Being Accountable for Capability—Getting Public Health Reform Right This Time

Abstract

This editorial argues that chronic underfunding has left the U.S. public health system with a persistent capability gap, proven by its sluggish response to the COVID-19 pandemic. Data showed that prior to the pandemic, states spent a disproportionate amount (60%) of their health budgets on clinical services compared to a mere 7% on foundational capabilities (like preparedness and IT infrastructure), which are crucial for an effective crisis response. To properly reform the system, the authors propose a bottom-up approach using local Public Health Capability Teams and empowerment grants to assess and build functional capacity at the local level.