Three deans of public health recently joined Pulitzer Prize-winning writer and 2022 Yale Poynter Fellow Ed Yong for a conversation on the current state of public health practice and education.
The April 8 discussion, which was titled Does Public Health Need a Reboot?, attracted a large crowd in the Yale School of Public Health’s Winslow Auditorium, and more than 600 others tuned in virtually. Participating in the roundtable discussion were Amy Fairchild, dean of The Ohio State University College of Public Health; Sten Vermund, dean of the Yale School of Public Health; and Michelle Williams, dean of the Harvard T.H. Chan School of Public Health.
Sponsored by YSPH, the discussion centered around an article Yong wrote last year in which he claimed that the field of public health had “participated in its own marginalization.” In the piece, Yong explained how early practitioners approached public health from a broad, societal perspective that led to important reforms such as improved sanitation, better housing and safer working conditions. But that approach, Yong said, was eclipsed by the rise of germ theory and advances in biotechnology that essentially shifted the field’s focus.
“This vision [centered on germ theory and biotechnology] gave people the license to avoid sticky social problems and move away from the kinds of social reforms that were seen as inefficient or overly political,” he said.
Fairchild, a historian who works at the intersection of history, public health ethics and public health policy and politics, agreed with Yong’s analysis.
“Because of this infatuation with science … it was going to be cheaper, more effective and wasn’t going to require … difficult sweeping political change,” she said.
Much of the funding priorities today still focus on biomedical interventions rather than prevention strategies, Fairchild noted. However, she said she remains optimistic, especially seeing how society has coalesced around movements such as Black Lives Matter, which have helped push ideas such as social determinants of health back into the core conversation on public health.
“What history gives us is the opportunity to think about different possibilities at a moment where there is a lot of potential,” she said.
Vermund drew on his personal experiences, recounting how, in the 1980s, he was told by a prominent scientist that epidemiology should only be “observational.”
“I saw academia almost in the way of progress,” he said.
Vermund believes that much has changed since then, and public health scholarship is no longer viewed as being disconnected from activism. He pointed to the expansion of the Yale School of Public Health’s Office of Public Health Practice as one example of scholarship merging directly with community impact. OPHP, which promotes sustainable and equitable collaborations involving students, faculty and community members, has seen almost a tripling of its staff, Vermund said.
Despite the progress that has been made in focusing public health more on social issues, Vermund is worried that the current political atmosphere could make it more difficult to find common ground in solving society’s challenges.
“We used to have people from all walks of life and from all perspectives in favor of public health; now public health seems almost like a socialism split,” he said.
Williams said she believes that the fundamental principles that guided public health 100 years ago still echo strongly in today’s research and practice work. However, she feels that there has been a disconnect between the practice of public health and academic public health over the last few decades.
“As public health became more vibrant and stronger across our elite institutions, [those institutions] were also becoming technocratic and moving away from the real seed corn and the ‘why’ for public health by dismantling strong relations with local and state departments,” she said, echoing critiques made by renowned epidemiologists Milton Terris and Abraham Lilienfeld.
However, Williams sees the tide turning. She believes the pandemic, as well as recent social movements such as those surrounding the death of George Floyd, will spur greater engagement in social issues by those on the academic side of public health.
“There is a movement towards this activism bend that the pandemic and current events have brought forward,” she said. “What the pandemic has also done is laid bare that there is an incredible amount of unfinished business in equity and environmental health and safety.”
Williams believes that the focus for academic public health going forward should be on striking a balance between generating knowledge and translating knowledge into action, as well as ensuring that academic institutions stay connected to community practitioners of public health.
“We are at an inflection point in public health,” she said.
The April 8 discussion was supported by Yale’s Poynter Fellowship in Journalism program and the Association of Schools and Programs of Public Health (ASPPH).
A recording of the discussion can be found on YouTube.