Originally published in How Public Health Gets Done, the monthly LinkedIn newsletter from our President & CEO, Christine Sow. Read the original and subscribe to follow along.
After 25 years working in global health across dozens of countries, I made a shift this past January to lead Heluna Health, an organization that has spent nearly six decades supporting public health programs across California and beyond. In this newsletter, I want to explore a question that has occupied much of my career: Not just what public health should do, but what it actually takes to get it done.
I’ve come to believe that the infrastructure behind public health is inseparable from its impact. The systems, partnerships, people, and processes that make programs possible are not simply administrative necessities. They are fundamental to whether public health delivers on its promise. A recent visit to the Bay Area brought that into sharp focus.
What Public Health Leaders Told Me
I recently spent time in Northern California visiting programs Heluna Health supports and meeting with public health leaders from city and state agencies. I expected to hear that we make their jobs easier, that we help lift some of the administrative burden. That’s the kind of acknowledgment I’m accustomed to hearing. Instead, person after person told me something more striking: They simply could not do this work without us. Not that it would be harder, but that it would not happen.
One story in particular stayed with me. A federal requirement came with a tight deadline. Moving through the agency’s standard hiring and procurement processes would have taken nearly three years. Working with Heluna Health, they accomplished it in thirty days. Three years or thirty days. That’s an extraordinary difference.
Is This a Symptom of Something Broken?
I’ve been thinking about that story ever since. The obvious question is whether this points to something fundamentally broken in government. If public agencies cannot move at the speed the work requires, are organizations like ours simply compensating for a system that doesn’t function as it should? I don’t think that’s the right way to look at it.
Government operates within rules designed to protect the public interest. Competitive procurement, civil service hiring, layered approvals, and public oversight exist for good reasons. They help ensure that decisions about public resources are transparent, fair, and accountable. Those safeguards matter, even when they slow things down. But those same systems aren’t designed to move at the speed of an outbreak, a sudden funding disruption, or a ninety-day federal deadline. That tension isn’t necessarily a failure. It’s a structural tradeoff between accountability and agility.
The question, then, isn’t how to make government less accountable so it can move faster. It’s how we build partnerships that allow the public sector to do more, respond faster, and remain accountable to the communities it serves.
That’s what I mean when I talk about public health infrastructure: public agencies, nonprofit organizations, and community partners working together to accomplish what none could reliably do alone. It’s also why organizations like Heluna Health are essential to a functioning public health system. Much of this work—from administering WIC services to supporting infectious disease research—exists to deliver a public good, not to generate a profit. It requires partners committed to the same public purpose, with the capacity to translate funding and policy into action.
What Global Health Taught Me About Infrastructure
Before joining Heluna Health, I spent most of my career in global health, where funding typically operates in three-to-five-year cycles. Renewals are possible, but long-term commitments are rare. There are legitimate reasons for this, including competition, accountability, and the desire to avoid entrenching particular organizations.
The practical consequence, however, is constant uncertainty for the people, programs, and communities involved. Relationships that take years to build can be disrupted by the next procurement cycle. Institutional knowledge disappears when a grant ends. Programs are forced to rebuild capacity they spent years developing. What I saw repeatedly was that the programs best able to weather these transitions weren’t necessarily the best funded. They were the ones that had built enough continuity, trust, and local capacity to sustain the work between grants.
That, to me, is what infrastructure really means. It’s what remains in place when funding changes, so the work doesn’t have to start over every time.
I saw this across countries and health systems, and I see it just as clearly here in California. For nearly six decades, Heluna Health has helped build that continuity alongside our partners. Our role extends beyond any single grant, administration, or crisis. We help sustain the relationships, expertise, and operational capacity that allow public health programs to keep showing up for their communities, year after year. That continuity is not incidental to impact. It’s what makes sustained impact possible.
The Moment We’re In
Every public health leader I met in the Bay Area described this as a time of significant uncertainty, but also one of opportunity. Funding is increasingly unpredictable. Federal guidance and coordination are less reliable. One leader described learning about a significant public health development through the news rather than through official channels.
In response, states, counties, and local organizations are finding new ways to collaborate, forming coalitions, sharing resources, and building capacity to fill emerging gaps. There is opportunity in that response, but I don’t want to romanticize the circumstances driving it. When routine disease monitoring disappears, for example, we may not recognize the consequences until an outbreak occurs. When programs lose funding or staff, the impact is felt by real people and communities, often those already facing the greatest barriers to health.
And yet, across the programs I visited, I heard a consistent determination: keep delivering what we can, adapt to the resources available, and remain ready to scale when opportunities return. That kind of agility doesn’t happen by accident. It requires deliberate investment in people, systems, partnerships, and organizational capacity—often long before the need becomes urgent.
We cannot build resilient public health systems only when a crisis arrives. We have to invest in the infrastructure that makes resilience possible.
What This Newsletter Will Explore
I want to use this newsletter to explore the part of public health that rarely makes headlines but often determines whether we succeed. Policy sets the direction. Funding determines the scale. But whether either translates into better health for an actual person, in an actual community, depends on the operational infrastructure that most people never see. I’ll be writing monthly about the practical realities of making public health work: how grant administration and fiscal sponsorship enable programs; what it takes to recruit and retain critical public health talent; how government agencies, community organizations, researchers, and funders work together; and what distinguishes partnerships that build lasting capacity from those that exist mostly on paper.
I’ll also explore what my experience in global health can teach us about strengthening public health infrastructure here at home, and vice versa. These may not be the most visible aspects of public health, but I believe they deserve much more attention. Because when the infrastructure works, communities benefit. And when it doesn’t, even the best policies and most promising programs can fall short.
If you work in or around public health—in government, a community organization, academia, philanthropy, or the private sector—I’d welcome your perspective. What are the invisible barriers that make your work harder? And what partnerships or approaches have helped you overcome them?
I’d love to hear your thoughts. Some of the most interesting conversations in this space may well begin there.
