Prioritizing Public Health Infrastructure: Why Improvement and Innovation Should Be Front and Center


Since taking office this past summer, Governor Mike Parson’s administration has championed an agenda to improve our state’s workforce and infrastructure. Infrastructure is commonly understood to include roads, bridges, airports, and railways – all of which are the foundation of the economy; but there is another crucial element of Missouri’s infrastructure that’s generating interest and becoming a hot topic, and that is public health infrastructure. This week, the governor is traveling across the state to discuss Missouri’s top health issues, including rural health and the opioid epidemic, and challenging stakeholders to collectively develop innovative approaches to address health barriers affecting Missourians.

Improvement and innovation are key to Missouri’s public health infrastructure, and the possibility of an uptick of momentum behind it is encouraging. Broadly defined, public health infrastructure is the capacity to enhance the health of a population in order to prevent disease, promote health, prepare for and respond to emergency threats, and take on other ongoing health problems. Core elements of public health infrastructure include a qualified workforce, interoperable information systems, and capable agencies that can react appropriately to community public health needs. Though public health isn’t a well-known topic or always seen as the most intriguing by some, it is a critical component of our society’s health system. In 2016, Missouri ranked second-to-last on public health funding, spending only $5.90 per person compared to the national median of $35.77. For context, Missouri spends around $8,000 per capita on health care services. The impact of this underinvestment on the health of our most vulnerable Missourians was an important factor in MFH launching a new program to strengthen public health infrastructure in our state.

In 2017, the Foundation began an effort to encourage improvement and innovation in public health infrastructure. The neglect of local public health agencies (LPHAs) underscored the urgency in addressing some of their most immediate needs. We provided one-time funding to each LPHA in our service area to sustain their critical functions. The one-time grants were used to purchase things like hot water heaters, HVAC units, generators, and went toward enhancing other brick-and-mortar items such as gutters, roofs, collapsed stairs, and toilets. One agency even used funding to replace outdated fire alarms, which demonstrates just how deep the need for improvement really is.

LPHAs are the first, and sometimes only, line of defense for protecting and advancing the health of communities; yet, on a regular basis, they are burdened by the most basic operational demands. In our work, we’ve found that a more collaborative approach provides greater context of the resources needed to serve communities. In the case of LPHAs, we cannot expect to stimulate systems-level innovation and creativity if we don’t first equip them with the fundamental elements required to fulfill their duties.

We have worked with partners across the state to cultivate new ways of thinking and collaborating around public health. One theme continues to emerge: LPHAs collectively agree that the state needs a revitalized public health sector to better serve Missouri communities. Sustainable public health infrastructure influences the ability to combat our most pressing health concerns, whether it be rural health access, preventive health, or substance use disorders. The administration’s decision to prioritize health systems improvement for our state, is promising and helps to elevate public health infrastructure as a bedrock to this work. Public health infrastructure is essential for bettering the health of all Missourians, and we are looking forward to seeing more on Missouri’s infrastructure investment.