This volume challenges current thinking on post-pandemic public health reform, which assumes that public health systems will naturally be strengthened in light of the shortcomings exposed by the COVID-19 pandemic. Instead, this volume asks why public health is such an intractable and difficult area for effective public policy initiatives and suggests two kinds of answers. The first is 'because of the very nature of public health', which is difficult to clearly define and conceptualize. The second answer is 'because of the specific contextual features of each discrete healthcare system within which public health is situated.'This comparative analysis examines how the public health systems of eight major jurisdictions are structured, the key public health challenges exposed by the pandemic, and the kinds of political constraints or policy directions informing public health reforms. The analyses interrogate the extent to which public health reform is constrained or facilitated by the larger international context, the key policy tensions or trade-offs in pursuing public health reform, and the way in which public health reforms fit into wider social and political priorities or narratives.