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• v.110(3); 2019 Jun

Language: English | French

Why public health matters today and tomorrow: the role of applied public health research

Lindsay mclaren.

1 University of Calgary, Calgary, Canada

Paula Braitstein

2 University of Toronto, Toronto, Canada

David Buckeridge

3 McGill University, Montreal, Canada

Damien Contandriopoulos

4 University of Victoria, Victoria, Canada

Maria I. Creatore

5 CIHR Institute of Population & Public Health and University of Toronto, Toronto, Canada

Guy Faulkner

6 University of British Columbia, Vancouver, Canada

David Hammond

7 University of Waterloo, Waterloo, Canada

Steven J. Hoffman

8 CIHR Institute of Population & Public Health and York University, Toronto, Canada

Yan Kestens

9 Université de Montréal, Montreal, Canada

Scott Leatherdale

Jonathan mcgavock.

10 University of Manitoba and the Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada

Wendy V. Norman

11 University of British Columbia, Vancouver, Canada

Candace Nykiforuk

12 University of Alberta, Edmonton, Canada

Valéry Ridde

13 IRD (French Institute For Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), ERL INSERM SAGESUD, Université Paris Sorbonne Cités, Paris, France

14 University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada

Janet Smylie

Public health is critical to a healthy, fair, and sustainable society. Realizing this vision requires imagining a public health community that can maintain its foundational core while adapting and responding to contemporary imperatives such as entrenched inequities and ecological degradation. In this commentary, we reflect on what tomorrow’s public health might look like, from the point of view of our collective experiences as researchers in Canada who are part of an Applied Public Health Chairs program designed to support “innovative population health research that improves health equity for citizens in Canada and around the world.” We view applied public health research as sitting at the intersection of core principles for population and public health: namely sustainability, equity, and effectiveness. We further identify three attributes of a robust applied public health research community that we argue are necessary to permit contribution to those principles: researcher autonomy, sustained intersectoral research capacity, and a critical perspective on the research-practice-policy interface. Our intention is to catalyze further discussion and debate about why and how public health matters today and tomorrow, and the role of applied public health research therein.

Résumé

La santé publique est essentielle à une société saine, juste et durable. Pour donner forme à cette vision, il faut imaginer une communauté de la santé publique capable de préserver ses valeurs fondamentales tout en s’adaptant et en réagissant aux impératifs du moment, comme les inégalités persistantes et la dégradation de l’environnement. Dans notre commentaire, nous esquissons un portrait possible de la santé publique de demain en partant de notre expérience collective de chercheurs d’un programme canadien de chaires en santé publique appliquée qui visent à appuyer « la recherche innovatrice sur la santé de la population en vue d’améliorer l’équité en santé au Canada et ailleurs ». Nous considérons la recherche appliquée en santé publique comme se trouvant à la croisée des principes fondamentaux de la santé publique et des populations, à savoir : la durabilité, l’équité et l’efficacité. Nous définissons aussi les trois attributs d’une solide communauté de recherche appliquée en santé publique nécessaires selon nous au respect de ces principes : l’autonomie des chercheurs, une capacité de recherche intersectorielle soutenue et une perspective critique de l’interface entre la recherche, la pratique et les politiques. Nous voulons susciter des discussions et des débats approfondis sur l’importance de la santé publique pour aujourd’hui et pour demain et sur le rôle de la recherche appliquée en santé publique.

Introduction

Public health is critical to a healthy, fair, and sustainable society. Public health’s role in this vision stems from its foundational values of social justice and collectivity (Rutty and Sullivan 2010 ) and—we argue—from its position at the interface of research, practice, and policy.

Realizing this vision requires imagining a public health community that can maintain that foundational core, embrace opportunities of our changing world, and predict and adapt to emerging challenges in a timely manner. Unprecedented ecosystem disruption creates far-reaching health implications for which the public health community is unprepared (CPHA 2015 ; Whitmee et al. 2015 ). Human displacement is at its highest levels on record; those forced from home include “stateless people,” who are denied access to basic rights such as education, health care, employment, and freedom of movement ( http://www.unhcr.org/figures-at-a-glance.html ). Significant growth in urban populations creates an urgent need to improve urban environments, including policies to reduce air pollution and prevent sprawl (CPHA 2015 ; Frumkin et al. 2004 ), to reduce the substantial burden of morbidity and mortality attributable to behaviours such as physical inactivity, which negatively impact quality and quantity of life (Manuel et al. 2016 ). Significant and entrenched forms of economic, social, political, and historical marginalization and exclusion (TRC 2015 ), coupled with inequitable and unsustainable patterns of resource consumption and technological development (CPHA 2015 ; Whitmee et al. 2015 ), cause and perpetuate health inequities. These inequities underlie the now longstanding recognition that the unequal distributions of health-damaging experiences are the main determinants of health (CSDH 2008 ; Ridde 2004 ).

These imperatives demand a broadly characterized public health community. A now classic definition of public health is the science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society (Last 2001 ). Public health, conceptualized in this manner, engages multiple sectors, embraces inclusion and empowerment (Ridde 2007 ), and demands navigating diverse political and economic agendas. Across Canada, a large and growing proportion of provincial spending is devoted to health care, while the proportion devoted to social spending (i.e., the social determinants of health) is small, flat-lining, and in some places declining (Dutton et al. 2018 ). Recent discourse has highlighted a weakening of formal public health infrastructure (Guyon et al. 2017 ) and points of fracture within the field (Lucyk and McLaren 2017 ). Efforts to strengthen public health, in its broadest sense, and to work towards unity of purpose (Talbot 2018 ) are needed now more than ever. What might such efforts look like?

We reflect on this question from our perspectives as researchers who are part of an Applied Public Health Chairs (APHC) program designed to support “innovative population health research that improves health equity for citizens in Canada and around the world.” 1 The applied dimension 2 is facilitated through the program’s focus on “interdisciplinary collaborations and mentorship of researchers and decision makers in health and other sectors” ( http://www.cihr-irsc.gc.ca/e/48898.html ). The APHC program (Box 1) is part of a broader set of efforts to address gaps in public health capacity, including research. Cross-cutting themes for the 2014 cohort (Box 2) include the following: healthy public policy, supportive environments (e.g., cities), diverse methodological approaches, global health, and health equity; many of which 3 align with a Public Health Services and Systems Research perspective in that they “identif[y] the implementation strategies that work, building evidence to support decision-making across the public health sphere” ( http://www.publichealthsystems.org/ ). Applied public health research is broad and could span CIHR Pillars 4 (social, cultural, environmental, and population health research) and 3 (health services research); the 2014 APHC cohort is predominantly aligned with Pillar 4.

The APHC program represents a significant Canadian investment in public health, and thus provides an important vantage point from which to reflect on why public health matters today, and tomorrow.

Box 1 The Applied Public Health Chairs program

Box 2 2014 cohort of Applied Public Health Chairs

More details available at: http://www.cihr-irsc.gc.ca/e/48898.html

Our proposal

We propose that applied public health research is a critical component of a robust population and public health community. As illustrated in Fig.  1 , we view applied public health research as sitting at the nexus of three core principles: (1) sustainability, (2) equity, and (3) effectiveness, which align with a vision of public health as critical to a healthy, fair, and sustainable society. By sustainability , we mean an approach or way of thinking, about public health in particular (e.g., Schell et al. 2013 ) and population well-being more broadly ( https://sustainabledevelopment.un.org/sdgs ) that emphasizes “meet[ing] the needs of the present generation without compromising the ability of future generations to meet their own needs” (Brundtland et al. 1987 ). Sustainability has social, economic, environmental, and political dimensions. We define equity as a worldview concerned with the embedded or systemic—and often invisible—drivers of unfair distributions of health-damaging experiences. In Canada and elsewhere, inequity is entrenched in legacies of colonial, structural racism designed to sustain inequitable patterns of power and wealth. Equity transcends diverse axes and perspectives, and an equity lens is action-oriented (Ridde 2007 ). Finally, effectiveness refers to impact or benefits for population well-being, as demonstrated by rigorous research. Explicit core values (e.g., equity), while important, are insufficient without translation to demonstrable outcomes (Potvin and Jones 2011 ). These core principles—sustainability, equity, and effectiveness—overlap and are mutually reinforcing; for example, the inequitable concentration of power, wealth, and exploitation of resources precludes sustainability.

Visual depiction of the role and attributes of applied public health research, vis-à-vis core population and public health principles of equity, sustainability, and effectiveness

Although these principles are applicable to the public health community broadly (i.e., including but not limited to researchers), applied public health researchers are uniquely situated to embrace sustainability, equity, and effectiveness when asking questions and generating policy- and practice-relevant knowledge, as illustrated below. Drawing on our collective experiences, we describe three necessary attributes of applied public health research that support our model in Fig.  1 : researcher autonomy, sustained intersectoral research capacity; and a critical perspective on the research-practice-policy interface. We assert that applied public health research is best positioned to contribute meaningfully to the principles of sustainability, effectiveness, and equity if the attributes described below are in place.

Researcher autonomy

Researcher autonomy is a precondition for innovation and independent thinking, and for building and sustaining the conditions for collective efforts. Our working definition of researcher autonomy is the capacity to devote time and energy to activities that, at the researcher’s discretion, facilitate research that embraces principles of sustainability, effectiveness, and equity. Autonomy, beyond the scope of general academic independence, provides the freedom to build and nurture partnerships, and to navigate among universities, health care systems, governments, communities, and across sectors. Effective and respectful partnerships are critical to rigorous intersectoral work and can provide an important platform to discuss systemic forms of inequity (e.g., Olivier et al. 2016 ; Morton Ninomiya et al. 2017 ). Recognizing a potential tension around the role of the researcher in an applied public health context, we deliberately selected the word “autonomy,” which we view as conducive to meaningful collaboration (although that may be experienced differently by different researchers), rather than “independence” which can be seen as contrary to such collaboration. Yet despite their importance, the time and resources to form and sustain those relationships are often not accommodated within funding and academic structures.

Autonomy, when coupled with resources and recognition, permits applied public health researchers to balance foundations of public health with current policy relevance. Although many of us have research programs with particular thematic foci (e.g., physical activity, dental health, HIV), autonomy provides space and credibility to connect those focal issues to enduring and evolving problems in public health (e.g., determinants of population well-being and equity), and to inform the contemporary policy context. Examples include research on health implications of neighbourhood gentrification in urban settings (Steinmetz-Wood et al. 2017 ); using community water fluoridation as a window into public and political understanding and acceptance of public health interventions that are universal in nature (McLaren and Petit 2018 ); and using innovative sampling methods to identify how census methods can perpetuate exclusion (Rotondi et al. 2017 ). That latter work, which estimated that the national census undercounts urban Indigenous populations in Toronto by a factor of approximately 2–4, provides impetus to work towards an inclusive system that respects individual and collective data sovereignty, and that is accountable to the communities from whom data are collected.

