Dear friends,
If you or someone you love got sick tomorrow, how confident are you that your community could help you stay healthy, not just treat you in an emergency?
Public health shapes the air you breathe, the water you drink, the shots your children can get, and the information you receive when something new and dangerous starts to spread. None of this erases the responsibility we must take for our own care, but you should not have to carry the burden of fixing an entire system from the waiting room.
When I first started out in medicine, I didn’t have to wonder. I knew the local health department was there as a safety net. You could walk in whether you had health insurance or not. You could get childhood vaccines, flu shots, and other basic immunizations that meant the difference between life and death. Public health ahandled the basics so that people did not fall through the cracks.
It was also where you went before you traveled overseas and where infectious diseases were tracked and treated. Staff could tell you which diseases to watch for, which shots you needed, and help patients with tuberculosis stay on treatment. The goal was simple: protect the community.
Over time, chronic underfunding hollowed out that work. The National Association of County and City Health Officials (NACCHO), which represents local health departments across the country, found in its 2019 national profile that local health departments have gone through years of budget cuts and flat funding, and that spending has not recovered in many communities. When funding stalls while community needs grow, the result is fewer services for the people who need them most.
We saw the consequences during COVID. Many Black and Brown communities already had good reasons to mistrust the system. When the public health response arrived late, or skipped certain neighborhoods, it confirmed what people had felt for generations. Mistrust was not paranoia. It was protection.
So why should you care about public health if you already have a doctor? Because public health shapes the air you breathe, the water you drink, the shots your children can get, and the information you receive when something new and dangerous starts to spread.
Health equity is not a slogan. It means everyone has a fair and just chance to be as healthy as possible. That cannot happen when some neighborhoods have clinics, grocery stores, and health educators on every corner and others have none. It cannot happen if we expect patients to do all the work of navigating a confusing system while the system stays the same.
So what would a reimagined public health system look like where you live?
First, the basics would be close to home. Vaccines, blood pressure checks, diabetes and cancer screening, and mental health support would be available in places people already visit. Think of mobile mammogram vans at churches, blood pressure checks at barbershops, quick walk-in testing for infections, and clear follow-up plans when a test is abnormal.
Second, access would be real, not just a word in a brochure. Federally qualified health centers were created to serve people who are uninsured or underinsured, yet many have lost funding or never received enough in the first place. We should restore and expand these centers in zip codes that need them most and support young physicians who want to serve there while paying down student loans. Patients would gain consistent care, and doctors would gain experience in the very communities that often struggle the most.
Third, insurance would support prevention, not block it. Any company that calls itself health insurance should have to cover a basic set of services that are non-negotiable. Evidence-based screenings, chronic disease management, and essential lab tests should not depend on which insurance card you present at the front desk. Patients should not receive surprise bills that keep them from going back to the doctor.
Most important, a reimagined public health system would be rooted in real relationships. Every county or city health department should have an advisory council that includes faith leaders, school officials, leaders from community clinics, and trusted voices from barbershops, beauty salons, and neighborhood groups. Their job would be to help set priorities, raise concerns, and hold systems accountable.
For communities of color, public health must shift from acting on us to working with us. That means acknowledging harm, listening without defensiveness, and sharing decision-making power. It grows when promises match actions and when lived experience is treated as expertise, not as a barrier.
So where do we begin when all of this feels so big? We start where we are. Here are a few practical steps you can take while we continue to call for larger change.
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Learn what your local health department offers. Ask about immunizations, screenings, and community programs, and share what you learn with your family and social networks.
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Show up where decisions are made. Many health departments hold public meetings or listening sessions. If you can, attend one in person or online and ask how they are addressing health equity in your community.
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Use your voice at the doctor’s office and at the ballot box. Ask questions about tests, bills, and treatment plans until you understand them. Vote for policies and leaders who fund prevention, community clinics, and fair insurance rules.
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Encourage the next generation. Talk with young people about careers in public health, nursing, mental health, and community health work. We need more Black and Brown professionals in these roles who understand the communities they serve.
None of this erases the responsibility that individuals and families have to care for their health. You still need to know your numbers, keep up with checkups, and speak up when something doesn’t feel right. But you should not have to carry the burden of fixing an entire system from the waiting room.
We are the public in public health. The system exists to protect us, not the other way around. Public health will never reach its potential until the public, especially those who have been ignored or harmed, feels seen, heard, and protected.
Health equity is not about who appears in the brochure. It is about who has power, who has access, and who can count on the system to show up before a crisis hits.
With your health in mind,
