Laying the Groundwork for a Public Health System Built by Communities
The federal public health infrastructure didn’t just weaken in 2025, large parts of it were dismantled. For Health Leads, that rupture created an uncomfortable but real opening: if the old systems were being torn down, communities could have a hand in shaping what comes next.
In 2025, Health Leads launched a planning effort for a co-designed, community-led public health futures initiative. The work is early-stage and deliberately so. Rather than arrive in communities with a predetermined agenda, Health Leads is building the initiative around a structured listening process, starting in Louisiana, Michigan and North Carolina, to identify what communities themselves see as their health, power and systems change priorities.
“We recognized that this moment, as disruptive as it is, is also a narrow window,” said Alexandra Quinn, CEO of Health Leads and co-lead of the initiative. “If we’re going to build something more durable than what existed before, communities have to be the ones defining what that looks like.”
The initiative’s design reflects that conviction. In each jurisdiction where it engages, Health Leads plans to resource local policy campaigns, strengthen existing advocacy infrastructure, and foster collaboration across jurisdictions so that wins in one place can inform strategy in others. The listening process will directly shape which campaigns get pursued and where, with regranting to community partners built into the model from the start.
“We recognized that this moment, as disruptive as it is, is also a narrow window. If we’re going to build something more durable than what existed before, communities have to be the ones defining what that looks like.”
Alexandra Quinn, CEO of Health Leads
The planning work also confronts a practical reality: public health has a narrative problem. In a fragmented media environment where misinformation moves fast, Health Leads is developing a strategic communications approach that reframes public health not as a partisan issue but as civic infrastructure foundational to economic strength, community stability and democratic life.
Through the end of 2027, Health Leads aims to complete the community listening process and move into specific campaigns in four to six jurisdictions. Contingent on resources, the initiative seeks to scale to 10 jurisdictions and advance a national approach. It’s an ambitious arc, but the 2025 work was about getting the foundation right—designing a process that earns trust, centers community voice and builds the kind of local capacity that doesn’t disappear when attention moves on.
The old public health infrastructure was fragile in part because communities didn’t have enough ownership of it. Health Leads is betting that the next version can be different if the people most affected by public health decisions are the ones making them.