These implications of autonomy are consistent with calls for greater reflexivity in public health research (Tremblay and Parent 2014 ).

Insight : To strengthen applied public health research in Canada, researcher autonomy – whereby researchers have the credibility and protected time to set their own agendas in partnerships with the communities they serve – must be privileged.

Sustained intersectoral research capacity

Applied public health research requires funding for resources and infrastructure that are essential to sustain an intersectoral research program, but for which operating funds are otherwise not readily available. Examples include ongoing cohort studies (e.g., Leatherdale et al. 2014 ), research software platforms (e.g., Shaban-Nejad et al. 2017 ), meaningful public sector engagement in developing public health priorities, and knowledge translation activities.

Partnerships, also considered under researcher autonomy above, are one form of intersectoral research capacity. In applied public health research, having strong partnerships in place permits timely response to research opportunities that arise quickly in real-world settings. Examples in our cohort include instances where researchers were able to mobilize for rapid response funding competitions in areas of environment and health, communicable disease in the global South, and Indigenous training networks, because collaborative teams and potential for knowledge co-creation and transfer were already in place.

Insight : A robust applied public health research community requires sustained funding to support foundations of a credible and internationally-competitive research program (e.g., cohort studies, research software platforms, meaningful public sector engagement) that are difficult to resource via usual operating grant channels.

A critical perspective on the research-practice-policy interface

One barrier to evidence-based policy in applied public health is an assumption that evidence is the most important factor in making policy decisions, versus a more holistic view of the policymaking process where evidence is one of many factors, as discussed in recent work (Fafard and Hoffman 2018 ; O’Neill et al. 2019 ; Ridde and Yaméogo 2018 ).

Applied public health research is ideally positioned to embrace a critical perspective on the research-practice-policy interface. Several recent trends are promising in that regard. These include the following: substantive efforts to bridge public health and social science scholarship ( http://www.cihr-irsc.gc.ca/e/50604.html ), growing success by Pillar 4 researchers (including applied public health) in CIHR’s open funding competitions ( http://www.cihr-irsc.gc.ca/e/50488.html ), and the CIHR Health System Impact Fellowship initiative ( http://www.cihr-irsc.gc.ca/e/50612.html ), which could facilitate the placement of doctoral and post-doctoral academic researchers within the public health system and related (e.g., public, NGO) organizations.

Insight : Applied public health researchers are ideally positioned to embrace and model a sophisticated and interdisciplinary perspective on the research-practice-policy interface. To do so, opportunities for researchers (including trainees) to gain skills and experience to navigate the policy context are needed.

Against the backdrop of discourse about a weakening of public health infrastructure and fracture within the field (Guyon et al. 2017 ; Lucyk and McLaren 2017 ), we believe that there is value in working towards a unity of purpose (Talbot 2018 ). This commentary was prompted by a shared belief that through our experience with the Applied Public Health Chair Program, we have seen a glimpse of what is needed to achieve a population and public health community that is positioned to tackle societal imperatives, which includes an important role for applied public health research, spanning CIHR Pillars 3 and 4. Anchored in principles of sustainability, equity, and effectiveness, we assert a strong need for applied research infrastructure that privileges and supports: researcher autonomy, sustained funding to support foundations of a credible and internationally competitive research program, and opportunities for researchers (including trainees) to gain skills and experience to navigate the policy context. We welcome and invite further discussion and debate.

1 Under CIHR-IPPH’s mandate, population health research refers to “research into the complex biological, social, cultural, and environmental interactions that determine the health of individuals, communities, and global populations.”

2 Applied may be defined as follows: “put to practical use,” as opposed to being theoretical ( https://www.merriam-webster.com/dictionary/applied ).

3 For example: https://uwaterloo.ca/compass-system/ (Leatherdale); http://cart-grac.ubc.ca/ (Norman); http://www.healthsystemsglobal.org/ (Ridde).

The original version of this article was revised due to a retrospective Open Access order.

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Change history

The article ���Why public health matters today and tomorrow: the role of applied public health research,��� written by Lindsay McLaren et al., was originally published Online First without Open Access.

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• Tim Lang , professor of food policy 1 ,
• Geof Rayner , honorary research fellow 1
• 1 Centre for Food Policy, City University London, Northampton Square, London EC1V 0HB, UK
• Correspondence to Tim Lang t.lang{at}city.ac.uk

Public health thinking requires an overhaul. Tim Lang and Geof Rayner outline five models and traditions, and argue that ecological public health—which integrates the material, biological, social, and cultural aspects of public health—is the way forward for the 21st century

It seems to be the fate of public health as concept, movement, and reality to veer between political sensitivity and the obscure margins. Only occasionally does it gain what policy analysts often refer to as traction. Partly this is because public health tends to be about the big picture of society, and thus threatens vested interests. Also, public health proponents have allowed themselves to be corralled into the narrow policy language of individualism and choice. These notions have extensively framed public discussion about health, as though they are not tempered by other values in the real world. As a result, the public health field suffers from poor articulation, image, and understanding. The connection between evidence, policy, and practice is often hesitant, not helped by the fact that public health can often be a matter of political action—a willingness to risk societal change to create a better fit between human bodies and the conditions in which they live.

We have reviewed how public health theory and practice have evolved over the last two or three centuries, and looked at the challenges present and ahead, and we conclude a rethink is in order. In difficult economic times, public health too easily falls down the political agenda. It is judged worthy but not a political priority. Yet there is strong evidence that health is societally determined, 1 that public health is high in the public’s notion of what a good society is, 2 and that health underpins economics. 3 4

What we’ve forgotten with public health

Today, as financial crises continue—banking failures, debt bubbles, slowing economic growth, nervous but contradictory consumerism—there is an opportunity to review what is meant by public health for the 21st century. The connection between health and societal progress has been severely weakened in public policy of late. It is adrift when it ought to help shape a new direction. Public health ought to be articulating what a good society and a good economy are. Improving public health is at the heart of defining what is meant by progress. Indeed, part of the current crisis is that 20th century notions of progress underplayed how economic development distorted the relationship of humans to the planet, despite it being known that human health ultimately depends on the health of ecosystems. With water, biodiversity, soil structures, energy, and biological resilience all becoming problematic in the era of climate change, this connection is once more central. Somehow, modern public health had almost forgotten the primacy of the human-environmental interface, despite this being a component part of the original sanitarian vision. Edwin Chadwick (1800-1880) and others fully recognised, for example, how the health of towns (now a majority human experience in the 21st century) depended on the sustainability of agriculture. The interface of human and ecosystems health now deserves to be central for policy making).

The public health project, born in the 18th century, established politically in the 19th century, and refined for a richer world in the 20th century, has too often been reduced to old notions of sanitation or newer notions of medical treatment or health education. It deserves better. It is still worth quoting in full Charles-Edward Winslow, who in 1920 defined public health thus:

Public health is the Science and Art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort for sanitation of the environment, the control of communicable disease, the education of the individual in personal hygiene, the organization of medical and nursing services for early diagnosis and preventive treatment of disease, and the development of the social machinery to insure everyone a standard of living adequate for maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity. 5

This definition conceives of public health as a list of intervention strategies requiring knowledge, imagination, and policy advocacy. Winslow’s focus was on sanitation, medical infrastructure, and education in personal hygiene, but what can this definition say about escalating climate change, a world population of 9 billion, or mass consumerism shaped by globalised media, or the global co-incidence of mass hunger and mass obesity and non-communicable diseases?

Refocusing on the transitions that shape modern life

Only in the early 20th century did the term public health begin to describe a field; before that it meant essentially what it said on the label: the health of the public. In our view, public health is essentially about shaping the conditions that enable good health to flourish. In policy terms, the rationale is that conditions enable outcomes. Today, this means public health must address and dare to reshape the big trends or transitions that already frame the 21st century. We see a number of major transitions as the forces on which public health must act: demographic, epidemiological, urban, energy, economic, nutrition, bio-ecological, cultural, and democratic. Only by addressing them all will public health regain its central societal relevance. 6

Some of these transitions are well documented and accepted within the public health field, notably the demographic and epidemiological transitions. Some are beginning to be acknowledged (if not surmounted), such as urbanisation, or the transformation of food supplies creating a nutrition transition, so important in creating non-communicable disease. Other transitions, such as that of energy, barely register as being within the purview of public health, despite, for example, public health activists in the past seeing the move to coal and oil for domestic and industrial power as both progress and pollution. Today, the energy transition rightly attracts attention in relation to climate change, yet pollution is less acknowledged. Similarly, the mass psychological impact of modern advertising, media, and virtual manipulators on the cultural conditions in which people live requires urgent action in the name of health. Current policy response is too narrowly corralled within the language of corporate social responsibility, partnerships, and so called shared value. The long pursuit of democracy is another problematic transition, critical for public health. What other notion than democracy—a sense of and actual engagement in shaping society and life—is appropriate for a world in which so many people are excluded from control or who experience a sense of alienation in their lives? How else can we reframe thinking about mental health, social exclusion, and inequalities in health? The pursuit of health and progress have become tangled up with consumerism as though there are no environmental consequences for health.

Too often the health of the public is confused with healthcare. While improvements in medical knowledge are wonderful, realism is required about healthcare’s scope. By 2018 the US is set to spend $344 billion (£219 billion; €280 billion) a year treating obesity—more than one health dollar out of every five. 7 One calculation even estimated the outcome that all American adults would be overweight or obese by 2048. 8 Such an economy and society must literally collapse under its own self-inflicted weight. Obesity may well be the sanitation problem of the 21st century. In a world where hypermarkets offer excess calories priced without thought to health, and where antibiotic resistance undermines genuine pharmaceutical advances, 21st century public health needs a better model of how human health depends on the complex processes of biological adaptation and rapid socioeconomic change. The mismatch of humans and conditions (that is, how we live) looms as the big public health challenge. In our view, this requires complex ecological thinking and it is why we propose ecological public health as the most appropriate 21st century model. But why act at all? Can this not all be left to market dynamics?

