Revitalizing Public Health in Missouri


Bob Hughes, Former President & CEO

In normal times, the public health system operates in the background, largely unnoticed by most of the public. The ability to turn on the tap and get clean water or eat food from a local restaurant without getting sick is simply part of our daily expectations. We don’t think about it until something goes wrong.

The COVID-19 pandemic has pushed forward the shortcomings of the public health system. While some aspects of our response to the pandemic – the dedication of frontline health workers, for example or the record pace of vaccine development – have been heroic, other facets, such as quarantine and isolation orders, testing and contact tracing, the basic “blocking and tackling” of public health, have proven challenging.

Elected officials have long overlooked public health, providing inadequate funding and support of basic infrastructure. The public health sector’s struggle or hesitance to effectively articulate its own role has contributed to the environment in which an indifferent community takes the lifesaving work of the public health system for granted. Mix in our deeply divided politics and we’re left with a toxic brew where even the straightforward facts of how to mitigate the spread of disease, such as face masks, social distancing, and good hygiene, have proven controversial and public health workers have faced opposition and harassment.

In Missouri and across the country, lawmakers are considering bills that limit the authority of public health entities during an emergency. While it is appropriate to ensure decisions by public health or executive bodies are clear and within reasonable confines, efforts to diminish or eliminate powers may be shortsighted and leave us less prepared to deal with the next public health crisis.  Further, some of these bills would create layers of bureaucracy and hinder effective and responsive government operations. At a time when Missouri is struggling to efficiently deliver COVID-19 vaccines, West Virginia’s relatively high vaccination rates demonstrate what can be achieved with strong partnerships and deference to public health expertise at the state and local levels.

Missouri must adapt and modernize if we are to be prepared for what’s next. The demands on public health are changing, and the field must be flexible to change with it. The current public health system –with 114 independent local public health agencies operating under different local structures and authorities – is highly fragmented. This fragmented system creates significant inequity, reinforcing that where you live does matter with regard to public health protection. Change may look like finding ways to better coordinate regionally or even standardizing core competencies through accreditation. But no enhancements can be made without investment and dedication from policymakers.

The importance of public health infrastructure has long been on Missouri Foundation for Health’s priority list. But the flawed response to the COVID-19 pandemic across the nation presents a unique window of opportunity for transformative change. To this end, we look forward to rolling out an adaptive, multidimensional strategy that will draw on research, policy, communications, and cross-sector partnership to catalyze the change Missouri needs. We are eager to work with the many dedicated public health professionals across the state who we know are equally committed to establishing a structure that will serve all Missourians. It is long past time to reexamine and revitalize Missouri’s public health system. The question can no longer be whether we prioritize public health, but instead, how we transform our public health system for the 21st century.