1034: Public Health at a Crossroads: Trust, Storytelling, and the Future of the Field

JOHN SHEEHAN: 

This is Public Health [Review] Morning Edition for December 1, 2025. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

Today, Dr. Susan Kansagra, ASTHO's chief medical officer, joins us in conversation with Jennifer Jean-Pierre to discuss what's happening in public health, the key trends shaping the field, and what public health officials should be focusing on to make the greatest impact.

JENNIFER JEAN-PIERRE 

All right, Dr. Kansagra, let's kick it off with how it all began. What inspired you to pursue a career in public health, and what continues to keep you motivated today?

SUSAN KANSAGRA: 

I've been in public health a long time, but to completely confess, I feel like I got into public health by accident, almost. I did the path of going to medical school. I did residency in internal medicine. It was a really long path. And of course, when you come out of that path, you usually go into clinical practice, clinical medicine. And I started to feel like toward the end of my residency that I really wanted to do more in health policy and more in community-based work. I just felt like what I was doing in the clinic was great, and I did feel like I was making a difference, but it felt like there were so many other things outside the control of a doc sitting in-clinic, that there were opportunities to support health, and so, I didn't actually really know what that meant or how to go about it, but I started just doing a little bit of talking to folks, and started looking into different types of opportunities, and I stumbled upon the New York City Health Department, which was doing just really amazing stuff around preventing chronic disease, just being really innovative in that space. And so, I reached out and was offered a position to support the commissioner at the time, but even getting that first job, it was really a leap of faith. I really didn't know all the different things that public health did. I learned a lot on the job, so I got a new appreciation for it, and then I loved it, and I've been in public health ever since. So glad I took that leap of faith, and I hope others out there that are thinking about a career in public health.

JEAN-PIERRE 

We are very fortunate to have you here at ASTHO, so I'm glad that you took that leap of faith and decided to go into public health. My next question might be a little bit more: what do you see as the most urgent public health issues right now, and why?

KANSAGRA: 

Yeah, there's so many things that I would put into the bucket of urgent public health issues in the here and now, but taking it up one level, I feel like a foundation to some of these issues, whether you're talking about vaccines or whether you're talking about nutrition, whether you're talking about chronic disease, I think it goes back to our ability and the ability of public health professionals to be able to communicate and be trusted in their communities. To me, like that feels like the most urgent piece of the conversation right now that underscores so many different health topics and issues, and we're at a point where that really is something that we are both seeing positively, but also that we are acknowledging that there's a struggle there right now and thinking about how we communicate some of these messages and get the buy-in and trust of the communities that we serve. So, I would say that, to me, feels really urgent in this time and space. Of course, there's other things that we are seeing now, whether that's around recommendations for vaccines or whether that's around our chronic disease burden in the U.S., there's a lot of different health issues downstream from that that we can talk about too, but I would put that one as a foundational one for all these other things that we do in public health.

JEAN-PIERRE 

I'm glad that you brought up the topic of foundational issues. So, looking ahead, in your opinion, what should public health leaders be prioritizing over the next five years?

KANSAGRA: 

Yeah, one is how we talk about public health, and this probably relates back to that first item. But you know, it's tough right now because we are seeing funding cuts to public health, we are seeing, again, a lot of mistrust, or lack of trust in public health or government in general, and it's a challenging place to be in, but I think there is an opportunity, especially over the next few years around how we talk about the core functions of public health and how that really makes a difference in everyday life. Whether you have a baby in a hospital and that baby is screened for all sorts of congenital illnesses to give that baby a best chance at life, and we are impacting every single newborn across the country through that work, or whether you walk into a restaurant and you we all expect to leave a restaurant without any fear of a GI illness afterwards, but that's thanks to the work of public health. So, how we talk about these very everyday things that public health does do that impacts everybody's daily life and their health outcomes as a result. I think telling that story is really important as we go forward, especially when we are being forced right now to think about those responsibilities in a contraction of those responsibilities with some of the funding going away.

JEAN-PIERRE 

I really appreciate the way that you explained that, because I think a lot of people hear public health and just think policy, right? Not the everyday work that actually affects lives, even something as simple as going into a restaurant, food inspectors, clean water, that is all public health. And you mentioned trust earlier, which I think is such an important point. How do we start changing the narrative? How can we tell the story of public health in a way that helps people really see it and trust it more?

KANSAGRA: 

Yeah, that's a great question. And I think to me, it goes back to also who the messenger is. I think we're seeing in this interesting space of social media and influencers. And even talking to my kids, I see that people get what they consume through increasingly smaller bubbles, and you tend to get fed the content that you're looking for. And that's how social media algorithms work. And people turn to their phone these days for news and for information. And so, us thinking about how we utilize some of these channels, how we think about influencers and ambassadors for public health that maybe don't look like what we've always thought of in the past, and certainly even I was the state health official, but I definitely am not always the messenger that is going to make a difference in certain communities or for certain groups of people. And so, how do we get others to be able to carry the voice of public health? And again, talk to those stories around how public health makes a difference in everybody's life. So, I think we've got to expand and get creative on how we do that into the future. We've got to break through that noise and get into some of these smaller spheres of content. And again, given how we know social media tends to give people the information they seek, how do we get creative in making sure that some of the information that public health wants to put out there is part of that?