Look back to look forward

Crusty Victorians like Edwin Chadwick weighed health in terms of cost versus benefit. He drew deeply upon the utilitarian philosophy of his mentor, Jeremy Bentham, for whom the purpose of public policy was to secure the “greatest happiness for the greatest number.” For Chadwick, happiness (or democracy for that matter) was probably too bold an aspiration: public health meant less death and disease for male heads of household, with long term financial benefits flowing to the state. His American follower, Lemuel Shattuck, however, promoted a new aspirational goal for public health in 1850, that of “perfect health”—an extraordinary vision for that time. 9

Nevertheless Chadwick’s thought encapsulated a broader notion: that good health flows from the population level to the individual rather than the other way round. By the end of the Victorian era, this implied that no-one, however rich, however well endowed with so called good genes (then expressed through eugenics), living in any circumstances, could wholly prevent the impact of the collective experience or poor conditions threatening their individual health. Among the multiple routes to health improvement that Chadwick promoted, one critical path lay with new professions. From this stemmed the penchant for viewing public health as a field, a task, a set of interventions or a set of laws or technologies, led by professional expertise. In constructing a technical route for public health, Chadwick sowed the seeds of the problem now binding much public health—that it is couched in managerialist terms, the language of “delivery” and “evidence based policy.” Now this managerialist language and focus are being reduced still further to the micro, the so called nudge, and minute behaviour change. 10 This diminution of perspective discourages attention on the macro, the large scale, the big picture, the shaping forces, and whatever frames the context for how people live. The capacity to think and plan on a large scale is ceded to corporations, world elites, and the dehumanised forces of the market, citing the inevitability of globalisation, as though that process was itself not initiated by vested interests who too often marginalised health impacts.

Is this what public health is becoming: a technocratic localised act; benign social engineering on the personalised scale? If so, the consequence may be irrelevancy. Political pragmatism, opportunism, and so called realism about what is feasible within the balance of forces are features of public health history. The smoking ban on London’s underground only happened in the policy space that emerged following the dreadful 31 deaths in the 1987 King’s Cross station fire. Winslow once observed that if the Boston school’s free medical programme, introduced in 1894, had been proposed in terms other than the medical policing of infectious disease, it would probably have been denounced as “socialism of the most dangerous kind.” 5 Public health advocacy, then as now, requires a political savvy not reflected in the mantras of evidence based policy. But if public health is understood more in terms of managerial actions than of visions and movements, the risk is that the possibility of the field being about altering circumstances to enable health fades.

Five models of public health

Too often policy makers think of public health as though it is one entity, or perhaps with two broad interpretations—biomedical and social. The World Health Organization (WHO)’s Commission on Social Determinants on Health, for example, mapped public health from a societal basis. 11 We chart not two but five main models for public health, each with different core ideas, conceptions, and traditions (table ⇓ ). Understanding each model clarifies both the tensions and possibilities in modernising public health.

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Like others, we identify a sanitary-environmental model. This model has historically focused on the health of populations in their physical circumstances. Like its early classical formulation pioneered by the Romans, the task of the sanitary-environmental model in the 19th century was to tackle the dirt and detritus of industrialisation, which were viewed as the determinants of epidemics. New professions were spawned, including public health inspectors, engineers, town planners, building regulators, and even street designers. In the richer parts of the world today, these measures are taken for granted, invisible because they are so normal. In the developing world, this is not the case.

The second model is biomedical, coming in two forms: individual and population focused. The latter is typified by vaccination from the early 1800s or in the creation of public health laboratories. The personalised version is also old but it has recently received unprecedented attention and investment. In the 1950s, the US spent only 4.4% of gross domestic product on healthcare, yet by 2009 this had become 17.4%, and by 2040 is expected to rise to nearly 30%. 12 At any amount of spending, however, medical technology cannot alter the conditions that shape the rising rates of many non-communicable diseases such as obesity.

This is the rationale for the third, social-behavioural, model, which may seem new but is not. Rulers have attempted to influence the behaviour of their people for health reasons for centuries. In modern terms, social-behavioural thinking invokes the evidence since the 1950s on how changes in behavioural rules and social norms affect health literacy and everyday habits. This model is now the main rival to the biomedical model proffered to tackle non-communicable diseases. The social-behavioural model, however, says little about who makes or influences these social-behavioural rules. Why not? In a study we conducted for WHO, we showed that Coca-Cola spent more on its marketing of soft drinks than the entire biannual WHO budget. 13 Such unequal distribution of power frames behaviour and choice, and helps set the conditions for public policy on health. Yet today adherents of this model continue to advocate that public health should emulate commercial methods, such as social marketing, or the latest fad, the so called nudge, on tiny budgets.

The fourth model we term techno-economic. This sees public health as dependent on two processes: economic growth and knowledge growth. Economic growth raises living standards which in turn improve health. Economics Nobel prize winner Robert Fogel termed this trend “technophysio evolution.” 14 There is in fact no automatic link between economic and knowledge growth and improved public health. Up to a point perhaps, but, critically, public health depends on other factors, such as how such knowledge and wealth is distributed, as well as effective institutions, the rule of law, and reasonable levels of democracy.

Each of these four models has merit but, tellingly, they mostly engage with health in anthropogenic terms. By this we mean that the health of the living, natural, and physical world—ecosystems health—is marginalised. This is one among many reasons we now champion a fifth model: ecological public health. Centrally, ecological public health focuses on interactions, with one strand focusing on the biological world—in concerns about increasing strains on biodiversity or antimicrobial resistance, for example. Another strand centres on material issues such as links between industrial pollution, energy use and toxicity, and the impact on human species and nature. The advantage of ecological thinking is that it theorises complexity, a key feature facing modern conceptions of health.

Ecological public health and embracing complexity

For some, ecological thinking means the socio-ecological model (actually Bronfenbrenner’s child development model extended into public health), but this has downplayed ecology’s biological linkages; indeed, the term ecology was coined by Ernst Haeckel, disciple of Darwin. For us, the power of ecological thinking is its acceptance of complex and multilayered connections. The philosopher John Dewey (1859-1952) cautioned against its compartmentalisation into biological, material, and social channels. In perhaps the first integrated presentation of ecological public health, John Hanlon, assistant US surgeon-general in the 1960s, said that public health needed to address the entire biological, material, social, and cultural dimensions of the human, living, and physical world. This tradition is again prominently espoused today by the US Institute of Medicine. 15

A strength of the ecological public health model is that it draws upon and integrates parts of the other models). Secondly, it articulates modern thinking about complexity and system dynamics, addressing, for example, questions of non-linearity, variations in scale, feedback, and other emergent qualities of nature, biology, and human behaviour. In the UK, we see some of such thinking in the government chief scientist’s Foresight programme. 16 Thirdly, ecological public health seeks to build knowledge as a continual intellectual engagement. This means more than just evidence, and includes the open pursuit of social values, highlighting the role of interest groups, and debate across society not just within restricted scientific circles. Think Darwin and Wallace, Beveridge or Roosevelt: big thinking about the nature of life, good societies, order and change. Fourthly, it incorporates an evolutionary perspective, from matters like nutritional mismatch to questions of biological feedback. Fifthly, this is an overtly interdisciplinary and multi-actor model. It celebrates that public health requires action on multiple fronts and embraces the argument familiar in the 19th century that public health action requires a public health movement.

We argue that 21st century ecological public health must address the inherent complexity of shaping factors across what we call the four dimensions of existence. These are: (a) the material dimension—that is, the physical and energetic infrastructure of existence (matter, energy, water), and the physical building blocks on which life depends; (b) the biological dimension—that is, the biophysiological processes and elements, including all animal and plant species and also micro-organisms; (c) the cultural dimension—that is, how people think and through which mental categories they think, and the spheres of interpersonal relationships, community, and group and family traditions; and (d) the social dimension—that is, institutions created between people and expressed in terms of laws, social arrangements, conventions, and the framework of daily living generally outside individual control.

Public health in the 21st century requires policies and actions to engage in all four dimensions of existence to be most effective. Behaviour change programmes designed to improve nutritional status, whether for individuals, communities, or populations, are unlikely to work if they are limited to what people know or think they know. The material and social context—where and how people live—also needs simultaneous change. Telling families who live in poverty that they should make healthy choices ignores the conditions that prevent them doing so and is insulting and even futile. We now all live in total commercial environments in which many drivers are dominated by sponsors. The modern Olympic games symbolise this world of contrast between the overweight mass and a superfit elite, with an alliance of state and commerce as mediator. Instead of Olympian spectacle, what is needed is a world in which fitness and sustainable diets are built into daily lives, requiring different investment.

The difference the ecological public health model makes

In Victorian times, the central state required action to be taken by local bodies; it created or empowered them accordingly. Today, public health requires multilevel action, coordinated across not just the state but private spheres, commerce, and civil society. The current localist focus in the UK superficially recalls past Victorian methods, but is inappropriate if economic and policy determinants are shaped at international and global levels. How can local action fully shape behaviour affected by decisions made in boardrooms on the other side of the planet? Although reorganisation of public health in the UK has put specialists back into the local authority, this is at a time when local government is squeezed more than ever. Money may be ring fenced for the moment, but political commitments are not. Specialists need to be noisy and to build alliances. The case for integrated public health activity across local government needs to be fleshed out. The risk is that specialists become statistical aides to town halls. They need to be change agents, building and supporting movements with agencies above and beyond the local. Specialists need to engage at the material, biological, social, and cultural levels like never before.

Public health success is as much about imagination as evidence: challenging what is accepted as the so called normal, or business as usual. Public health must regain the capacity and will to address complexity and dare to confront power. This demands a new mix of interventions and actions to alter and ameliorate the determinants of health; the better framing of public and private choices to achieve sustainable planetary, economic, societal, and human health; and the active participation of movements to that end. Public health professions today need to think and act ecologically if they are to help reshape the conditions that enable good health to flourish.

Cite this as: BMJ 2012;345:e5466

• Analysis, doi:10.1136/bmj.e5124

Competing interests: the authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Provenance and peer review: Commissioned; externally peer reviewed.

