Director's Message

Welcome to the Center for Public Health Systems at Columbia University.  We are housed within the Department of Health Policy and Management, at the Mailman School of Public Health. 

Our mission is to conduct needed research, facilitate public discussion, develop policy proposals, and provide educational programs, all with the goal of encouraging a better, more efficient, and more equitable public health system.

We start with the recognition that the public health system has two very different components.  First is the public health sector, those government agencies, at the local, state, and national level, whose mission is to protect, promote, and preserve the health of their populations.  In the United States, there are approximately 2800 of these agencies, of different size, organizational structure, and institutional capacity.  To achieve its mission, however, the public health sector works with collaborators in other government agencies, with the medical care system, and with a host of private sector players.  Taken together, the work of these agencies and organizations constitutes the nation’s public health system.

The nation’s public health sector is in crisis: it is under-staffed, under-paid, and under-valued. 

The nation’s broader public health system is in crisis as well: it is fragmented, disorganized, and ill-equipped to respond to a growing number of complicated public health crises. 

Part of the problem is money: in a $4.8 trillion health sector, less than three percent of the dollars go to public health.

Another major problem is confusion of who should do what.  In recent years, for example, most public health agencies have focused on the so-called “foundational health services,” such as infectious disease response, environmental oversight (such as restaurant inspections), maintaining vital records (such as birth certificates) and developing health promotion initiatives.  At the same time, however, there is a growing tendency to label a variety of social ills as public health crises, including rising levels of opioid addiction, gun violence, loneliness, and the misuse of social media.  The role of the public health sector in addressing these emerging public health crises is unclear, as is the role of other participants in the broader public health system.  Public health agencies face similar challenges in considering their role in addressing the health-related social needs of their community members, such as the shortage of affordable housing or nutritious food.  There also are ongoing debates over whether public health agencies should provide some basic clinical care services as part of the health care safety net, a task previously performed by most such agencies but one that now is increasingly rare.

There is no perfect organizational chart to answer these questions: there will be variation by community and timeframe.  But we need research on the pros and cons of different approaches, public discussions to set public health priorities, policy proposals that emerge from that research and discussion, and educational programs that provide training and skills.  Our Center will engage in each of these needed activities, focusing primarily on the United States but informed by the experiences and expertise of public health systems around the world.

We invite you to share your questions and ideas as we begin our work.

Michael S. Sparer, JD, PhD
Professor and Department Chair
Department of Health Policy & Management
Columbia University Mailman School of Public Health