In Support of Revitalizing Public Health

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As the field of public health faces a steep upward trajectory, growing pains are certainly felt as limited resources attempt to serve an expanding range of issues. Reshaping our collective approach to public health requires all of us, as a society, to drive progress on several key issues plaguing the current system.

Although healthcare advances are often ascribed to medical care developments and innovative research techniques, there is a clear disconnect in the application of new field knowledge to amplifying treatment and prevention initiatives. The gaps that occur in this paradigm originate from a weakened public health system, which is chronically underfunded yet burdened with heightened demand for new opportunities that match pace with research insights on effective treatment and prevention initiatives. Scientific literature on contemporary issues in public health, including increase in drug resistance, higher prevalence of risk factors such as diabetes and obesity, aging of the population and greater complexity of medical interventions, has consistently demonstrated a greater understanding of the complex roots of public health in social determinants [1]. This necessitates that public health initiatives grow in complexity and interdisciplinary collaboration when it is clear that even long-standing issues have yet to be effectively approached. For example, although front-line physicians have long understood how structural violence contributes to premature death and disability, a lacking public health infrastructure continues to enforce barriers against vaccines, diagnostics, and effective therapeutics [2].

Public health is a keystone in addressing large-scale issues; yet, driving truly interdisciplinary collaboration towards the unified goal of improving human health still remains out-of-reach. Recent pushes towards cross-sectoral collaboration in more comprehensive targeting of a host of health influencers – including education, safe environments, housing, transportation, economic development, food access – has been consistent with the refined public health vision pioneered through the Department of Health and Human Services’ Public Health 3.0 initiative [3]. Common challenges with pioneering collaborative projects under this vision include forming partnerships with community stakeholders, receiving timely feedback and actionable data, establishing clear metrics for community success and modifying funding models for greater financial support. 

Addressing such challenges in interagency collaboration is critical for the formation of an actionable policy network. Evidence demonstrates how interagency collaboration does not necessarily provide an effective means to health improvement over standard services if such collaboration lacks goals, methods of working, monitoring and evaluation before implementation to protect programme fidelity and increase the potential for effectiveness [4]. In particular, improving community partnership requires acknowledging how mistrust undermines health promotion; a 2015 Oxford Academic Journal study found that 47 percent of study participants with previous experiences in partnership structures believed  that “trust is assumed or presumed to be there in the partnership and that it is not actually discussed by the partners” [5]. Furthermore, simply creating transparency in methods and goals amongst initiatives is not enough to maximize efficiency. A 2018 study investigating Community Health Improvement Plan (CHIP) objectives of various public health agencies revealed that only a third of measurable objectives focused on changes in population outcomes [6]. Instead, the majority of targets were dedicated to the organizations own outputs and services without further study into the effectiveness of these programs. Instituting feedback mechanisms and adopting an outward perspective in creating CHIP objectives and similar targets are a clear area of improvement in maximizing efficiency in community public health initiatives.

Promoting the credibility and importance of public health presents additional challenge in an era rife with misinformation and skepticism. Disseminating a clear and unified message through a singular agency communication outlet must be achieved before an additional health crisis to block the spread of misinformation, improve credibility amongst the general public, and mitigating the politicization of public health. Furthermore, it has become clear that improving public health relies both on changing large-scale governmental approaches and small-scale individualistic personal attitudes. Although governments should be held accountable to upholding their key role in healthcare by protecting individuals from preventable harm caused by other individuals or groups, constituent concerns about sacrificing individual freedom and personal responsibility in the name of population health should also be addressed [7].

Recent difficulties in achieving a unified pandemic response were exacerbated by high-level government mismanagement in implementing safety measures, misinformation and institutional lack of credibility amongst the general public, and lack of agency as well as interconnectivity among public health bodies. For the first time, many have come to face the alarming possibility that public health systems will largely, and quickly, need to be bolstered as COVID-like pandemics are expected to continue to shape this era. It is time to stop neglecting the public health systems we so desperately continue to rely on. 

Edited by: Soyi Sarkar

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