• ↵ World Health Organization, Commission on Social Determinants of Health. Closing the Gap in a Generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. 2008. www.who.int/social_determinants/final_report/en/index.html .
• ↵ International Research Institutes (IRIS). Health Perceptions around the globe: a 23-country study. International Research Institutes, 2004.
• ↵ Jackson T. Prosperity without growth: economics for a finite planet. Routledge, 2009.
• ↵ Commission on macroeconomics and health. Macroeconomics and health: investing in health for economic development. Harvard University/Center for International Development/World Health Organization, 2002.
• ↵ Winslow CE. The untilled fields of public health. Science 1920 ; 51 : 23 -33. OpenUrl FREE Full Text
• ↵ Rayner G, Lang T. Ecological public health: reshaping the conditions for good health. Earthscan/Routledge, 2012.
• ↵ Thorpe KE, United Health Foundation, American Public Health Association, Partnership for Prevention. The future costs of obesity: national and state estimates of the impact of obesity on direct health care expenses. 2009.
• ↵ Wang Y, Beydoun MA, Liang L, Caballero B, Kumanyika SK. Will all Americans become overweight or obese? estimating the progression and cost of the US obesity epidemic. Obesity 2008 ; 16 : 2323 -30. OpenUrl CrossRef PubMed Web of Science
• ↵ Shattuck L, Banks NP Jr, Abbot J. Report of a general plan for the promotion of public and personal health. Dutton and Wentworth, 1850.
• ↵ House of Lords Science and Technology Select Committee. Behaviour change. 2nd report of session 2010-12. The Stationery Office, 2011.
• ↵ World Health Organization, Commission on the Social Determinants of Health. Achieving health equity: from root causes to fair outcomes. Interim statement from the commission. 2007. www.who.int/social_determinants/resources/interim_statement/en/index.html .
• ↵ Fogel RW. Forecasting the cost of US health care in 2040. NBER working paper no. 14361. National Bureau of Economic Research, 2008.
• ↵ Lang T, Rayner G, Kaelin E. The food industry, diet, physical activity and health: a review of reported commitments and practice of 25 of the world’s largest food companies. Report to the World Health Organization. City University Centre for Food Policy, 2006.
• ↵ Fogel RW. The escape from hunger and premature death, 1700-2100: Europe, America and the third world. Cambridge University Press, 2004.
• ↵ Institute of Medicine of the National Academies. The future of the public’s health in the 21st century. National Academies Press, 2002.
• ↵ Foresight. The Foresight programme of the chief scientific adviser. 2012. www.bis.gov.uk/foresight .

Writing Guide

Writing serves as a useful skill for anyone in the field of public health — students and professionals alike. Public health students must enroll in writing-intensive courses that require essays and research papers. Once students graduate, they put their skills to use writing reports on community health. They may compose presentations, research studies, or press releases, depending on their jobs. Those who stay in academia continue to write research papers throughout their careers.

Students should begin cultivating a clear and concise writing style long before they graduate.

They should also learn how to use standardized citations. Understanding how to properly cite sources will help students as they conduct research and publish their findings. Citations also help students and researchers avoid plagiarism.

This guide explains how to write a public health report, a research paper, and an exam essay. The page also advises students on how to conduct research online and find trustworthy sources. Students can review citation style guides and public health writing samples.

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Types of writing public health students will do in school, personal statements.

When applying to a public health program, schools often require students to submit personal statements. Schools may either ask students to write a general personal essay answer a certain prompt. Usually, prompts center around applicants’ interest in public health or about the public health field in general. Students might come across a prompt similar to this one: “Identify a public health issue in the U.S., and how you would work to rectify it as a public health professional.” Alternately, students may encounter this common topic: “What drove you to pursue a career in public health?”

Schools look for essays that are honest, well-written, and well-organized. Students should get the reader’s attention with an anecdote illustrating their commitment to public health. Was it an experience with adversity or discrimination that prompted you to pursue this career? Did you learn about the importance of public health while volunteering or traveling? Include those details in the story.

Students should also demonstrate their current knowledge of public health. They may write about their career goals as well. However, students should avoid writing exaggerations, falsehoods, or superlatives. People who read admissions essays can typically sense when applicants are stretching the truth. If the school makes the personal statement optional, students should still consider writing one. A personal statement demonstrates commitment and hard work, and may help make up for flawed or weak admissions materials.

In some public health courses, professors require students to answer essay questions during exams. This can be intimidating since students do not usually know the prompt until they actually start the exam. Students have a limited amount of time to write the essay, typically one or two hours. Students should allot their time accordingly. Some students do not plan their work before they begin writing; this can lead to sloppy essays with weak supporting points, disorganized information, and tangents unrelated to the prompt.

For a 60-minute time frame, students may give themselves 10 minutes to brainstorm, plan, and outline.

During the brainstorming process, students should write their thesis statement.

Then they should jot down three points that support the thesis. These ideas will serve as the three body paragraphs. Students may give themselves five minutes to write the introduction, 30 minutes to write the body, and then five minutes to write the conclusion. They then have 10 minutes to proofread. Students often inadvertently miss this step, but proofreading may make or break the essay.

Students should begin planning long before the day of the essay. Students ought to review the material well enough to be prepared for any prompt. They should carefully look over their lecture notes to determine which points the professor emphasized during classes. These points will likely prove significant when it comes time for the exam. Students should also make sure that they actually answer the prompt instead of rushing and jumping to assumptions.

Research Papers

In a research paper, students examine the existing research, theories, case studies, and ideas about a particular topic. Students have several weeks to write research papers, which may seem like a huge amount of time. However, research papers demand a lot of work, so students should start early. Professors rarely assign strict, narrow prompts for research papers. Instead, they usually give students a topic or range of topics, and students choose their focus. Public health topics may include how poverty or race affects access to healthcare; opioid abuse; the social consequences of HIV/AIDS; childhood obesity; or maternal mortality in third world countries.

Students should start by brainstorming a list of points and ideas they will investigate. Then comes the most time-intensive and significant part of a research paper: the research itself. Students ought to use multiple different resources to help them craft their arguments. Options include online databases, academic journals, and their college library. Make sure you keep track of citations and sources as you go.

Students should also make sure their essays are well-structured. A well-written thesis unites the main points of the paper. Unlike essays, research papers usually include more than five paragraphs. Students may break down their arguments into different sections. A research paper must include a works cited or bibliography that credits all sources. The exact length of the paper and number of sources depends on the professor’s expectations.

Over the course of their academic careers, public health students write many kinds of essays. Professors often assign persuasive essays, in which the student must make a convincing argument; expository essays, in which the student explores and explains an idea; narrative essays, in which the student tells a story; comparative essays, in which the students analyzes two different viewpoints; and cause and effect essays, in which the student must explain the logic behind why certain events or phenomena occur.

• Narrative: In a narrative essay, the author tells a meaningful story. Studying public health, you probably won’t write many narratives. However, narrative essays can support an argument or prove a point. For instance, if you argue that every community should have a free clinic, you might tell a personal story about your experience growing up in a low-income neighborhood with no access to healthcare. Make sure your essay demonstrates a clear plot, follows an organized structure, and includes many details.
• Expository: When professors assign expository essays, they expect students to explain or describe a concept. These essays help professors evaluate whether students have a firm grasp on a topic. Expository essay often include five paragraphs: an introduction with a thesis statement, three main points backing that thesis statement, and a conclusion. Students should do plenty of planning and research before writing to ensure they adequately address the prompt and include enough evidence.
• Persuasive: Persuasive essays appear commonly in academic assignments. Students first develop an argument as a thesis statement. Then, they generate a cogent defense of that argument by researching supporting evidence. Students should be able to anticipate arguments against their thesis statement and include counterpoints. In persuasive essays, students not only demonstrate their knowledge of the course material, but also prove their critical thinking skills by developing their case.
• Comparative: A comparative essay requires students to compare and contrast two ideas, viewpoints, or things. For example, public health students may compare two texts, theories, public health systems, or positions on an issue. First of all, students should create a list of similarities and differences between the two items. After that, they can develop a thesis statement on whether the similarities outweigh the differences or vice versa. Finally, they should organize the essay. They can either defend their thesis statement by listing each point of comparison, or they can split the essay in half by discussing subject one and then subject two.
• Cause and Effect: These essays require students to explain how one event or theory leads to a specific consequence. For instance, a public health student might argue that abstinence-only education in public schools leads to a higher rate of teenage pregnancies. Students should remember that just because one event follows another, those two events do not necessarily influence one another. In other words, correlation does not equal causation. In the analysis portion of the essay, students must explain specific reasons why they think the two events are connected using data and other evidence.

Citations Guide for Public Health Students

In public health writing, just as any other discipline, students must cite their sources. If students use ideas, theories, or research without crediting the original source — even unintentionally — then they have plagiarised. An accusation of plagiarism could follow the student throughout their education and professional career. Professors may fail students who plagiarise, sinking their GPA. Plagiarism accusations can also ruin a student’s credibility. Fortunately, students can avoid plagiarism by properly giving credit for their data and ideas. Common citation styles include those listed below.

American Psychological Association (APA) Style

Students in the social sciences use APA style when writing their essays and research papers. Business and nursing students also commonly use APA style. APA prefers active voice over passive voice, as well as concise language over flowery words. Research papers written in APA style should include a title page, abstract, and a reference page. In-text citations list the author’s name, year of publication, and page number if applicable. Below is an example of how to cite a source using APA style.

In-text citation:

In Milwaukee, poor neighbourhoods were segregated by design (Desmond, 2017, p. 249).

On the works cited page:

Desmond, M. (2017). Evicted: Poverty and profit in the American city . London: Penguin Books.

Chicago Manual of Style (CMS)

History students and students of the natural sciences typically use Chicago, or Turabian, style in their research. Papers written in Chicago style include three sections: the title page, the main body, and a references page. This style also uses footnotes to source information and provide more context. In-text citations list the author’s name, the date of publication, and the page where the student found the data. Unlike APA style, though, the in-text citation does not use a “p.” before the page number. See the example below:

In Milwaukee, poor neighbourhoods were segregated by design (Desmond 2017, 249).

Desmond, Matthew. Evicted: Poverty and Profit in the American City . London: Penguin Books, 2017.

Modern Language Association (MLA) Format

Students of the humanities — including literature, foreign languages, and cultural studies — use MLA style in their research papers. Unlike APA and Chicago style, MLA style does not require students to add a title page. MLA papers also do not include an abstract. Students only need to include the paper itself and a works cited page that corresponds with in-text citations. When adding citations in the body of the text, MLA includes the author’s last name and the page number in parentheses. This style does not list the publication year. You can find an example of MLA citation below:

In Milwaukee, poor neighbourhoods were segregated by design (Desmond 249).

Associated Press (AP) Style

Journalists use Associated Press, or AP style, in their work. AP style standardizes grammar and spelling usage across news media and mass communications. Students rarely use AP style, unless they are writing an article in their subject area for a newspaper or magazine. AP style prioritizes brevity and conciseness above all else. Therefore, it includes several rules that differ from other writing styles. For instance, AP style eliminates the last comma in a list of items (for example: “She dressed in capris, a tank top and sandals”). Since students and professors do not use AP style for academic papers, AP style does not include a reference page like other style guides. Instead, AP style simply uses non-parenthetical in-text citations.

