When the Supreme Court in 2022 struck down President Biden's COVID vaccine mandate, it wasn't really about vaccines—it was about who has the constitutional power to issue such a mandate. As it turns out, the 10th
amendment gives states—and by extension, local governments— the "police power" to regulate and oversee our public health system. This is why we have 3,300 state and local health departments instead of one national system.
But here's the surprising part: when New York State created
the nation's first municipal health department in 1866, they didn't fight
disease with medicine. They fought it with garbage trucks. The city's streets
were filled with rotting food, dead animals, and human waste and the germs that emerged were causing deadly epidemics. During the "Great Sanitary
Awakening," reformers realized the solution was sanitation.
While the American public health system traces its roots to
the unglamorous work of street cleaning, today the scope is much broader. This episode reviews this history and makes clear why it matters.
00:00 Biden's COVID Mandate and the Court
01:15 Introducing Who the Health Cares
02:40 1787: The Constitutional Convention
03:57 Hamilton vs Jefferson: Federal Power
05:10 Jefferson's Vision: State Control
06:52 Local Police Power and Social Welfare
08:17 Fighting Epidemics in Early America
09:41 The Medical Revolution of the 1860s
11:17 NYC's First Board of Health
12:53 Why Local Health Departments Matter
14:44 Who the Health Cares? We All Should
Michael S. Sparer, J.D., Ph.D. is Chair of the Department of Health Policy and Management at Columbia University's Mailman School of Public Health, where he has taught for over 30 years. He also directs the Center for Public Health Systems, which examines how America's fragmented public health infrastructure functions and how it can better serve communities.
Professor Sparer’s research examines how policy shapes politics both in health insurance systems and in local health departments. He is particularly expert in Medicaid policy and in the inter-governmental dynamics that have shaped the evolution of that program. His work on public health has also focused on federalism and on the ways in which local health departments respond to changing political and fiscal environments. Before his academic career, he spent seven years as a litigator for the New York City Law Department. He is a three-time recipient of Columbia teaching excellence awards and former editor of the Journal of Health Politics, Policy and Law.
About the Mailman School of Public Health, Center for Public Health Systems
The Center for Public Health Systems at Columbia's Mailman School of Public Health conducts needed research, facilitates public discussions, develops policy proposals, and provides educational programs, all with the goal of encouraging a better, more efficient, and more equitable public health system. This work builds on the recognition that the nation’s public health system is currently under-resourced, under-paid, and under-valued and that a stabilized and strengthened system would benefit all of us.
