Three Myths Hindering Advancements in Public Health

I hope everyone enjoyed the long weekend and short break! It is hard to believe that the semester is coming to a close. Each year, I rent a house on the Outer Banks of North Carolina to spend the break with my two sons. Sometimes, it’s just us. Other times, friends come along and fill the house. This year, it was just us. On one of the days, it rained – not in the way it rains in Colorado, but a 14-hour soaking rain. The day opened space to contemplate the future of public health how we make strides toward improving the health of our society.

The COVID-19 pandemic was, and may continue as, one of the most substantial infectious disease threats in modern times that required an immediate public health response. However, the United States alongside other nations, was slow to provide widespread and convenient testing, distribute masks, and effectively communicate about safe practices and the changing scientific landscape. Nonetheless, the United States invested in new technology and developed an efficacious vaccine in record time. While its distribution, deployment, and uptake could have been improved, the scientific community achieved remarkable breakthroughs by sharing data and tissue samples at a pace not previously seen. Researchers openly collaborated at an international level. Meanwhile, the COVID-19 pandemic laid bare an inadequate public health infrastructure especially around inconsistent communication between federal, state, and local policies that prevented a cohesive response to the pandemic.

What can we learn from the public-private partnerships that brought us exciting new treatments but also highlighted some of the shortcomings of public health? How can we use these lessons to reimagine the public health infrastructure? As the new dean of the Colorado School of Public Health, I’ve reflected at length as to why and how our nation rapidly responded to developing a new treatment, but large scale, transformational public health investments such as access to health care, new models of care delivery, and data integration across systems for policy development have been slower to come. In my first State of the School address, I suggested that public health, as a field and practice, is plagued by three myths that must be overcome. These myths are: public health isn’t sexy; public health isn’t a science; and public health is invisible until it fails.

Myth #1: Public health isn’t sexy.

As a society, we are drawn to new treatments and promises for a cure. The technology is exciting; the breakthroughs are breathtaking. What government or individual donor does not want to invest in an early-stage treatment that may cure or slow the progress of a disease that affects millions of people? The motivation for financial support is higher if this disease affects them or their loved ones. This enthusiasm remains high, almost without regard to a treatment’s chances of success, costs, and possible risk. How do we make the case for public health to be as equally exciting and breathtaking? Public health breakthroughs (e.g., clean water, sanitation practices, food inspection) have changed the course of history for civilization and have prevented countless deaths. Yet, the achievements of public health are not widely promoted as life-saving interventions. Public health interventions have a high chance of success, often come at low costs relative to the development of pharmaceutical interventions, and are generally associated with few downside risks. Tobacco companies made smoking sexy, a habit that is deadly, stinky, costly, and turns its users’ teeth yellow. Surely the case for public health’s ‘sex appeal’ is easier to make than the case made for tobacco products. We must be creative in how we change the narrative for public health.

Myth #2: Public health isn’t a science.

A quick google search defines science as “the pursuit and application of knowledge and understanding of the natural and social world following a systematic methodology based on evidence.” Public health professionals produce research that is grounded in theory, data driven, and evidence-based. Our papers are subject to rigorous review and our researchers compete for incredibly scarce resources—it is public health after all. Yet, the message of “science” often gets lost in the work we do and has even come under attack in recent years. “Science” is sometimes lost when we disseminate our evidence to colleagues in basic, translational, and clinical science who may not appreciate the complexity of our work. The average person understands that microbiology is a science but is unaware that public health research and practice is also a science and is guided by economic, social, and behavioral theories, among others.

As a public health community, we must take responsibility for this perception and communicate more effectively about the thought and rigor that goes into what we do. Public health science uses data from complex tracking systems assembled for public health purposes, and often enhances those data with additional data that were assembled for other purposes but can inform our models and subsequent decisions. These data are stress tested with varying assumptions and sensitivity analyses and then frequently updated with new data. Furthermore, our scientists develop new methods to handle the ensuing complex analyses. Public health science exists at the intersections of human behavior, environmental forces, policy, society at large, and health. Therefore, our landscape is continually changing, and our scientists have to be nimble in response. A good example is how well our faculty worked together to produce evidence for Colorado’s governor to make data-driven and evidence-based decisions. We must do much more to educate everyone within and outside of our field about the science of public health and that our process is no different than basic, translational, and clinical science.

Myth #3: Public health is invisible until it fails.

Despite public health’s struggles with sex appeal and perceptions about its science, much of public health is “invisible” because it works so well. We take for granted that our food and drinking water are safe and that smoking is prohibited on airplanes. Most of us instinctively reach for the seatbelt when we settle into a car – all because of public health. However, when these measures were first introduced, they were met with resistance. We owe it to our field to point out the areas where public health continues to save lives. It is in these examples where we regain trust and convince the population, including policymakers, to adopt new measures that make our world a safer place where we can all thrive.

How is public health not sexy when it saves so many lives? How is it not science when public health is theory grounded, data driven, and evidence-based? And how is public health invisible when there are so many examples of public health in action all around us, every day? Public health is visible, but it needs to be clearly understood.

There are not enough resources in our society to treat each individual who has a health need. Because of this, societal level interventions are needed to make us safer, saner, and stronger. It is public health where such interventions are developed – and it is worthy of repeating that they are grounded in theory, data driven, and evidence-based, or simply put, science.