“People who live in low-income communities lack opportunities to exercise,” said Lydia Homerton, professor of public health at Hero College.

The Best Writing Style for Public Health Majors

Professionals in the public health field use APA, the most common style in the social sciences. Professors expect students to use APA style as well. Public health research follows a standardized system of citing sources, making it easier for students and professionals in the field to conduct further research. Students should add a title page and abstract before the essay, as well as a list of references in the back.

Common Writing Mistakes Students Make

Active vs. passive voice.

When writing essays and research papers, students should use active voice and avoid passive voice. Learning the difference between passive and active constructions can be tricky. First of all, students should be able to identify the subject in a sentence. The subject is the noun performing an action. Take this sentence: “The woman catches the keys.” In this case, the woman is the subject of the sentence because she is the one performing the action, catching. The sentence “The woman catches the keys” is active because it focuses on the subject and the action. You can identify an active sentence by checking if the first noun is a subject performing an action.

By contrast, examine this sentence: “The keys were caught by the woman.” The first noun, “keys,” is not performing an action. Instead, it is being acted upon. The subject performing the action — the woman — is at the end of the sentence and not the beginning. This sentence uses passive voice instead of active voice. Some passive sentences do not include a subject at all. For example, “The keys were caught.”

Active voice makes writing more concise and easy to understand. Active sentences often include more information, especially about the subject performing an action. In research papers, students should use active voice whenever possible. However, sometimes it is clear that the author is the one performing the action, so active voice is not necessary. For instance, a researcher might write “the experiment was conducted Friday” instead of “I conducted the experiment Friday.”

Punctuation

Incorrect punctuation confuses readers. The wrong punctuation can change or obfuscate the meaning of a sentence, paragraph, or the entire essay. Publishers, professors, and other researchers often look down on papers with incorrect grammar, even if the content includes important or accurate research. Consequently, students should always use proper grammar in their essays.

The wrong punctuation can change or obfuscate the meaning of a sentence, paragraph, or the entire essay.

While students make many different errors with punctuation, most common errors revolve around colons and commas. Understand the difference between colons and semicolons. Both punctuation marks separate two parts of a sentence. Students should use colons when introducing a list. (“He ate lots of meat: pork, chicken, steak, veal, and duck.”) Colons can also introduce an appositive or new idea. (“She finally gave him the gift: a new computer.”) Semicolons, on the other hand, connect two complete, independent sentences. These sentences should be separate but related. (“He ate a lot of meat; he was ravenous.”)

Students should also take care to avoid comma splices. A comma splice occurs when writers connect two independent sentences using a comma. The following sentence includes a comma splice: “She danced with her boyfriend, he was very clumsy.” Instead, students could add an “and” to connect the two sentences. (“She danced with her boyfriend, and he was very clumsy.”) Alternately, writers could connect the sentences with a semicolon. (“She danced with her boyfriend; he was very clumsy.”) Lastly, writers could separate the two sentences with a period.

Proper grammar helps readers understand your essays. Proper grammar also gives your essay credibility. If you have a perfectly-argued essay, but your paper includes multiple grammar mistakes, the reader will likely be skeptical of the entire argument.

Understand the difference between there/their/they’re. “There” refers to a place. (“The dog is over there.”) Their shows possession. (“This is their house.”) “They’re” is a contraction for “they are.” (“They’re eating at the diner.”)

Also learn the difference between it’s and its. “It’s” is the contraction for “it is.” (“It’s hot outside.”) “Its” shows possession. (“The bird eats in its cage.”)

Make sure your sentences include proper subject-verb agreement. In other words, if the subject of a sentence is plural, the verb should also be plural. For example, use “The boy and his sisters are eating breakfast” instead of “The boy and his sisters is eating breakfast.”

Writing Resources for Public Health Students

• Guide to Improving Scientific Writing in Public Health : This guide from the World Health Organization and the Pan American Health Organization teaches students how to write about complicated scientific material in a way that’s easy for readers to understand. The guide includes tips on vocabulary and format.
• Argument, Structure, and Credibility in Public Health Writing : Written by a professor at Harvard’s School of Public Health, this essay breaks down how to make effective arguments in public health writing. The page includes flow charts and figures to help illustrate exactly how public health essays should be organized.
• Purdue Online Writing Lab APA Style Guide : Purdue’s Online Writing Lab includes style guides for all writing and citation styles, including APA. The style guides help students understand how to format papers, use in-text citations, and create reference pages.
• Award-Winning Health Articles : One of the best ways to improve your writing is to read good examples. This page lists nine award-winning public health writing samples.
• The Women’s and Children’s Health Policy Center Writing Skills Guide : This website links to several modules on writing public health documents. Lessons include policy briefs and memos.

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Promoting Public Health with Blunt Instruments: Evidence from Vaccine Mandates

We study the effect of mandates requiring COVID-19 vaccination among healthcare industry workers adopted in 2021 in the United States. There are long-standing worker shortages in the U.S. healthcare industry, pre-dating the COVID-19 pandemic. The impact of COVID-19 vaccine mandates on shortages is ex ante ambiguous. If mandates increase perceived safety of the healthcare industry, marginal workers may be drawn to healthcare, relaxing shortages. On the other hand, if marginal workers are vaccine hesitant or averse, then mandates may push workers away from the industry and exacerbate shortages. We combine monthly data from the Current Population Survey 2021 to 2022 with difference-in-differences methods to study the effects of state vaccine mandates on the probability of working in healthcare, and of employment transitions into and out of the industry. Our findings suggest that vaccine mandates may have worsened healthcare workforce shortages: following adoption of a state-level mandate, the probability of working in the healthcare industry declines by 6%. Effects are larger among workers in healthcare-specific occupations, who leave the industry at higher rates in response to mandates and are slower to be replaced than workers in non-healthcare occupations. Findings suggest trade-offs faced by health policymakers seeking to achieve multiple health objectives.

Research reported in this publication was supported by the National Institute on Mental Health of the National Institutes of Health under Award Number 1R01MH132552 (PI: Johanna Catherine Maclean). John Earle also acknowledges support from the Russell Sage Foundation. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Institutes of Health or the National Bureau of Economic Research.

MARC RIS BibTeΧ

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Finding the egg yolk: Why I chose public health

Mymai yuan mph ’23 health management she/her/hers.

A metaphor spoke to me during a time in my life when I was thinking deeply about my purpose: To find our “dream job,” we must find the egg yolk. That is, we should base our search not on job descriptions out there, but by considering the parts of our own experience we cherished. In this way, we find the core values that drive our explorations.

Born and raised in Thailand, I attended an international English-speaking high school. My trilingual background, the cultural diversity of my social bubble, and the striking economic disparities of my country drew me to people’s stories. At school, I started a spoken poetry movement on the healing nature of community storytelling.

I came to the U.S. for the first time in my life to pursue my undergraduate studies at the University of Pennsylvania, where I majored in both cognitive neuroscience and creative writing. Both fields enabled deeper exploration into the humanity of health. While cognitive neuroscience delves into the tissue of memory, creative writing dissects the power of our inherent mortality through the language of grief and love. The privilege of an empowering education affirmed my dream of building more equitable care in Thailand and other low-to-middle-income countries.

In preparation for my hopes of working in resource-constrained settings, I spent two years at a New York-based health care management consulting firm where I worked on projects looking at chronic illnesses and health care innovation. As I gained financial skills and language in the private sector, I realized the core importance of public health.

With this knowledge, I moved back home to Thailand and joined an international public health non-governmental organization (NGO). There, I co-led a global health project to reduce non-communicable diseases and support Thailand’s COVID-19 response. This role and the compassion of my colleagues shaped me profoundly. While witnessing the inequities of COVID-19 across populations, I dove into global health’s history and the political economy that has shaped it. There, I created a protocol exploring ways for project members to share the historical context of the countries in which we worked, prioritizing language and cultural inclusivity. I recognized that such a protocol treats only the symptoms of a deep-rooted issue.

That year, I made the difficult (and very lucky) decision to defer medical school and, instead, pursue public health at Harvard Chan. I was drawn to the global impact and socio-economic-political lens of public health, which I felt was crucially lacking in the world’s COVID-19 response. I was particularly drawn to  Dr. Jesse Bump ’s work in the history of global political economies and decolonizing global health, and a previously hosted student-led conference, “ Decolonizing Global Health .”

Today, I work as a research assistant and teaching fellow with Dr. Bump; an Equity, Diversity, and Inclusion (EDI) fellow ; and co-founder of the student organization “Harvard Chan Students for Decolonizing Global Health.” My research interests also include global health economics, financing, and payment systems. I am so grateful for the conversations I’ve been able to have with my peers here, and how much I’ve learned from them.

My passion for the humanity of health continues as a Harvard Chan student. Though my path has had many curves, my time here has helped me continue to define the “yolk” that connects everything I have explored. The students, mentors, and professors at Harvard have deepened my understanding of global health equity, and I am thankful to share with them an affinity to build a more just world.

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Why Study Public Health?

Why Is Public Health Important?

The field of public health plays a critical role in the promotion of health, prevention of disease, and empowerment of individuals to manage illness and disabilities. Every scientific finding, awareness campaign, and new policy has the potential to positively impact the lives of millions of people around the world . A unique blend of research, inquiry, and action, public health brings together people from across disciplines, backgrounds, and perspectives to discover the root causes of health problems and develop long-lasting, innovative solutions that improve everyone’s quality of life.

While the field of medicine traditionally aims to treat diseases and injuries, public health aims to proactively prevent them and keep populations healthy. In doing so, public health practitioners discover and share health interventions that ensure health and equity now and far into the future.    

What Will You Learn in a Public Health Degree Program?

In a public health degree program, you’ll learn how the conditions in the places where people live, learn, work, grow, and play affect their health outcomes. You’ll learn how public health professionals collaborate to uncover these conditions and build interventions that address them. Depending on your interests and passions, your coursework in Michigan Public Health’s six departments can explore the science behind the spread and control of disease, environmental impacts on human health, how policy and data can transform the health of populations, and the ways diet and nutrition shape our lives and our health. 

What Can You Do with a Public Health Degree?

A public health degree gives you the professional foundation and transferable skills you need to understand and work on a wide range of issues in a variety of industries and fields, including issues you see in the news every day, from COVID-19 to health care policy, firearm safety, and racism. Those with public health degrees keep communities healthy, protect workers, prevent and address pandemics, pursue social justice, drive public policy, spearhead disaster relief, ensure access to healthcare, and so much more. Public health professionals are at the forefront of research, practice, and service in nonprofits, community organizations, higher education, government, private industry, and health care. Discover jobs and careers in public health by learning more about our alumni .