JEAN-PIERRE 

So, what I'm hearing is, meet the public where they are. And right now social media short-form content ambassadors, influencers. So, do you see any other big opportunities for innovation or transformation within public health, outside of short-form content and social media?

KANSAGRA: 

Yeah, the other big space is around, of course, AI. We are seeing AI take off in different sectors, and certainly it feels like it's the 'Wild West' as far as thinking about how we might be able to use AI in the way that we are seeing AI quickly develop in all these different spaces. And it also reminds me of even when the internet, some of us remember when the internet was emerging, I do certainly. And I remember first seeing www and not knowing what that meant, and then I started seeing it pop up everywhere. And of course, then you got to fully understand the scope and scale of what having an internet meant, and how that fundamentally changed your daily life. It's interesting. I think we're in that space now for AI, as well, and we're seeing just such quick emergence of the use of AI in different aspects of things that we use every day, or information that we consume. So, how do we as public health also utilize AI in a way that can be helpful for sharing our message, distilling public health messages, supporting community? I feel like so much opportunity out there, so that, to me, is definitely high on the list.

JEAN-PIERRE 

You actually beat me to the punch, because I was going to ask you your thoughts on utilizing AI and public health work. I think one of the biggest things everyone is- has a fear that AI is going to take over, but I know there are ways to use it to help with the more administration work, so that public health officials, leaders, staff, can actually be more hands-on and figure out more ways to impact the public.

KANSAGRA: 

Fear is real, and sometimes I also I'm like, "Wow, where can this potentially go," into I feel like, let go of our fears and think about how we take control and take charge of our own destiny in this path that is emerging rapidly. And think about those as opportunities and not things to fear.

JEAN-PIERRE 

Oh, that's a great reminder. Take them as opportunities and not fear. Excellent point. So, we touched on this earlier, but I'd love for you to go deeper. What are you hearing on the front lines about some of the challenges and needs that are starting to come up in public health?

KANSAGRA: 

Yeah, I think overall, certainly, it is a challenging to- time to be in public health. I think there are a lot of concerns about funding for public health. Going forward, we are already seeing some funding be pulled back. I think workforce morale and engagement in this time where it's really hard to be a public health official, be a public health staff member. Sometimes it feels you're doing what you feel is good work, but that work is not always appreciated, and in some cases, even attacked. And I think that, unfortunately, is the climate that we are living in. So, morale is another thing on the front lines that I think I know is hard for people right now who are doing that work and don't always feel supported by the broader context of the world that we're living in right now. But I do feel fortunate, and I always go back to what we do in public health, I feel, is so special, though it's hard, there's plenty of other hard things that people have to do that don't have the significant impact to health, to lives saved, to community, and we do. So, I look to that, and that is what buoys me and keeps me uplifted and hopeful for the future and thankful that I get to do something every day that does provide and have real, meaningful impact at the end of the day, even if it's hard at times.

JEAN-PIERRE 

That is a powerful reflection, and I think it resonates deeply with so many in public health right now. The reality is, it's hard, and yet there's still so much purpose in what's being done every day, and the fact that you mentioned holding on to that sense of impact, because it really is what sustains so many in this work, is important. With that in mind, if you could give one piece of advice to someone just starting out in public health today, especially at a time when morale is low and challenges are real, what would that advice be?

KANSAGRA: 

Yeah, I'll say "keep the long view" is my advice for anybody. Public health advancement and public health innovation sometimes takes years, many years, if not decades. And there's so many successes that we see in public health that were decades and many years in the making. And so, any one moment in time I know certainly weighs- the present weighs on you longer. The unknowns of the future weigh on people, too. But keeping the long arc of public health advancements and innovation in mind, I think, is really important, because it's a marathon, it's not a sprint.

SHEEHAN: 

Dr. Susan Kansagra, ASTHO's chief medical officer, speaking with ASTHO's Jennifer Jean-Pierre.

Coming up tomorrow, December 2, at 2 p.m. Eastern, ASTHO and the Building Our Largest Dementia Public Health Centers of Excellence will host a webinar on how community health workers can support brain health and address dementias in their communities. You'll hear about a new report on developing community health worker roles and dementia efforts and explore ASTHO's new e-learning module designed to equip them for this important work. Don't miss your chance to join. Secure your seat using the link in the show notes.

A new ASTHO video explores how states have implemented the One Health approach in wastewater surveillance for infectious disease. Hear interviews that highlight the roles of coordination and communication across different sectors and the impact that collaboration has on strengthening wastewater surveillance by clicking on the link in the show notes.

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.