I chose a career in public health because of its power to improve lives, as the field did in the United States in the late 19th and early 20th centuries by controlling infectious diseases such as cholera and tuberculosis. I was fortunate to begin my career as a program analyst at the National Institutes of Health working to streamline funding allocation decisions. Over the past few weeks, it has been painful to witness the White House issuing directives curtailing federal funding, communications disparaging public health leaders, and directives to fire staff at numerous federal public health agencies, including NIH. Like many public health professionals, I fear what will happen next.

These attacks on public health efforts — and the feelings of anger and frustration from Covid-19 policy failures — have sent me searching for how the field fell from its glory years over a century ago. Where exactly did we go wrong?

U.S. public health efforts began in a vastly different era. In 19th century New York City, for example, diarrhea was a larger health threat than cancer or heart disease. And across the U.S., it was common for families to lose multiple children before their fifth birthday. Medicine offered little reprieve. Doctors’ orders could be more harmful than beneficial, and hospitals were only for the lower classes, while the wealthy received medical care at home.

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In the period after the Civil War, many states and cities founded public health departments with an objective to prevent disease, especially because medical treatments were so ineffective. Boosted by the discovery of germ theory in the mid-1800s, these departments prevented disease through large-scale projects. They supported implementing water sanitation, trash removal services, housing regulations, and plumbing standards, along with distributing pasteurized milk to poor families and educating the public about personal hygiene.

The enormous success of this work changed patterns of disease — a process now known as the epidemiological transition. Though national metrics are unavailable, data from New York City show that the death rate fell 60 percent between 1875 and 1925. And from 1880 to 1920, life expectancy increased from 36 to 53 years. If the same proportional rise had occurred in the last 40 years, U.S. life expectancy in 2025 would be 110. The era was described as the “golden age” of public health. The improvements were due primarily to decreasing deaths from communicable diseases — at least one of which declined by 99 percent. However, as fewer people died from communicable diseases, more deaths were due to chronic diseases such as cancer and cardiovascular disease — the same health issues we see today.

Public health of the time was not equipped to address chronic disease. Early germ theory did not point to solutions, and the interventions used to........

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