Why Michigan Public Health?

As the #5 ranked school of public health in the US, we educate and train tomorrow’s public health leaders. Michigan Public Health students prepare to pursue positive, transformative change through engaging learning opportunities with top faculty, access to innovative laboratory and field settings, and community-based and entrepreneurial training. Our graduates join a community of 18,000 alumni and enter the world prepared to meet the challenges of a shifting landscape and anticipate where new challenges might arise.

What our students say about why they chose public health 

Staying grounded: Building public health skills for local impact

Matthew Hernandez, MPH ’24

COVID-19 experience influences career in health policy and equity

Jonathan Amos, MPH ’24

Beirut tragedy inspires graduate's public health mission

Wadad Itani, MPH ’24

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Good Essay About Public Health

Type of paper: Essay

Topic: Health , Public , Medicine , Disease , World , History , Organization , People

Words: 1100

Published: 11/11/2021

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Public Health has resulted in longer and more fulfilling lives for many people all over the world. The profession has now developed at both the local and international level. Ancient societies were aware of public health issues and attempted to prevent disease through religious practice however historical phenomena such as Black Death caused the very early formation of modern public health in the 15th century. This has continued beyond the industrial revolution. Disease has been one of the most significant issues that has shaped the profession of public health. The profession has now grown into one that includes many different professions and organisations that often work collaboratively to solve some of the world’s most difficult illnesses and diseases. Modern Public Health has contributed to an improvement in the health status and quality of life as a result of Non-Governmental Organisations like The World Health Organization. There have also been many governmental agencies at the local, state and national level of all countries that are responsible for the improvement of health. These organizations often work collaboratively to prevent and treat some of the world’s biggest health problems. The work requires the expertise of various professionals such as doctors, nurses, public health officers, occupational health and safety as well as many others. They participate in educational campaigns, treat the actual disease or work on ways of preventing illness and health problems. For example, if a person came from the past back into the future, they would notice a significant decline in the number of smoking related illnesses in western countries. This is not only as a result of better medicine but also because of education campaigns and arguably the taxing of cigarettes. The modern public health system has replaced traditional ways for societies to address public health concerns. Before the modern public health system that most people are now accustomed to, it was the church that would often advise of proper sexual practices or those behaviours that inhibit human health like the drinking of alcohol, eating excessively and many other destructive behaviours. Ancient societies also were tied to religion but also attempted to explain the spread of disease through scientific means. For example, in Ancient Greece Hippocrates wrote ‘Air, Water and Places’; a book showing the relationship between disease and what was going on around the individual. Disease was one of the most important historical phenomena responsible for the development of public health responses. Many ancient societies like the Greeks and Romans were aware of the need to provide sanitation for the prevention of disease and health problems. This is evident by the number of large engineering projects that included sewers and drainage in these societies. Better organized public health started to become prevalent after black death caused widespread deaths throughout Europe. For example, in 1485 the Republic of Venice established a Permanent Court of Health Supervisors in order to stop epidemics in the territory. A Grand Council was also established in 1537 and two judges were appointed to oversee it. Later epidemics like cholera also resulted in a better organization of public health that devastated England in the 1800’s that focused on the management of the disease by looking at the spread in public areas where the disease could circulate. Modern Public Health also reacted to the spread of disease throughout the Industrial Revolution. Poor housing and sanitation resulted in advice from prominent writers such as Jeremy Bentham and Thomas Malthus. They warned officials of illness and disease due to overpopulation of the slums. The result was new engineering and public health policies created by the Poor Law Commission that began to deal with the effects of disease in the slums due to poor sanitation. Later legislation such as the Public Health Act of 1848 continued to improve sanitation throughout towns in England. Public health is a multidisciplinary area of health that uses the expertise of various professions including doctors, nurses, educators, sociologists, dentists and many more. It also collaborates local and international efforts to address areas of public health. For example, the World Health Organisation recognizes that smoking related illnesses are ending the life of millions of people early due to associated diseases. Countries have worked with The World Health Organization to educate their citizens about the harmful effects of smoking. Public Health is unique because it attempts to solves issues that are beyond the capabilities of one health discipline. Stopping people smoking requires research, attempts to prevent and educate citizens of the dangers before they arise. This is unlike traditional health disciplines like medicine that are often more reactive than proactive by treating patients but having little to do with the prevention of health issues unless the patient has a long relationship with those in the medical profession. Public Health also monitors the health of large amounts of people in communities, regions or countries unlike many health professions. For example, there has been a recent breakout of STDs in a community and there are concerns that there will be an increase. Public Health officials from the government may try proactive strategies of dealing with the outbreak such as educating, conducting studies and distributing condoms. At the same time public health officials prepare those in the medical profession by dispersing information to those responsible for treatment. Without coordinated public health in this situation it may result in sporadic treatment of individuals and a lack of knowledge about how to deal with an outbreak of STDs in a designated area resulting in more cases that are severe and long lasting. Public Health has been responsible for longer life expectancies and an improvement in the health of individuals throughout the world. Some examples include better sexual health through safe sex practices that can prevent HIV and aids. Other examples include but are not limited to education about the harmful effects of smoking on individuals from the World Health Organization in coordination with governments throughout the world. Many events throughout history have shaped the development of public health and the most significant has been the spread of incurable diseases such as black death and cholera resulting from poor sanitation or slum housing. Public Health differs to other health disciplines in that it is an expansive discipline that uses the expertise of many health professions and uses proactive strategies to prevent diseases through collaborative efforts from the local to global level. It coordinates health experts and can react to research of health problems in certain areas quickly by preparing health officials with information so that they can react to health problems efficiently.

Britannica, E. (2016). Public health . Fraser, B. (1975). World Health. Fraser, D. (2009). The Evolution of the British Welfare State: A History of Social Policy Since the Industrial Revolution. United Kingdom: Macmillian Education.

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Effective Leadership in Public Health: Essential Skills

What is effective leadership in public health? Public health leaders work around the clock and around the globe to build a healthier world grounded in the principles of health equity and justice. Their work is interdisciplinary — drawing from the best of biological science, biostatistics, epidemiology, environmental health science, social and behavioral science, and health policy and management. 

“We do not have to accept the status quo. We can do better on behalf of each other,” Mona Hanna-Attisha, director, Hurley Children’s Hospital Pediatric Public Health Initiative, said. 

To accomplish so much — from cutting-edge scientific research to trenchant policy analysis and successful public health advocacy — public health leaders must develop a range of core competencies and professional abilities. Explore the essential skills required for effective leadership in public health. 

Roles of Public Health Leaders  

Public health leaders are experts in the field who reliably provide vision and clear communication. Through their inspiring work ethic and dedication to excellence, public health leaders can effect real change at the national, state, and local levels. 

Characteristics of Effective Leaders               

An effective leader should have some core characteristics:

• Integrity : acting in alignment with one’s values; doing what one says one will do
• Decisiveness : making decisions based on evidence and strong reasoning
• The ability to balance hard truths with optimism : adopting a realistic perspective while maintaining hope for a better future
• Transparency (to the right extent) : tactfully and wisely sharing information with those who need it rather than gatekeeping or obscuring information
• Encouragement of risk-taking : showing the courage to take a calculated chance on new programs and initiatives 
• The ability to influence others : inspiring and motivating others from different backgrounds to share in the same mission

In the midst of a public health crisis, it is easy to see why these traits are crucial for a successful response. 

What Public Health Leaders Do               

What do public health leaders do? It depends on their specializations and roles, of course, but here are some examples of the many responsibilities of public health professionals that require strong leadership:

• Crisis communication. At the height of a disease outbreak or during an environmental disaster, the public needs clear direction about what specific actions to take to protect themselves. Public health leaders are experts at safeguarding communities during health emergencies.
• Emergency planning. Public health leaders are also expert planners, strategically coordinating federal, state, local, and community stakeholders’ efforts to create emergency plans in response to bioterrorism events, environmental catastrophes, disease outbreaks, and other threats to public health. 
• Public health initiatives. The U.S. needs competent leaders to run public health initiatives at every level of government, from city health departments to federal health agencies. Government leaders implement public health policy, collect data, allocate resources, and deliver services to communities. 
• Advocacy for vulnerable groups. Public health is about advancing the greater good. Sometimes that means shining a light on problems in our health delivery systems and speaking up for vulnerable groups. For example, during the COVID-19 pandemic, many public health leaders emphasized how a global pandemic worsened health disparities in communities of color across the country. 
• Technology and data use. Leaders in public health understand the importance of collecting, analyzing, interpreting, storing, and synthesizing data. To conduct research and advance evidence-based practices, public health leaders must leverage data platforms and emerging technologies. 

What Is Leadership in Public Health?  

To understand core competencies in public health leadership, it is useful to consider general leadership qualities and best practices that can be applied to a wide range of public health contexts. 

Three core competencies related to leadership in public health are: vision, values, and influence. 

Leadership Vision in Public Health               

Leaders with vision can see beyond the status quo, imagining how changes to public health systems can make our communities healthier and more equitable. 

Successful public health leaders have a strong knowledge base in their specialization area and also see the bigger picture. Leaders with a strong vision may understand some of the many shifting factors in public health today, such as:

• Technological advancements, especially the “information technology revolution” driven by big data and the digitization of health records
• Advancements in biomedical and management technologies
• Divergent health models (e.g., social determinants of health, the ecological model of health)
• Health communication systems (e.g., health web platforms, social media, telehealth)

A clear and compelling vision, including both critiques of current systems and positive proposals for change, can support collaborative planning and consensus building among diverse public health stakeholders. 

Public Health Values               

Public health leadership involves service and cooperation. Like other government and nonprofit leaders, public health leaders should see themselves as public servants — individuals who work for the public, in the public’s best interests. In their capacities as public servants, health officials typically abide by these values:

• Accuracy. Public health leaders should produce recommendations that are always evidence-based and grounded in best practices, according to public health expertise. 
• Transparency. Public health leaders should empower the public with key information about issues related to public safety, health, and well-being. Leaders should clearly explain public policy, translate complex data into usable and easily understandable information, and shed light on topics that are of public health interest. 
• Honesty. The public deserves to know how its leaders are working to protect their health. That means public health leaders should be honest and transparent about their practices. 
• Responsiveness. During a public health crisis, time is precious. The public deserves accurate, timely information related to public health, so leaders must be prepared to respond. 
• Accountability. Public health leaders serve the public, so they should be accountable to the public by conducting research according to the highest scientific ethical standards.

