Public health and primary care in 2025: ‘We are a trusted partner to you’

© Big Cities Health Coalition

Primary care physicians are not alone in the quest for improving the health of their patients and their communities, said the leader of a national public health organization.

The Big Cities Health Coalition (BCHC) is a group of the leaders of public health departments of 35 metropolitan areas serving a combined population of more than 61 million people around the country. BCHC has published “Protecting and Promoting the Public’s Health: Recommendations for a New Administration and Congress 2025.” Its leaders met online with news media to discuss it and the public health landscape as the nation prepares for a new administration under President-elect Donald Trump.

A message for primary care

Michelle Taylor, MD, DrPH, MPA
_{© Big Cities Health Coalition}

Primary care physicians (PCPs) battle reportable infectious diseases every day, patient by patient, said BCHC board Vice Chair Michelle Taylor, MD, DrPH, MPA. In 2025, they should understand that public health is a vital partner to them, she said.

A pediatrician by training, Taylor is health officer and director of the Shelby County Health Department in Memphis, Tennessee. In that jurisdiction, primary care physicians understand that partnership, she said, and so do many others, based on combined efforts during the COVID-19 pandemic.

“I will tell you that, that's one of the ways that the pandemic really forced the health system to come together, was to say, hey, you know, you’re a PCP over here, you're a hospital over here, you're a public health department over here. But in order to save everybody in the community and as many lives as possible, we have to work together,” Taylor said.

“And at least in my jurisdiction, and I know in a lot of my colleagues’ jurisdictions, we have continued that work in every area of public health, not just along infectious diseases, because we understand how effective it was to really try to protect the population from COVID,” she said. “So that would be my main message, is that we are a trusted partner to you. We want to do everything we can to help you do your jobs even better than you already are doing. And you don't have to do this alone. A lot of times as a primary care physician, when you're in the trenches in that clinic, you feel like you're by yourself. You are not by yourself. You have whole local public health departments across the country who are there to help you to figure out how best to protect your patient population.”

From Washington, D.C., on down

Chrissie Juliano, MPP
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At the U.S. Centers for Disease Control and Prevention (CDC), more than 80% of the domestic budget flows out to state and local level departments tasked with developing public health in communities.

BCHC’s 2025 guideline included the recommendation that the next director of CDC have governmental public health leadership experience at the local or state level. President-elect Donald Trump has announced his nominee is Dave Weldon, MD, an Army veteran and former Republican congressman from Florida.

BCHC so far has not interacted with Weldon, said BCHC Executive Director Chrissie Juliano, MPP.

“We've yet to have any interactions,” she said. “I think one of the things that is critical is making sure that the person that leads the CDC knows public health, understands public health, ideally, has been in the seat and made decisions in communities, and really thinks about the whole of the system.

“We've spent so much time in the past five years, rightly so, focused on COVID and infectious disease,” Juliano said. “There's so much more that happens at CDC and that happens in communities. And I hope we can get to a place where we remember all the things so that we can continue to, you know, make communities healthier.”

Raynard Washington, PhD, MPH
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The next CDC leader must first seek to understand because leading the CDC is a huge responsibility, said Raynard Washington, BCHC board chair and director of Mecklenburg County Public Health in Charlotte, North Carolina.

“The CDC is not just responsible for domestic threats,” he said. “They're also responsible for supporting our global health initiatives to help protect Americans from threats that might exist globally. And so there's a whole robust network of employees across the world that work for CDC, that are working to make sure we protect the health of Americans. And so I think there's a lot to understand there.

“It's one of those tough jobs I don't know that anybody's fully ever ready for,” Washington said. “But I just hope that whoever gets to sit in that seat will first seek to understand what the responsibilities are, and then work to make strategic decisions in partnership with us locally at the state level.”

Health care skepticism

Weldon’s potential new boss would be Robert F. Kennedy Jr., who has been tapped by the president-elect to lead the U.S. Department of Health and Human Services, CDC’s governmental parent agency. He has expressed skepticism about vaccine safety and effectiveness, and the BCHC leaders were asked about how that could affect their organizations.

“I think it’s important to start with the facts,” Washington said. “The fact of the matter is that vaccines have saved millions and millions and millions of lives, not just here domestically, but across the world. And so we don't want to in any way sort of create the question that vaccines are not effective tools to help us manage and fight infectious diseases in our communities. And so that is a message that we all continue to resound in local, state and federal public health agencies, has been supported not just by our public health agencies, but also health care agencies.”

It is important to acknowledge that health care professionals must deal with headwinds of misinformation and disinformation, Washington said. To counter that, health professionals are ramping up social media and face-to-face engagement to ensure patients get accurate information, he said.

The local and state health leaders need federal partners to speak in unison messages based in science, and that are transparent, to create trust, Washington said.

Taylor described it as “listening aggressively” to communities to build and rebuild trust. Most people want to do what’s best for themselves, their families and their communities when they are presented with accurate information, she said.

“I like to say that our public health workforce knows that we can trust our population to make really good decisions when it comes to protecting their community's health, but they have to be presented with information that speaks to them,” she said.