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Four Big Challenges for Public Health… and for Us

Posted on September 26, 2016

As we begin a new academic year and welcome 153 new graduate students, 22 new undergraduate majors, and 8 new faculty to our school, it is worth taking a moment to reflect on who we are and our mission as a school of public health. Our mission and goals are articulated in our most recent strategic plan, updated in 2015 with input from faculty, staff and students. We have launched a series of activities in pursuit of the specific objectives listed in the plan, and are putting in place the systems we need to measure our progress. I encourage everyone to review the plan, and think about things we can do to make the objectives listed there a reality. This is meant to be a living document that adapts to new challenges and needs, so I welcome your ideas and suggestions.

As I reflect back on our plan and on current events, three key elements of our vision of public health strike me as especially relevant today, not only here in Philadelphia, but also globally.

  1. Health is affected by much more than health care. Certainly health care is important, and for some health conditions it is critically important.Assuring timely access to quality health care is a major responsibility of all societies. But we have known for a long time that access to quality health care likely explains only a small proportion of variations in health, and for the most common causes of disease, disability and death, health care plays only a small role. And yet the perception that health is primarily about health care is still dominant in the media, in US political discussions, and likely in the minds of a large proportion of the public. A major task of pubic health is to make the impact of these other factors visible through surveillance and research and to advocate for the broad set of policies necessary to address them through public health practice and through partnerships with many sectors and groups.

  2. All persons have the right to health. This means that inequalities in heath by social class, race, place or other indicators of disadvantage or discrimination are unacceptable and eliminating these inequalities needs to be prioritized.  This cannot be done without addressing the fundamental social drivers of ill health.  The issue of health inequities, defined as avoidable and inherently unjust systematic differences in health across population groups linked to social conditions (such as income, education, race or ethnic background, sexual orientation or other social circumstances) is as relevant today as it has ever been. This is true not only in the United States but all over the world. Our challenge is to move beyond documenting these social inequalities in health (important as that is) to implementing the strategies and policies necessary to eliminate them.

  3. Research and action are both critical to good public health, they can and should reinforce each other. It is fallacious (and naïve) to assume that research informs action (or practice) in a unidirectional manner. Practice can and should inform research. Practice can itself be a critical source of data even for causal, etiologic or “basic” research. Research can of course also be done in ways that are directly relevant to practice and policy (such as dissemination/ implementation research or policy evaluation).  This intersection between science and practice is what defines public health and makes it both a relevant and challenging field.

I’d like to add a fourth key element, stimulated in part by my recent travels to Latin America and Asia, and by thinking I have been doing on the links between urban living and health:

4. Population health and environmental sustainability are linked. Addressing one necessarily implies and is critical to addressing the other. The things that we do to improve our environment, such as reducing automobile transportation, emissions and other activities linked to global warming, will improve health. Likewise, things that we do to improve health, such as reducing consumption of meats and processed foods and promoting active transportation, will also help the environment. This link is very evident in cities, but it is also relevant in rural areas. Clearly, the ways in which we are living now – including our exorbitant consumption of energy (especially some of us… because a large proportion of the world’s population actually consumes very little energy), our continued and in many places increasing reliance on automobile transportation, and our emphasis on consumption of disposable goods – is not good for the environment. But it is also clearly not good for population health. The challenge of organizing our societies so that we promote health and protect the environment is probably the biggest challenge we face, and one of the most important things we could to improve population health.

Every autumn, we get a fresh opportunity to renew our commitment to teaching, learning and service to society. In that spirit, I encourage every member of our Dornsife School of Public Health community to think about ways in which we can promote dialogue, research, and action to address these four key challenges and make our world healthier for all.

Again, welcome to all. I look forward to an exciting and stimulating year ahead.