Moreover, public health leaders direct multidisciplinary teams of scientists, researchers, elected officials, public servants, and community members — so a collaborative approach to leadership is an absolute must. Effective public health leaders, therefore, also value:

• Teamwork. To coordinate and execute complex public health plans across communities, cities, states, and even entire nations, public health leaders must value and prioritize productive teamwork strategies. 
• Networking. Public health leaders should recognize the importance of bringing new experts into the fold.
• Clear communication. Public health leaders need to be expert communicators, adeptly able to interpret and convey complex ideas to diverse stakeholders with various levels of expertise — from professionals with advanced degrees in epidemiology to community workers who are just learning about public health programs for the first time. 
• Information management. Public health leaders must find ways to store, catalog, and quickly reference correct, up-to-date information. Given the sheer amount of data that is available through big data tools today, public health leaders should be on the cutting edge of information management. 

Public Health Influence               

Ultimately, public health leaders need to be effective — and to be effective, leaders must wield influence over institutions that affect people’s health. 

For public health to be even more influential as a field, its leaders must embrace public health work’s interdisciplinarity. What does that mean? 

Public health initiatives often require many different groups to come together and work in tandem to get a job done. For example, disease preparedness efforts require a coordinated response from healthcare institutions, social service organizations, state health departments, transportation services, and many other groups. 

Sometimes such efforts require global coordination across agencies and organizations. For instance, the national COVID-19 pandemic response drew on international networks of public health organizations, from the World Health Organization (WHO) to individual nations’ public health departments and private sector groups — all working together to curb the pandemic. 

Public health requires inter-organizational coordination, too. For example, public health policy analysts may need to work with biostatisticians to apply insights from predictive modeling to the creation of actionable policy recommendations. Public health leaders therefore must become skilled at building relationships across teams and departments, earning trust, and creating open lines of communication along the way.

Why Leadership Is Important in Public Health

Leadership is important for public health initiatives to succeed. Effective leaders can streamline public health services, improving access to key public health information and services. Without leadership, however, public health initiatives fall flat.

Public Health Leadership Successes               

When public health leaders work together, they can achieve amazing results. Notably, the World Health Organization (WHO) — a specialized United Nations agency that oversees international public health — has successfully:

• Eradicated smallpox in 1980, with no naturally occurring cases emerging since.
• Nearly eradicated polio through vaccines.
• Empowered the development of other vaccines for deadly viruses including Ebola.

When public health leaders do their jobs well, they can prevent disease outbreaks and promote health across communities — work that sometimes appears invisible when potential crises are averted. 

Public Health Leadership Organizations               

At a national level, the U.S. has created specific government agencies that, when led well, can effect sweeping public health changes that promote health equity and justice. Key public health agencies in the U.S. include:

• Centers for Disease Control and Prevention (CDC)
• National Institutes of Health (NIH)
• Health Resources and Services Administration (HRSA), which includes the Bureau of Health Professions (BHPr)
• Substance Abuse and Mental Health Services Administration (SAMHSA)
• Agency for Healthcare Research and Quality (AHRQ)

Federal agencies, including those listed above, can aid public health leadership in several ways. These include supporting:

• Technological development
• Predictive and prescriptive modeling
• Continuing education
• Student and early professional development
• Public health educator development
• Public health academic program development

For instance, the BHPr in particular offers several programs specific to leadership development in public health:

• Public health traineeships that train professionals in critical public health professions
• Public health special projects that create academic-community partnerships for public health curriculum revisions
• Preventive medicine residencies that support and expand residency training programs
• Health administration traineeships to increase the number of people from underrepresented groups in the health administration field

Public Health Leadership Barriers to Success               

Sometimes the investment in public health resources can dwindle during relatively calm and safe periods. This can lead to preventable public health crises due to understaffing, as well as atrophied connections between public health agencies and organizations.

Barriers to success in public health include:

• Failures to articulate and take action on a clear public health mission
• Inadequate resources to carry out essential public health activities, including developing policy, assessing current public health metrics, and delivering services
• Making decisions without required data
• Unequal distribution of public health services and resources
• Leadership attrition and turnover, leading to a lack of continuity in public health leadership
• Inadequate partnerships with clinical or medical professionals, public servants, and community representatives
• Funding inadequacies and lack of financial support
• Communication barriers between different levels of government

Public Health Leadership Skills  

Leadership in public health requires many skills in complex environments. Globalization, economic crises, international tensions, and political strife can all affect public health functions and the resources available for dealing with existing and emerging health issues. 

Skills to Lead Complex Public Health Initiatives               

Four necessary public health leadership components are:

• Identifying and gaining support for specific health issues
• Securing (or allocating) funds to accomplish specific public health aims
• Gaining support for implementing specific actions toward public health goals
• Supporting the ongoing development of public health knowledge and data 

Public health leadership skills overlap. For example, securing funding for a public health educator may mean drafting a compelling, well-researched grant proposal. This can involve similar evidence-based research a health policy analyst may conduct when creating a proposal for equitable funds allocation. 

In all of these complex public health initiatives, leaders must demonstrate the skills of:

• Excellent communication: fluency in technical and scientific communication as well as clear, concise communication with the general public (which includes, especially, communication with nonexperts)
• Critical thinking: the ability to synthesize and draw out public health data’s implications
• Ethical decision-making: the commitment to using public health leadership power to serve society by promoting the common good

Skills to Form Alliances and Foster Cooperation in Public Health               

Public health leaders must form alliances with many different stakeholders — communicating clearly and effectively, synthesizing information, and making tough decisions based on evidence and grounded in the ethical principles of responsibility, equity, and justice. 

Today’s public health leaders must support inclusion, collaboration, and empowerment:

• Inclusion means creating and championing policies, proposals, and programs that support people from all backgrounds, including people who have been and continue to be affected by racism, classism, xenophobia, sexism, homophobia, transphobia, imperialism, and other forms of discrimination and oppression that have both direct and indirect effects on an individual’s health and well-being. 
• Collaboration means bringing together stakeholders with different perspectives, values, resources, and responsibilities to contribute to decision-making together.
• Empowerment means sharing resources, including vital public health information so that individuals and communities can make informed decisions to promote and maintain their own health and safety. 

Skills to Build Critical Public Health Infrastructure               

To assure a consistently competent public health workforce, public health leaders need to invest in public health infrastructure. This means thinking about and creating long-term plans for training future public health leaders. It also requires creating leadership support systems so public health organizations can sustain leadership changes over time. 

Gain Critical Leadership Skills for a Career in Public Health  

In a rapidly changing world, the public needs competent leaders to drive equitable, accessible public health initiatives. Society demands strong leadership in public health to create inclusive, effective health systems that serve everyone. 

Are you passionate about promoting equity and inclusion in public health? A DrPH in Leadership, Advocacy, and Equity program can equip future public health leaders with the skills and connections they need to amplify their voices and spearhead true change in their communities.

Through a combination of classroom engagement in co-curricular experiences, a DrPH program focused on leadership, advocacy, and equity can teach professionals of all backgrounds how to apply these principles in public health. Discover how the program can help you make a difference in public health.

American Public Health Association, Public Health Leaders 

Centers for Disease Control and Prevention, National Leadership Academy for the Public’s Health 

De Beaumont Foundation, 10 Inspiring Quotes from APHA 2020

Harvard Business Review , “5 Skills Public Health Officials Need to Combat the Next Pandemic”  

Indeed, “Core Values of a Great Leader”

Journal of Ahima, “Public Health Leadership During the COVID-19 Pandemic”  

Public Health Institute, National Leadership Academy for the Public’s Health (NLAPH)  

U.S. Department of Health and Human Services, HHS Agencies & Offices 

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• Grad School
• Sample Essays
• The Public Health Student

What if people lived healthier lives, practiced preventive medicine, and took precautions against illness and disease? My days in the physical therapy department often made me think about the prevention of injuries as well as the injuries themselves. I was already doubting my future career choice as a physical therapist. Although I loved the science of it and helping people, the lack of variety within the field and its limited options for growth bothered me. I needed a career that helped a large number of people, emphasized prevention and primary care rather than tertiary care, and would continually challenge and motivate me to improve. Knowing that I really did not want to pursue physical therapy as I had originally planned, my thoughts wandered to the area of public health, particularly health management.

My first true introduction to the public health arena came in a class offered through the Big U School of Public Health. As I listened to experts speak about contemporary health issues, I was intrigued. The world of "capitation," "rationing of care," and Medicaid fascinated me as I saw the range of problems that public health professionals were trying to solve in innovative ways. This one semester class provided me with a basic but thorough understanding of the issues faced in health care today. In the last two years I have continued to learn about public health both through coursework and work in the field.

Because field experience is such a valuable learning tool, I searched for a research assistant position that would allow me to view public health at a different level. I worked on a project at a county health clinic in Englewood, a low-income, minority community. The program attempted to increase treatment compliance rates for adolescents diagnosed with tuberculosis who must complete a six-month medical program. Working for the county exposed me to a different side of health care that I had previously seen. Service and organization were not assets of the county and yet its role in the public health "ecosystem" was and is critical. Its job of immunizing thousands and interacting with all members of the community is often forgotten, but is important for keeping an entire community healthy.

My work at the county health clinic as well as my knowledge of some areas of public health led me to accept an internship in Washington D.C. this past summer. The internship provided me with a greater understanding of a federal public health agency’s operations and allowed me to contribute in a variety of ways to the XYZ Department in which I worked. Most importantly I worked on "policy issues" which involved identifying and summarizing problems that were out of the ordinary as well as documenting resolved issues in order to establish protocols to increase the department’s efficiency. In addition I served on a scientific review panel which was responsible for editing a seventy-page proposed regulation before its submission.

Along with my duties at XYZ, I attended seminars and met with public health leaders at different functions and events. All these activities confirmed my growing interest in preventive medicine, outcomes and effectiveness, and quality of care, particularly within the private/managed care sector. These are my strongest interests because I believe they are fundamental to our nation’s health. We must achieve efficiency and access without sacrificing quality.

The University of ____ would help me achieve my goals of furthering my public health education through the specialized coursework offered as part of its health administration program. [The client provides specifics here about the program’s specific appeal and strengths]

Since rejecting physical therapy as a career possibility my interest in public health has only grown. I welcome the challenge of serving a large community and participating in such a dynamic and challenging field. What if an aspirin a day could prevent heart attacks? What if abandoning unnecessary procedures saved thousands of dollars, which then allowed a hospital to treat other patients needing care? What if every person was guaranteed care and that care was good? I would like to find answers for these questions during my career as a public health graduate student and professional.

