

MFH is part of FORESIGHT , the first initiative of its kind to design a bold, new future for health—together. FORESIGHT is working to re-envision health using a futuring process that includes the voices of thousands of people across the U.S. We’re asking partners like you to share your unique perspective. 
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This quarterly online publication was designed especially with our grantees in mind as a means to provide you with updates, news, noteworthy CEO experiences, and most importantly to serve as a connector between all of you and Dr. Robert Hughes, Foundation president and CEO.

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