Public Health: Moving Forward

Colleen Moran, MPH MS
Wisconsin Population Health Service Fellow
Wisconsin Division of Public Health
Madison, WI

Public Health is cool, right? Well, I suppose it depends upon whom you ask. This became a topic of discussion the other day - how do we "rebrand" public health? How do we communicate what it is and how cool it is? Most of the time when I tell people I work in public health, they ask me something regarding primary care, something clinical. I have to gently let them know that I'm not in, "that kind of health," that, "I work in prevention - I try to change the environments we live, work, learn and play in, and incorporate health into policies, to make the healthy choice the easy choice, so that fewer people have to visit the clinic," I'm usually met with a blank stare and the inevitable followup question: "so what is it exactly that you do?"

That question, a good one I might add, is what I dedicate my blog post to today. I'd like to answer that question of "what is it that I do" and in the process, try to explain just how amazingly cool public health really is. So in recognition of National Public Health Week, this blog post is dedicated to celebrating the great successes public health has accomplished so far, while also focusing on where the future lies for the world of public health. And hopefully along the way I'll answer that nagging question.

How Far We've Come . . .

First, let's take a moment to remember how far we've come. Back in the early days of public health, contaminated water was causing disease outbreaks such as cholera (remember Dr. Jon Snow and the Broad St. pump?), overcrowding was leading to transmission of infectious diseases, workplaces were unsafe, and family planning was unheard of. Just a few generations ago mothers and father worried about their children contracting polio, measles and mumps, and many did with devastating effects
We've come a very long way. Listed below are 10 of the greatest public health achievements of the 20th century. To many, the achievements listed below are so basic that they virtually go unnoticed. However, I think it's time to pause and recognize how far we've come, thanks to public health.

Ten Great Public Health Achievements in the 20th Century
  1. Immunizations*
  2. Motor-Vehicle Safety
  3. Workplace Safety
  4. Control of Infectious Diseases
  5. Declines in Deaths from Heart Disease and Stroke
  6. Safer and Healthier Foods
  7. Healthier Mothers and Babies
  8. Family Planning*
  9. Fluoridation of Drinking Water*
  10. Tobacco as a Health Hazard

While  most of us take these advances for granted, there a few of the achievements on the list that create controversy and I would feel remiss if I did not make note of that (the * above denote these controversial public health practices). However, I do not want to spend time refuting the arguments people make against these public health achievements. Rather, I would like to use this blog post to acknowledge the fact that we've largely moved from the focus of the 20th century on infectious diseases and injury prevention to a 21st century focus on chronic diseases and the environments, systems and policies that must be changed to create a healthier world. There is so much more to be done in public health. It's time to move forward. 

So What IS Public Health . . . ?

So what do we mean when we say "environmental, systems and policy level changes"? Well, think about your daily routine: 
  • How do you get to work? 
  • How do your kids get to school and are they safe and happy there?
  • Where do you purchase your groceries? 
  • Where do your kids play outside?
If you said you drive to work, is this because there is no public transportation? The research demonstrates that if you use public transportation you get more exercise simply getting to and from the transit stop than if you drove yourself, thereby helping you reach your recommended levels of physical activity. Not to mention the environmental benefits of using public transit which lead to improved respiratory health outcomes from cleaner air. We must change your environment so that you can access public transit but this must be done at a systems and policy level. This is public health.
If you said, "I drive my kids to school because it's too far for them to walk," or, "I don't feel safe letting my kids take the bus," that is public health. If you said, "my child is bullied at school," or,"the lunch they are fed is not healthful" - that too is public health. Where we site our schools, if our kids can incorporate physical activity into their daily routine by walking to and from school, if you feel that the neighborhood is safe enough for your children to walk in - this is your environment and changes to the systems and policies that create this environment must be made. This is public health.
If you said, "I drive 30 minutes to the nearest full service grocery store to purchase my groceries," this is a public health issue. What about the folks that don't have access to a grocery store because they don't have a car, can't drive, and/or there is no public transportation? How do we feed ourselves healthy foods if we can't access them, can't afford them, or have to spend hours per week simply in transport to retrieve them? What type of zoning we create, where we site our grocery stores, and what types of foods we sell in them create our environment and at the systems and policy level, we must make changes. This is public health.
If you said, "my kids don't play outside," why is this? Is there no park in your neighborhood? Are there no sidewalks for your children to walk, bike or play on? Is there a  park but you don't feel safe sending your children there? Do the cars drive too fast to allow you to feel safe letting your kids walk anywhere? This is your environment and we can make systems and policy level changes to make it healthier. We can change the zoning regulations to allow for urban agriculture in empty lots and front yards, we can create "road diets" to slow down traffic, we can increase the pedestrian and biking infrastructure, plant shade trees, and create community centers. This is public health. 

So Where Do We Go From Here?

The new face of public health focuses on these upstream social determinants of health. Where you live, work, learn and play are the biggest factors in your health and well being. An example of such public health work in action is an op ed recently posted by my friend and fellow Fellow, Carly Hood, on How to improve the health of Wisconsin families.

County Health Rankings Model
University of Wisconsin Population Health Institute
County Health Rankings and Roadmaps 2014.
"In short, when people don't have access to education, healthy food options, safe and active living environments or transportation to and from a decent-paying job, their health suffers."

In short, EVERYTHING is public health. As public health professionals today, we work to create healthier environments in which to live, work, learn and play tomorrow.