D.C. Is Cutting Health Funding — Who Keeps Us Healthy Now?

Healthcare Reframed

Discover the framework reframing U.S. health from "sick care" to well-being.

In this feature-length conversation, host Judson Howe sits down with Becky Payne (20 years at CDC; now at The Rippel Foundation) to explore the Vital Conditions for Health & Well-Being, why Belonging & Civic Muscle sits at the center, and how Shared Stewardship helps leaders bridge divides and shift dollars from perpetual emergencies to prosperity.

Inside: what went wrong in COVID communications, what communities can do locally, and what happens when 47 federal agencies row in the same direction.

Why Watch

• Health ≠ well-being. Expand the playing field beyond hospitals to housing, education, safety, work, nature, and belonging.

• From crisis loops to prosperity loops. Stop paying only for urgent services; invest in conditions that prevent the next emergency.

• Shared Stewardship 101. Fifteen skills that help leaders bridge, learn, and create—no saviors required.

• What hospital leaders can do now. Use CHNAs, community benefit, and convening power to invest where health is produced.

• Trust after COVID. Inside the unified command: communication gaps, lessons learned, and why local institutions matter most.

• Evidence, not slogans. Modeling suggests a +20-point jump in thriving and +2.6 years when investments shift across all seven Vital Conditions.

Chapters

00:00 – Episode opening and audio issue

02:03 – Becky's upbringing and path to public health

04:32 – Structural injustice, wealth, and well-being

09:51 – Defining health vs. well-being and the seven vital conditions

13:05 – Belonging, civic muscle, and community assets

14:47 – Origin and theory behind the vital conditions and "Thriving Together"

18:47 – Shared stewardship and steward skillsets

21:54 – How stewards act and build bridges across differences

26:46 – Pandemic insights: systems fragility and adopting vital conditions

33:45 – Framework use across agencies and cautions on turfing

39:23 – Hospitals, community leadership, and applying the vital conditions locally

46:33 – Modeling the impact: national and state examples

54:42 – Pandemic experience, trust erosion, and agency challenges

63:43 – Language, equity, and engaging different communities

75:25 – Foundations, systems change, and the urgency to rebuild locally

84:21 – Practical leadership: local convening, secretary priorities, and homework

96:16 – Long-term vision, call to curiosity, and closing ask

What You'll Take Away

1. A usable map—the 7 Vital Conditions—to guide place-based investments.

2. How Belonging functions as a public-health strategy.

3. When to fund urgent services vs. when to shift toward prosperity loops.

4. Practical steps for health systems: CHNA reframe, community-benefit alignment, and cross-sector convening.

5. A leader's posture: suspend certainty, get curious, and co-create.

Who It's For

Health-system CEOs, hospital administrators, public-health officials, community-foundation leaders, city/county leaders, FQHCs, CHNA teams, payers, philanthropies, educators, students—and anyone tired of hearing U.S. healthcare is "too broken" to fix.

Press play, take notes, then share this with the colleague who needs the map.