The WashU Public Health Moment

August 31, 2025

Dear colleagues,

The first half of 2025 has been a challenging moment for public health. A new U.S. federal administration has implemented substantial workforce reductions across the Department of Health and Human Services, affecting core agencies responsible for disease surveillance, research, and regulation, including the Centers for Disease Control and Prevention (CDC), the Environmental Protection Agency, and others. The director of the CDC, and key deputies, were removed or resigned last week. Threats to federal funding of research challenge the long-standing infrastructure that has sustained world-class population health scholarship as the foundation of the practice of public health.

In domestic social infrastructure, recent legislative changes have introduced deep Medicaid cuts, estimated to total between $793 billion and $1 trillion over the next decade. The introduction of work requirements, more frequent eligibility redeterminations, and higher cost-sharing, are expected to result in millions losing health coverage, reversing many of the gains achieved under the Affordable Care Act.  Additional reductions in programs like the Supplemental Nutrition Assistance Program (SNAP) raise concerns about food security and downstream impacts on diet-related health outcomes. Taken together, these policy shifts have the potential to weaken a broad range of systems — both directly and indirectly — that sustain the health of the public. At the same time, the United States has initiated withdrawal from the World Health Organization and reduced funding for international health programs, with reverberations of these changes worldwide.

These developments come at a time when the public health system in the U.S., and globally, is still contending with persistent challenges that predate the current administration. Rates of opioid-related mortality remain high, mental health needs continue to grow, and noncommunicable diseases such as diabetes and cardiovascular disease continue to lead the burden of disease nationwide. Emerging infectious disease threats, including resurgent measles outbreaks in under-immunized communities, underscore the continuing importance of immunization and surveillance infrastructure, even as the same scaffolding for that infrastructure is shaken. Trust in public health institutions remains fragile, shaped by the conflicts and polarization that accompanied the COVID-19 response. This erosion of trust has complicated efforts to sustain vaccination uptake, mobilize collective action, and secure durable public support for new health initiatives. The convergence of these ongoing population health issues with reductions in institutional capacity raise important questions about how we as a country can respond to ongoing and potentially emerging threats to the health of the public.

In this difficult moment, the question is: How should the public health community respond? Clearly, one path is to retrench, step back from the political and social turbulence, and hope that the pressures of the current period eventually recede. Another path is to lean in — to treat this as both a challenge and an opportunity to re-examine our assumptions, renew our commitments, and strengthen the field for the decades to come.

That is the path we are taking at WashU School of Public Health. We are leaning in and learning. We are asking difficult questions about what public health has done well and where it has fallen short. We are examining how we can do better, not only in scientific inquiry but also in communication and engagement with the communities we serve. We are not shying away from political discussion and debate, but we are committed to doing so in a way that listens to a breadth of perspectives, to recognize that no one political party owns public health, and that our responsibility is ultimately to populations — all of them. We see our role as helping write the next chapter of public health, in the U.S. and globally, and doing so with an open mind to different ways of doing things, but clarity of conviction about our fundamental goal: to ensure that all can live longer, healthier lives.

Because as long as societies are concerned with heart disease, stroke, and mental health, as long as we remain invested in creating a healthier and more equitable world for the next generation, the need for public health endures. Guided by our 4x4 plan, WashU is building a school that leads with excellence in interdisciplinary population health science and scholarship, distinction in educational programs, and a deep commitment to local and global impact. The Moment is our weekly newsletter, highlighting the work of our faculty, staff, students, alumni, and partners. We invite you to join us in this work, to learn together, to lean in with us.

Warmly,
Sandro

Margaret C. Ryan Dean of the School of Public Health
Eugene S. and Constance Kahn Distinguished Professor in Public Health
Vice Provost for Interdisciplinary Initiatives
Washington University in St. Louis

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The WashU Public Health Moment is published by the School of Public Health Office of Communications. You can reach us at sphcomms@wustl.edu.

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