Other Sample Essays

Home — Essay Samples — Life — Career Choice — Why I Chose Public Health: A Path to Fulfillment and Impact

Why I Chose Public Health: a Path to Fulfillment and Impact

• Categories: Career Choice Doctor

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Words: 696 |

Published: Sep 7, 2023

Words: 696 | Pages: 2 | 4 min read

Table of contents

A desire to address health disparities, promoting preventive health measures, furthering education and research, contributing to policy and advocacy, fulfillment and reward in public health, conclusion: a journey of purpose.

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Public Health Roles to Pursue Before Medical School

Gap years before med school can be spent many ways, such as volunteering at nonprofit organizations or startup companies.

Public Health Roles Before Med School

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There are opportunities in health research that potential medical school applicants can do before they apply.

Premedical students taking a gap year or years before medical school can consider pursuing public health opportunities to complement their patient care experiences.

Public health experiences equip future doctors with essential skills to address broader societal health care issues, such as health care disparities, infectious disease outbreaks, health effects of climate change, water sanitation and access to health care. Premeds can also gain insights into epidemiology , health policy and health promotion strategies.

Gap years are opportune times to pursue public health experiences because premeds can gain hands-on experiences rather than the more theoretical approach to public health offered during college courses.

During my first gap year after graduating from college, I wanted to apply the public health knowledge I had learned in the classroom and affect health care at the population level. Entering my gap years, I had some specific goals related to public health.

First, I wanted to learn how to build public health programs and initiatives. Second, I wanted to understand the dynamics among local health care clinics, governments and nongovernmental organizations. Third, I wanted to see how physicians could take their clinical insights and create public health programs to affect population-level changes. Finally, I was excited to learn as much about public health as possible.

So how did I pursue these objectives during my gap year and what public health initiatives did I pursue?

I spent my first gap year as a Fulbright scholar in the Philippines. I first sought out doctors who were involved in public health initiatives. I learned how their clinical experiences inspired their public health initiatives.

Second, I volunteered my time to help with any public health initiatives. From these volunteering opportunities, I gained on-the-ground experience with different public health projects. I learned how to create new public health initiatives and partnerships with other community organizations.

For example, I helped one doctor launch a national HIV awareness campaign in the Philippines facilitated by unique partnerships with the music industry and media. With another doctor, I traveled to rural Philippines to volunteer at a cervical cancer screening program she created for low-income women.

As I was helping physicians with their public health projects, I was pitching other health care leaders about a public health program I wanted to create – I had a vision to increase access to vaccinations, which was also the topic of my senior thesis research at Princeton University in New Jersey.

Through persistently telling everyone about my interest in vaccinations, I was able to work on a project with the World Health Organization on improving hepatitis B vaccine rates among newborns in Manila. I learned how to collaborate with organizations like the World Health Organization and city governments.

Finally, I was hungry to leverage every opportunity possible to learn more about a broad array of public health and global health topics. Any time I received an invite to a public health conference, I said yes. Every time a policy leader or doctor invited me to a public health meeting, I said yes. Every time I was offered a chance to volunteer at a public health event, I said yes.

During my gap year, I was essentially a public health sponge. I had a great year learning about topics ranging from nutrition to neonatal health to disaster medicine . I was able to pick the brains of health care leaders about public health and gain tips to make public health initiatives successful.

Premedical students often ask me about how I find public health opportunities. My first piece of advice is that premeds should network with other physicians involved with public health. While some opportunities are widely publicized, many are discovered through networking.

Here are common public health opportunities premed students can pursue during their gap years.

Public Health Research

Many medical schools and public health schools around the U.S. have faculty members who are engaged in public health research . Popular types include epidemiology, analyzing large data sets to understand health outcomes among different subsets of the population and analyzing the success of public health programs and initiatives.

Public Health Departments

Premed students can work for public health departments at the community, state or national level. National-level opportunities are found at organizations like the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services.

Gap year jobs at public health departments often include working on existing public health projects. For example, you can lead car seat safety classes in the community or prenatal classes for women.

Nonprofit and Nongovernmental Organizations

Premeds can work for large NGOs and nonprofits like the Bill & Melinda Gates Foundation, the Clinton Foundation or AmeriCorps, an independent agency of the U.S. government. Premeds can conduct research or health programming at these organizations.

There are also excellent public health opportunities at smaller, community-based nonprofits. They may have more niche opportunities and work with more specific populations, such as homeless people and individuals with disabilities or drug use disorders. As a premed working at a small nonprofit, your work will tackle initiatives toward improving the health of specific populations.

Startups and Other Companies

Many premed students don’t know that they can gain public health experience at private companies, particularly startups . For example, my mentees have worked at health education companies. Other mentees have worked for companies where they created and analyzed community-based public health programs.

Smaller companies are less likely to have official job postings. If premeds are interested in a specific company, I encourage them to reach out to the founder directly to see if there are opportunities. Chances are high that the companies are looking for bright, motivated talent!

Pursuing public health opportunities during gap years can be enriching. Learning about public health can help you translate your insights from patients you see in clinic to projects and research that can benefit entire populations.

Med Schools With the Highest MCAT Scores

About Medical School Admissions Doctor

Need a guide through the murky medical school admissions process? Medical School Admissions Doctor offers a roundup of expert and student voices in the field to guide prospective students in their pursuit of a medical education. The blog is currently authored by Dr. Ali Loftizadeh, Dr. Azadeh Salek and Zach Grimmett at Admissions Helpers , a provider of medical school application services; Dr. Renee Marinelli at MedSchoolCoach , a premed and med school admissions consultancy; Dr. Rachel Rizal, co-founder and CEO of the Cracking Med School Admissions consultancy; Dr. Cassie Kosarec at Varsity Tutors , an advertiser with U.S. News & World Report; Dr. Kathleen Franco, a med school emeritus professor and psychiatrist; and Liana Meffert, a fourth-year medical student at the University of Iowa's Carver College of Medicine and a writer for Admissions Helpers. Got a question? Email [email protected] .

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I Hope You All Feel Terrible Now

How the internet—and Stephen Colbert—hounded Kate Middleton into revealing her diagnosis

Updated at 4:04 p.m ET on March 22, 2024

For many years, the most-complained-about cover of the British satirical magazine Private Eye was the one it published in the week after the death of Diana, Princess of Wales, in 1997. At the time, many people in Britain were loudly revolted by the tabloid newspapers that had hounded Diana after her divorce from Charles, and by the paparazzi whose quest for profitable pictures of the princess ended in an underpass in Paris.

Under the headline “Media to Blame,” the Eye cover carried a photograph of a crowd outside Buckingham Palace, with three speech bubbles. The first was: “The papers are a disgrace.” The next two said: “Yeah, I couldn’t get one anywhere” and “Borrow mine, it’s got a picture of the car.” People were furious. Sacks of angry, defensive mail arrived for days afterward, and several outlets withdrew the magazine from sale. (I am an Eye contributor, and these events have passed into office legend.) But with the benefit of hindsight, the implication was accurate: Intruding on the private lives of the royals is close to a British tradition. We Britons might have the occasional fit of remorse, but that doesn’t stop us. And now, because of the internet, everyone else can join in too.

Read: Just asking questions about Kate Middleton

That cover instantly sprang to mind when, earlier today, the current Princess of Wales announced that she has cancer. In a video recorded on Wednesday in Windsor, the former Kate Middleton outlined her diagnosis in order to put an end to weeks of speculation, largely incubated online but amplified and echoed by mainstream media outlets, about the state of her health and marriage.

Kate has effectively been bullied into this statement, because the alternative—a wildfire of gossip and conspiracy theories—was worse. So please, let’s not immediately switch into maudlin recriminations about how this happened. It happened because people felt they had the right to know Kate’s private medical information. The culprits may include three staff members at the London hospital that treated her, who have been accused of accessing her medical records, perhaps driven by the same curiosity that has lit up my WhatsApp inbox for weeks. Everyone hates the tabloid papers, until they become them.

In her statement, Kate said that after her abdominal surgery earlier in the year, which the press was told at the time was “planned”—a word designed to minimize its seriousness—later tests revealed an unspecified cancer. She is now undergoing “preventative chemotherapy,” but has not revealed the progression of the disease, or her exact prognosis. “I am well,” she said, promising that she is getting stronger every day. “I hope you will understand that as a family, we now need some time, space and privacy while I complete my treatment.”

This news will surely make many people feel bad. The massive online guessing game about the reasons for Kate’s invisibility seems far less fun now. Stephen Colbert’s “spilling the tea” monologue , which declared open season on the princess’s marriage, should probably be quietly interred somewhere. The sad simplicity of today’s statement, filmed on a bench with Kate in casual jeans and a striped sweater, certainly gave me pause. She mentioned the difficulty of having to “process” the news, as well as explaining her condition to her three young children in terms they could understand. The reference to the importance of “having William by my side” was pointed, given how much of the speculation has gleefully dwelt on the possibility that she was leaving him or vice versa.

Read: The eternal scrutiny of Kate Middleton

However, the statement also reveals that the online commentators who suggested that the royal household was keeping something from the public weren’t entirely wrong. Kate’s condition was described as noncancerous when her break from public life was announced in late January . The updated diagnosis appears to have been delivered in February, around the time her husband, Prince William, abruptly pulled out of speaking at a memorial service for the former king of Greece. Today’s statement represents a failure of Kensington Palace to control the narrative: first, by publishing a photograph of Kate and her children that was so obviously edited that photo agencies retracted it, and second, by giving its implicit permission for the publication of a grainy video of the couple shopping in Windsor over the weekend. Neither of those decisions quenched the inferno raging online—in fact, they fed it.

Some will say that Kate has finally done what she should have done much earlier: directly address the rumors in an official video, rather than drip-feed images that raised more questions than they answered. King Charles III has taken a different approach to his own (also unspecified) cancer, allowing footage to be filmed of him working from home. But then again, Kate has cancer at 42, is having chemo, and has three young children. Do you really have it in you to grade her media strategy and find it wanting?

Ironically, Britain’s tabloid papers have shown remarkable restraint; as I wrote earlier this month , they declined to publish the first paparazzi pictures of Kate taken after her withdrawal from public life. They have weighted their decisions toward respect and dignity—more so than the Meghan stans, royal tea-spillers, and KateGate theorists, who have generated such an unstoppable wave of interest in this story that its final destination was a woman with cancer being forced to reveal her diagnosis. If you ever wanted proof that the “mainstream media” are less powerful than ever before, this video of Kate Middleton sitting on a bench is it.