Redefining public health

A recent article in the Chronicle of Higher Education by Philip Alcabes speculated that public health has become irrelevant, because it focuses almost exclusively on individuals’ health problems, has become obsessively moralistic and doesn’t address the real threats to health. The author argued that public health would be more relevant if it regained some of its focus from the early 20th century.

While the author did not get it all right, I believe he had some good arguments. We have the opportunity to redefine public health for the 21st century and to state clearly that it must address the problems of individuals, but that solutions should eradicate root causes of ill health. We are about individuals and populations, chronic and acute diseases, high technology solutions and the dissemination of simple solutions that people will adopt.

Achieving our goals often will require interventions that transcend individuals. It may mean altering health systems, changing payment structures for health care and altering what food and services are available to people. Individuals don’t exist in a social vacuum. Even those of us whose interventions have focused primarily on individuals should realize that sustained behavior change needs more than willing individuals in most cases. With the election approaching, we should not be afraid to engage in the political arena. Sustained changes require political will.

As we in the U.S. contemplate the choice of candidates for our next President, we should ask tough questions about their positions on health and health care, what they will do to encourage healthier lives and how they will work with schools of public health to achieve that. Whether we are talking about what foods should be available in school cafeterias, how to deal with droughts and how to finance health care for all, schools of public health have critical expertise to help define the issues and the arguments.