The Questions That Policy Never Answered: Finding Public Health Through Caregiving, Law, and Lived Experience

Public health often asks caregivers to do extraordinary work with extraordinary resilience. Yet resilience should never become an excuse for inadequate policy. If we truly value healthy aging, rural communities, and family caregivers, we must begin designing systems that care for those who spend their lives caring for everyone else.

I never intended to study the Political Determinants of Health (PDOHs).

For much of my career, I advocated for underserved communities without realizing there was a formal language for the work I was already doing. As a U.S. Navy veteran, investigative journalist, public policy professional and advocate for aging populations, I have spent years asking difficult questions about systems, accountability and equity. Journalism taught me to investigate. Public policy taught me to question institutions. Military service taught me resilience. Together, they prepared me to recognize patterns long before I understood the academic discipline devoted to studying them.

More notably, I never imagined those questions would eventually lead me home.

When my mother experienced a fall last year at her continued care facility, I expected what any daughter would: that someone would call, that a physician would evaluate her and that the systems designed to protect older adults would work as intended. Instead, I found myself searching for answers. What were the facility’s legal obligations? What rights did she retain? What responsibilities did I have as her caregiver? Why had communication failed? Where had the system broken down?

In that moment, I stopped thinking like a frightened daughter and began asking questions like a curious, determined investigator.

The answers to my questions stemmed from an issue much larger than a single incident or a single family. It forced me to reconsider what independence truly means for older adults.

Independence is far more than the absence of physical dependence. It is the ability to age with dignity, to have one’s rights protected, to receive transparent communication, to participate in decisions about one’s own care and to remain visible within systems that too often render older adults (and their caregivers) invisible. Dignity should never depend on someone’s ability to navigate bureaucracy or understand complex legal frameworks. It should already be built into the systems designed to protect them.

What began as concern for one person became a much broader examination of how law,

governance and public policy shape the lives of aging adults, caregivers and veterans in rural communities. Because caregiving does not exist apart from policy; it is shaped by decisions surrounding long-term care regulation, Medicare and Medicaid, disability policy, veterans’ benefits, transportation, housing, disaster preparedness, succession law and access to health care.

These systems determine not only how people receive care, but whether they receive it with dignity.

As I navigated my mother’s care, I also found myself navigating my own health. Managing

chronic illness while serving as a caregiver forced me to confront a reality that public health rarely acknowledges: caregivers are expected to continue “caring” even when they themselves become patients. A growing body of evidence demonstrates that caregiving is associated with poorer physical and mental health, financial hardship, employment disruption, and delayed self-care, supporting the need to recognize caregiving as a determinant of health. Yet caregiving itself is still too often treated as a personal responsibility rather than a measurable determinant of health worthy of policy attention.

Living in rural Louisiana reinforced those lessons. The first weather event of the 2026 hurricane season, Tropical Storm Arthur did more than flood homes and damage infrastructure. It exposed the fragility of the systems surrounding them. Though the storm made landfall in June, caregivers continue to struggle to replace medications, reach physicians, protect aging parents, navigate insurance claims, secure housing and recover while managing their own health.

Recovery became more than rebuilding homes; it became a lesson in how disaster policy,

housing accessibility, succession law, transportation, insurance and political representation shape health long after floodwaters recede.

Those experiences deepened my appreciation for PDOHs. Decisions made in legislative

chambers and courtrooms influence who receives resources, who has access to care and whose communities remain visible in policy discussions. Questions surrounding voting rights, congressional representation, and legal decisions such as Callais v. Louisiana remind us that governance is not independent of public health. Representation influences priorities, priorities influence policy and policy ultimately influences health outcomes.

Veterans’ policy offers another example. Landmark legislation such as the PACT Act represents meaningful progress in expanding benefits for those exposed to toxic substances during military service. But we all know that legislation alone does not guarantee equitable care. Geography, provider shortages, transportation barriers, disability status, gender-specific services, administrative complexity and workforce capacity all determine whether statutory benefits translate into meaningful improvements in health. Policy succeeds only when implementation finally ensures that the people it was designed to serve are served.

Today, as a graduate student studying health law, policy and management, I appreciate these events through a different lens. These were never isolated events. They were illustrations of the social, structural, legal and political determinants of health, all acting simultaneously. My research draws on legal epidemiology, qualitative inquiry, policy analysis and lived experience to examine a question that continues to guide my work: How do law, governance, and public policy shape the health of caregivers and aging communities before, during, and after crisis?

Caregiving deserves greater recognition within public health, not simply as an act of compassion, but as a measurable determinant. The health of caregivers directly influences the health of families, communities and the systems that support them. As our population ages, understanding that relationship becomes increasingly urgent.

Public health often celebrates resilience. I’ve grown to abhor that word, along with strong. Because resilience seems to camouflage sound policy, we should not rely on caregivers to compensate for fragmented systems, nor should healthy aging depend on geography, legal literacy or an individual’s capability to navigate bureaucracy during crises. People design systems. That means they can also be redesigned, guided by evidence, informed by lived experience and grounded in the belief that dignity, independence and equitable access to care should never depend on circumstances.

It is incumbent on those in public health to contribute to that work by advancing research on the intersection of law, governance and health equity, ensuring that caregivers are recognized not as invisible participants in our health system but as vital partners whose well-being is fundamental to the health of all of us. Because the questions that once began after my mother’s fall are now the questions that guide my scholarship. They are the questions that policy has never answered.