The Road Ahead: Public Health Leadership in a Time of Seismic Change

Public health is undergoing seismic change in identity, funding, and purpose. The field has become an increasingly frayed and isolated patchwork of programs, and its ability to influence various determinants of health—from access to health care to environmental protection to school safety—has waned. This is due in part to systemic changes in funding, the rapid advancement of technology, and a cultural shift toward more personalized and individual health. While public health has been in crisis for decades, it has reached a tipping point in the United States. For the health of the people we serve, our communities, and our country, public health must step into its role as chief health strategist—leading systems that advance community health while grounding policy in shared decision making, harm reduction, long-term prevention, and improving whole-person health.

As the Common Health Coalition stated in its June 2025 special report,1 when public health is lacking, the rest of health care pays for it—with sicker patients, higher costs, and hospitals forced to backfill core public health functions. Public health and health care are intrinsically linked; when one thrives, so does the other. However, findings from the Public Health Reaching Across Sectors (PHRASES) program indicate some health systems leaders view public health as a siloed entity focused on education or care for the uninsured, not an accountable partner in a population’s health. Some have trouble defining public health and consider it a concept rather than a field.2 We are bound by decades-old regulations and laws that stifle health innovation and progress. We lack shared data and funding. We lack a common language.

In governmental public health, the population we serve comprises the people represented by that local government. The work of public health in government often extends beyond a division or a department of health; ensuring access to nutritious food and quality health care among SNAP and Medicaid recipients, for example, requires governmental teams working together. To serve as chief health strategists, public health leaders must work across all sectors to improve systems that support both individual and community health, and local governments should realign to meet this mission.3

The road forward is already visible: North Carolina built a statewide, closed-loop referral network so clinicians and community organizations can connect patients to services. Oregon’s Coordinated Care Organizations use health-related services to address social drivers long before hospital admission. Vermont’s 1115 waiver lets Medicaid participate in its vaccine assessment program, decreasing cost and improving access. Alaska’s Fresh Start campaign embeds insurance providers into its programs so all Alaskans can access free health services for the biggest drivers of poor health outcomes. When financing, data, and community priorities line up, the seams of the disjointed public health infrastructure start to mend.

The newest PH WINS results indicate that our governmental public health workforce is ready for bold changes. Our workforce is younger, innovative, and dedicated, with 3-quarters planning to stay at their agency in the next year.4 The workforce is asking for practical tools in budgeting and financial management, policy engagement, and systems and strategic thinking to effectively advocate for and improve the well-being of the populations they serve.5 Most say their agencies are committed to collaborating with external organizations (90.7%) and are skilled in engaging with the community (82.5%).6 These are strengths to build on.

We need to start by listening to the communities we serve, including their clinicians and insurers. What are their struggles? What data or information do they need? How can public health help? Public health practitioners need to share syndromic and other data with health agencies to collaboratively address population needs. We need to consider the value of health data sets like those available at PopHIVE, a health information exchange, or all-payer claims to create insights for prevention and cost savings.7 We should collect data once and focus on sharing, collaborating, and reusing it rather than building something new.

We must train supervisors and managers in finance, policy, and how to effectively engage with and influence the complex public health and health care systems so they feel confident when interacting with a hospital’s chief financial officer or a Medicaid director, while still speaking up and out for their communities. We must rethink opportunities for public health workers, such as developing shared positions with other governmental departments, hospitals and other clinicians, and social services agencies.

Public health supports systems that serve the whole population it covers, insured and uninsured, by partnering where care and community meet. We know the destination, so let’s rise and meet the road. The articles in this supplement translate the workforce’s perspectives captured through PH WINS into actionable insights, offering a roadmap for leaders and practitioners to become the chief health strategists in their communities.