The System Isn’t Broken—It’s Just Full of People
What I’ve learned working inside public health, and why I’m still here
You can read all the books. You can study the systems. You can diagram inefficiencies, forecast disparities, cite policy briefs, and run regression models. You can get an MPH, like I did.
And still, nothing prepares you for the moment when you realize someone’s job—an actual human being’s job—is to update the spreadsheet that tells the spreadsheet manager which spreadsheet is outdated.
Welcome to public health in the real world.
This isn’t a takedown. It’s a love letter.
I’ve worked closely with the Alabama Department of Public Health on an oral health project—building a study that mixes data and narrative, surveys and story. It’s real work. It matters. And it’s been a gift to be in the room.
But if I’ve learned anything, it’s this: public health is not a clean machine. It’s a patchwork of people trying really hard with limited time, limited funds, and often, limited support.
It’s not sexy. It’s not tidy. It’s brilliant and janky and vital. And it deserves more credit than it gets.
What it actually looks like
You’re in a room with someone who knows the Medicaid waiver process better than anyone alive—but they also haven’t had a real lunch break in three weeks.
You’re coordinating across systems that don’t talk to each other, while explaining to outside partners why they’ll need to fill out the same form twice.
You’re trying to design a meaningful survey while keeping it readable at a sixth-grade level, printable in bulk, and compliant with four overlapping data policies.
This isn’t dysfunction. This is how public service happens in a chronically underfunded state agency trying to do the right thing.
And it’s not a failure. It’s a quiet kind of heroism.
The view from the inside
I’ve taught public health from the outside. I’ve critiqued it. I’ve read the stats on Alabama’s maternal mortality, Medicaid gaps, dental deserts, rural closures. And I still believe those critiques are valid.
But working inside a project—watching how the sausage is made—has changed how I talk about systems.
Because when you zoom in, the system disappears.
And what’s left are people.
People juggling three roles. People navigating policy changes mid-project. People doing logistics, ethics, copyediting, and diplomacy all in one day. People with graduate degrees and state salaries and fifteen sticky notes taped to their monitor.
Why I’m still doing this
I’m not writing this to suggest public health is perfect. It isn’t.
I’m writing this because I think a lot of people misunderstand what public service looks like on the ground. And because I think some of the best people I’ve met in this work will never be the ones giving TED talks about innovation.
They’re the ones printing shipping labels, calling superintendents, rewriting consent forms, and adjusting timelines without complaint.
They’re the ones who remind me that care, in any form, is slow and deeply human.
And they’re the reason I haven’t burned out yet.
So what does all this mean?
It means the next time I critique a health system, I’ll still do it—but I’ll also name the people inside trying to make it suck less.
It means when I teach students about public policy, I’ll remind them that most of the real work doesn’t happen in press releases—it happens in staff meetings with broken projectors (if you’re luck enough to have a projector) and half-drunk coffee (if you’re lucky enough to have a food budget or a boss who pays OOP).
And it means when I talk about absurd care, I’m not just talking about the failures.
I’m talking about the people who keep showing up anyway.
Thanks to them, and to you, for reading.