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GUEST OP ED - Los Angeles is a city that prides itself on innovation. We are home to world-class universities, cutting-edge industries, and a culture that constantly reinvents itself. But beneath that forward-looking identity lies a quieter, less glamorous truth: much of the infrastructure that supports our communities is aging, and in some cases, it is failing the people who depend on it most.
That is especially true in healthcare. And in Los Angeles, it is a crisis hiding in plain sight.
When we talk about infrastructure in this city, the conversation often focuses on roads, bridges, water systems, or the Metro. Those are critical. But healthcare facilities, particularly those serving seniors, low-income residents, and other vulnerable populations, are just as essential to our city’s survival. Clinics, nonprofit providers, and community-based care centers form the backbone of access for hundreds of thousands of Angelenos. Many of those facilities were built decades ago. They are operating today under increasing strain, with deferred maintenance stacking up and capital budgets running dry.
Take a look at the Federally Qualified Health Centers serving communities from Boyle Heights up to the San Fernando Valley. These clinics are doing incredible work, but many are in buildings not designed for modern medicine, and the numbers make that clear. About 30 percent of FQHC facilities nationwide are more than 30 years old. When it comes to the actual cost to fix this, national studies estimate the overdue infrastructure backlog at around $13 billion, with newer projections suggesting health centers will need roughly $17.5 billion in upgrades over the next five years to keep pace with demand. Locally, that means typical renovation or expansion projects in LA run $10 to $15 million per clinic, and in 2024 alone, the region saw about $146 million in construction and expansion to address part of that need. That's real money, and it's still not enough.
Aging infrastructure in healthcare is not merely a facilities issue. It is a public health issue. In a region where access to care already varies dramatically by zip code, the condition of a building can be the difference between treatment and delay, between prevention and crisis.
We saw this during COVID-19. The pandemic exposed just how fragile parts of our healthcare ecosystem had become. Community-based providers, often the first and most trusted line of care in underserved neighborhoods, were stretched to the breaking point. Surge capacity was nonexistent in many facilities. The County’s Department of Health Services scrambled to adapt buildings never intended for crisis-level care. When the buildings aren’t ready, the system isn’t ready.
But as the immediate crisis faded, so too did much of the urgency. County budget cycles moved on. Private philanthropy pivoted. That is a mistake Los Angeles cannot afford to repeat.
The demographic reality demands better. Los Angeles County’s population over 65 is projected to nearly double by 2040. Chronic disease rates are rising. Behavioral health needs, already at crisis levels, continue to grow. These are not temporary trends. They require sustained, forward-thinking investment in the places where care is delivered.
So who is responsible? The answer is everyone, and right now, almost no one is stepping up adequately.
The Los Angeles County Board of Supervisors has the authority and the obligation to prioritize capital investment in community health infrastructure as part of the County’s long-term budget planning. The Mayor’s office should be championing public-private partnerships that leverage philanthropic and corporate capital to modernize nonprofit health facilities. The State of California has bond authority and Medi-Cal waiver flexibility that could fund facility upgrades, tools that are being underutilized. And the private sector, which benefits from a healthy and productive workforce, needs to do more than write occasional checks.
This is where executive leadership matters. Through my work with The Executives, a group of more than 350 business and community leaders who support Los Angeles Jewish Health, I have seen firsthand how private-sector engagement can move the needle. But I have also seen the limits of volunteerism when the structural challenges are this large. We need policy change, not just philanthropy.
Corporate and civic leaders have a role beyond charitable giving. We can bring operational expertise, strategic planning, capital formation, and long-term accountability to projects that modernize critical facilities. We can use our platforms to demand that healthcare infrastructure receives the same attention we give to stadiums and transit corridors. We can push the County and City to create dedicated funding streams, similar to Measure M for transit or Measure H for homelessness, specifically for community health facility upgrades.
The case is not complicated. Whether a senior can access preventive care close to home. Whether a working parent can receive treatment without losing a day’s wages to travel across the city. Whether vulnerable residents can rely on facilities that are safe, modern, and prepared for the next emergency, these outcomes are shaped, in part, by whether the buildings are up to the task.
Modernizing healthcare infrastructure is not charity. It is an investment in stability, productivity, and human dignity.
Los Angeles stands at a decision point. We can continue to defer hard choices about aging systems and hope the cracks don’t widen into crises. Or we can act with the same ambition we apply to every other challenge this city faces. The latter requires the Board of Supervisors to prioritize capital budgets for community health. It requires the Mayor to broker real public-private deals. It requires business leaders to advocate loudly, not just give quietly. And it requires all of us to expand our definition of infrastructure to include the places where the most vulnerable among us go to heal.
The institutions that serve our communities deserve facilities that reflect their importance. The residents of Los Angeles deserve a healthcare system that is physically equipped to meet today’s needs and tomorrow’s demands.
The future health of this city depends on it. And the people responsible for making it happen know who they are.
(Robert Glucroft is Vice President, Social, with The Executives, who enhance the dignity and quality of life of seniors at LAJHealth, and is CEO of Glucroft Investigations, Inc.)
