The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
A bipartisan group of state health policymakers from both the executive and legislative branches who are focused on improving population health.
Networks of state officials, advocates, and others aiming to invest in and transform primary care.
A program dedicated to advancing state-based efforts to make health care more affordable for residents, employers, and states.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
A leadership development program for early and mid-career state government officials who are committed to improving the health of all people in their communities.
A leadership program for senior state government officials who are committed to improving population health.
The Fund focuses on creating an affordable health care system built on strong primary care and partnerships that improve health outcomes for all.
Improving state leaders’ ability to enact and implement evidence-based health policies.
Advancing policies that create a more prevention- and primary care-oriented health system.
Improving population health through policies that contain health care cost growth.
Our state health policy resources offer relevant data analysis and best practices.
The Fund publishes reports, issues briefs, and case studies on state health policy issues.
Short takes on health policy issues from Milbank staff and guest authors.
Insights from Milbank President Debra Lubar on state health policymaking.
Reported articles and Q&As on timely health policy issues, as well as foundation updates.
Milbank Memorial Fund and Milbank Quarterly webinars featuring state health policymakers and researchers.
Updates and expert contact information for reporters.
The Milbank Memorial Fund is a private foundation that works to improve population health and health equity.
September 22, 2026
Quarterly Article
Charles P. Webel
December 2024
June 2024
The Future of Population Health
Back to The Milbank Quarterly
Policy Points:
Context: The Czech Republic’s COVID-19 excess mortality represents a preparedness paradox. Despite entering the pandemic with substantial technical capacity—including the highest intensive care unit density in the Organisation for Economic Co-operation and Development, an early national mask mandate, and an initially effective contact-tracing system—that country experienced age-standardized excess mortality of 15.24 per 10,000, approximately twice the European mean and 49% higher than neighboring Austria.
Methods: This mixed-methods comparative case analysis examined relevant data from March 2020 through December 2023. Austria was chosen as a comparative governance benchmark to the Czech Republic because it closely matched that country’s initial governmental trust level (entering the pandemic within approximately two percentage points), and Slovakia is a historically and geographically proximate comparator. Age-standardized excess mortality was examined alongside government trust measures, mobility indicators, vaccination data, and policy stringency indices. Exploratory lag correlations assessed the temporal relationship between changes in trust and subsequent mortality.
Findings: Czech governmental trust declined from approximately 71% to 19% during the pandemic period, among the largest declines in Europe. Austrian trust remained comparatively stable, whereas Slovakia also experienced a substantial decline in trust alongside high excess mortality. Czech mortality divergence from Austria emerged approximately 8–10 weeks after trust deterioration. Four mechanisms are proposed through which trust erosion may have influenced mortality: reduced compliance with public health measures, vaccine hesitancy, collapse of contact tracing, and governance-associated misperceptions of the scientific consensus.
Conclusions: This analysis suggests that governance stability and institutional trust appear to function as important public health pandemic preparedness measures.