Systemic Investing Is Coming for Public Health Financing. Are We Ready?
At a recent systemic investing summit in Rio, something unexpected emerged. It was not a breakthrough, a new model, or a major funding announcement, but rather a realization: public health and system change more broadly do not suffer from a lack of capital. They suffer from a misalignment between capital and reality. That distinction is more important than it may initially seem because, if it holds, it challenges one of the core assumptions underlying public health financing: that the solution is simply to increase funding.
The Core Problem: Capital Is Out of Sync with Systems
Traditional public health financing follows a familiar sequence: identify a need, secure funding, implement an intervention, and then measure outcomes. Systemic investing turns this logic on its head. Rather than asking how to fund solutions, it asks where solutions are already happening and why capital is not flowing to them. One insight from the summit stands out clearly: system change is already underway, particularly in communities that have long operated outside formal funding systems. For public health, this represents a significant disruption.It suggests:
- Community health innovation is not “emerging”—it’s ongoing and under-recognized
- Funding systems are often lagging indicators, not drivers of change
- Public health financing may be misallocated not due to scarcity, but misperception
Implication #1: Public Health Needs a “Recognition System,” Not Just a Funding System
If the real issue is capital readiness rather than capital availability, then public health systems need to rethink their infrastructure. This means building the capacity to identify community-led solutions earlier, to validate non-traditional forms of evidence, and to fund existing systems rather than continuously designing new ones. At present, most funding mechanisms rely on formal evaluation structures, prioritize scalability over contextual fit, and favor organizations that can effectively “speak funder language.” The result is a filtering effect in which the most embedded, relational, and often most effective solutions remain largely invisible to funders.
Implication #2: Measurement Frameworks May Be Holding Back Transformation
A recurring tension from the summit is that measurement systems can become so refined that they ultimately prevent meaningful change. This is a familiar dynamic in public health, where we measure to reduce risk, standardize indicators, and optimize for comparability. Systemic investing challenges this approach by raising a more fundamental question about who defines what counts as success, and what may be excluded as a result. Emerging alternatives point toward relational metrics such as trust and reciprocity, indicators of system vitality, and long-term intergenerational outcomes. While these are more difficult to quantify, they may be far more aligned with the kinds of impact public health ultimately seeks to achieve.
Implication #3: Public Health Financing Must Shift from “Transactions” to “Participation”
One of the most powerful reframes to emerge is that capital’s role is not to fund change but to join it. This has significant implications for how public health agencies operate. Rather than focusing primarily on funding programs, contracting services, and scaling interventions, agencies may need to move toward building long-term relationships with communities, sharing governance and decision-making, and accepting outcomes that are slower and less predictable.
This shift goes beyond financing mechanisms.
It represents a deeper redistribution of power and a redefinition of how public health engages with the communities it serves.
Implication #4: The Real Barrier Is Cultural, NOT Technical
Another key insight is that the primary constraint is not capital itself, but the worldview that shapes how we relate to it. Public health professionals will recognize familiar patterns such as a preference for control over uncertainty, a reliance on evidence before action, and institutional incentives that reward caution. Systemic investing challenges the assumption that these are neutral practices, suggesting instead that they can function as structural barriers to transformation. Addressing this requires more than new funding models. It calls for new norms around risk and trust, new forms of leadership that emphasize relationships over transactions, and broader ways of knowing that extend beyond traditional data and metrics.
Implication #5: Public Health May Need to Fund “Conditions,” Not Just Programs
One of the most actionable takeaways is the need to resource the conditions in which new systems can actually take shape. This includes allowing time for trust-building, creating spaces for meaningful collaboration, and supporting community leadership. In practice, this could mean investing in community convening infrastructure, relationship-building efforts, and long-term ecosystem development. While these activities are often categorized as overhead in traditional funding models, systemic investing reframes them as essential components of impact and therefore worthy of core investment.
What This Means for Public Health Leaders
If this shift continues, public health leaders may begin to see funding move earlier into community ecosystems, with less emphasis on rigid program design and greater reliance on flexible, trust-based funding models. There may also be a growing expectation for power-sharing with communities, particularly in decision-making and governance. The uncomfortable reality is that public health institutions themselves may need to change as much as the systems they are trying to improve, adapting their structures, incentives, and ways of working to better align with how change actually happens.
Final Thought
Systemic investing challenges how public health defines evidence, understands impact, distributes power, and approaches change. At its core, it raises a deeper question: are we willing to fund the future already taking shape, even if it exists outside the systems and frameworks we have been trained to recognize?
Learn more about how we’re pushing the science and strategy of funding forward at:
