By Christine Sow, President & CEO, Heluna Health
Same Work, Different Flavor
People have recently been asking me what it’s like to go from leading global health programs across 60 countries to leading a public health organization here in the United States. My honest answer: it’s a lot like ice cream. Different flavors, same dessert.
The work I did in Mali, West Africa, and across dozens of other countries looked different on the surface; different languages, different infrastructure, vastly different resources. But the fundamentals were the same: How do you reach people where they are? How do you earn trust in communities that have reason to be skeptical of institutions? How do you deliver services that are relevant to people’s lives?
Here in California, we’re asking these same questions. In Los Angeles County alone, 224 different languages are spoken. When I think about how we design health education, enrollment materials, or outreach campaigns, I don’t approach it any differently than I did when designing multilingual, low-literacy materials for communities in West Africa. Of course we do it in multiple languages. Of course, we meet people where they are. That’s just what good public health looks like, whether the setting is Bamako or Boyle Heights.
The global experience didn’t prepare me for something foreign. It prepared me, more than I expected, for something familiar.
When Scarcity Forces a Leap
There is something else my international work taught me that feels urgently relevant right now: what scarcity forces you to do.
When you work in resource-constrained environments for long enough, you stop thinking of limited resources as purely a problem. You start recognizing them as a pressure that, under the right conditions, produces something incremental progress rarely can: a genuine leap forward.
I watched this happen with health information systems across sub-Saharan Africa. Countries that had been working with handwritten record books made U.S.-funded investments through programs like PEPFAR, to skip the slow, decade-long migration that health systems in wealthier countries were plodding through. They went from paper to sophisticated electronic health records in years, not generations. They didn’t upgrade the old system. They built a new one.
The United States has historically had the luxury of incremental progress. Deep funding, established systems, decades of investment — all of it creates enormous value, but it also creates inertia. When the system mostly works, no one wants to rock the boat.
However, in this moment, for better or worse, the boat has been rocked. Considerably.
You Don’t Always Need the Maserati
There is a related habit I’ve observed in global health and in American institutions alike that I think of as the Maserati problem.
We assume that solving hard problems requires the most sophisticated, expensive, technologically complex solution available. In my international work, I watched teams develop simpler, more durable tools — diagnostic equipment, supply chain systems, community health protocols — that worked reliably in resource-limited settings because they were designed to be fit for purpose, not to impress. Designed with care, they didn’t break down as often and when they did break down, a local technician could fix them.
You don’t always need the Maserati. Sometimes a reliable Ford gets you there just as well, at a fraction of the cost, and it’s a lot easier to fix when something goes wrong.
As we think about redesigning public health infrastructure here, I find myself returning to this. Not everything needs to be rebuilt at full complexity. Some of our most effective interventions may be simpler, more human-centered, and more durable than what we’ve been building.
The Boat Has Tipped. Now What Do We Build?
The disruption we are living through in public health right now is painful and damaging. The funding cuts, the institutional uncertainty, the very real impact on communities and the people who serve them — none of that is abstract to me, and I won’t pretend otherwise.
But I have spent my career working in environments where stability was never guaranteed. Where the funding could shift, the government could change, the security situation could deteriorate. You learn, in those conditions, to hold two things at once: a clear-eyed acknowledgment of how hard the moment is, and an equally clear-eyed commitment to figuring out what comes next.
Change is extraordinarily difficult in systems defined by decades of entrenched process. “We’ve always done it this way” is one of the most powerful forces in any institution. In that setting, those who want to do things differently face a reasonable counter-argument: the system mostly works, so let’s not rock the boat.
However, now the boat has been tipped over. This has caused, and will continue to cause, real harm. But it also means the counter-argument is gone. We are no longer debating whether to change. We are deciding what to build next.
Why I’m Here
This is why I made the choice to bring the lessons of 25 years in global health to bear on the domestic public health infrastructure challenge, right now, at this moment. It’s why I joined Heluna Health, an organization that has spent nearly six decades doing the essential work of holding up the operational backbone of community health programs across California and beyond.
The resources, the talent, the institutional knowledge, the community health infrastructure we have built are an incredible asset for the communities in which we work and the clients that we serve. On top of this, we recognize that the current model is not the only model. We are ready to develop new models that outpace and leapfrog where we are today. We are genuinely excited about expanding our role – helping to absorb public health compliance burden, strengthen public health infrastructure, and free up community health programs to focus on the people they serve.
The global health experience I carry with me positions me to ask: what would we build if we weren’t constrained by what already exists? What can we change? What should we strengthen? Where can simplicity outperform sophistication?
National Public Health Week is a moment to honor the extraordinary people doing this work every day. I want to use it to also say: Our collective efforts have built an incredible foundation doing lifesaving work. Today’s disruption is real. So is the opportunity. I believe in what we can build next.
