Repairing Public Health Means Building Institutions Resilient to Political Change
For generations, America’s public health agencies have protected people from contaminated food, unsafe medicines, and infectious disease. But the Trump administration’s overhaul of federal health agencies exposed something experts have long understood: many of those protections relied as much on shared norms as they did on law.
In the latest installment of our Repairing America series, Kavin Senapathy explores what it will take to rebuild public health—not simply by replacing leadership, but by strengthening the institutions themselves against future political interference.
America’s Public Health System Was Too Easy to Break
America’s network of federal health agencies worked so well that its successes became easy to forget. Diseases that once killed or disabled huge numbers of people receded from everyday life, while safer drugs, vaccines, disease surveillance, and other public-health protections became part of the background. But as the consequences of those older threats faded from collective memory, so did an understanding of why these institutions—and the scientific expertise behind them—matter. Rebuilding them now will mean restoring that expertise, bringing qualified people back into government, repairing public trust, and putting stronger legal protections in place so public health is less vulnerable to political whims.
From the Reporter’s Notebook 📓
In reporting this DAME story on rebuilding federal health agencies, my biggest takeaway is that a perfect storm led to the collapse of both defense and offense in public health: existing vulnerabilities in the structures upholding them and Robert F. Kennedy gaining the highest level of power over them. The United States achieved these giant leaps in disease control, prevention, surveillance, treatment, and research and development because officials behind them have historically valued scientific integrity and believed that the comprehensive body of evidence, within a dynamic context, is the best way to inform health decisions, which are inherently political. In the incessant war against harm to the public, the government must not only bring back officials who respect these long-held principles, but structurally patch up and reinforce the exposed weaknesses in the federal public health machine, and make sure to keep it well-oiled.
Next Up in the Series: Child Care
America’s child care crisis isn’t just a problem of cost or availability—it’s the result of decades of policy choices. Elliot Haspel explores how the country arrived at a system that leaves families struggling, and what a new generation of state-led solutions reveals about rebuilding child care as essential infrastructure.
Read More From the Series
America’s Disaster Response Is Failing. Here’s How to Rebuild It.
Experts say stronger local partnerships, more investment in preparedness, and a reimagined FEMA could save lives—and billions of dollars.
Read Sarah Sloat’s reporting here.
The Tax Code America Needs for the Next 250 Years
The history of taxation reveals how the nation has defined belonging—and how a fairer system could help repair the fractures of American democracy.
Read the full reporting from Portia Allen-Kyle here.
The Post-Trump Challenge Isn’t Restoration. It’s Reinvention.
Experts warn the federal government has lost generations of institutional knowledge under the latest Trump administration. They also believe the destruction could force long-overdue structural reforms.
Read the full piece from Max Burns here.
The Case for Rebuilding America’s Immigration System
With public anger mounting over aggressive raids and deaths in detention, immigration reform advocates are advancing a broader agenda aimed at limiting detention, strengthening oversight, and reducing the federal government’s enforcement powers.y
Read Felipe De La Hoz’s reporting here.
The Blueprint for a More Affordable America Already Exists
From guaranteed income to universal childcare, solutions to the affordability crisis are already in motion. The challenge now is political will—not policy design.
Rainesford Stauffer reports.