Fit for the future: from siloed to integrated public health systems

Despite compelling evidence on the value of prevention, public health remains chronically underfunded and structurally deprioritised. Spending on prevention has remained stable at around 3% of total health expenditure across Organisation for Economic Co-operation and Development countries for the past two decades, and despite a temporary doubling of spending during the COVID-19 pandemic, this trend has already reversed. The central challenge for the next decade lies not in the absence of evidence, but rather the absence of political will and systems capable of translating evidence into action. Three interconnected priorities stand out: (1) embedding public health in cross-sectoral governance frameworks so that prevention is assessed on equal terms with curative care; (2) strengthening data to support public health investment and budgeting, especially in a highly volatile fiscal environment for many countries; and (3) accelerating digital transformation to increase analytical ability, targeted public health intervention, and public trust. Progress in all three areas requires strong political leadership and rethinking current systems to ensure that they are fit for the future.