Professional Priorities: A New Public Health Agenda

Public Health is the most recent site of structural violence and control. What can we do?

We have a responsibility as intellectuals to speak truth and expose lies in media, government, elite institutions, and in our own communities. Noam Chomsky warned us in the 60s of the need to hold systems of power to account and avoid the tendency to align our professional priorities with state power. The political economy of misinformation and managed chaos in the Trump Administration is the new frontier; and we must learn to navigate this terrain if we are to outlast the fusillades of fascist ideology that is upon us.

Public Health is the best example for how state power and private interests work together to systematically deconstruct the very principles underlying the structures of care on which our public health and human services delivery system is built. Root and stem, they move with precision to exploit vulnerabilities, create controversies, and disrupt the financial and regulatory systems through administrative barriers. 

Our responsibility is to have the same militant focus in organizing against this agenda. The quadruplicity of the public health domain: education, promotion, epidemiology, and environmental health, are foundational forms of democratic governance. They promote general welfare in society and therefor threaten authoritarian agendas aimed at the concentration and exploitation of our collective labor power. So, any attempt to slow this movement will require all of public health leadership working together with the communities they serve to build alternatives to existing systems of care. And if we let the needs of the most vulnerable direct our collective works, we might survive.

We treat sources not symptoms.

Famously, John Snow removed the Broad Street Pump because he realized it was that part of the system that was the source of illness- treating symptoms was never going to be enough to stop the sickness. As the Founding Father of Public Health, we should look to his example and identify the systems that threaten our communities today. Who is primarily responsible for climate change, pollution, and the adverse impacts on health? Where does the funding originate that is used to lobby against clean and water? How does private equity benefit from medical debt and what is the correlation between the cash used to block Medicaid expansion efforts and profits of these same firm? Why is medically accurate health education not taught in all public schools? Who benefits from a lack of marketing and campaigns designed to promote health behaviors, like vaccination? These a few questions representing the interwoven fields of public health. But the most important question is: What connects all of these inquires and issues?

Capital and the State

Disciplinary domains are governed by the principles of the current political economy: late stage cspitalism. This is reflected in our institutional scholarship, the diverse applications of our profession, and the collective conscience which defines our commitments and responsibility to society. By aligning ourselves with state power, who truly sets the agenda is unclear, especially when funding depends on outcomes decided by those outside your domain. So, the capacity for intellectuals (scholars, professionals, or community leaders) to act independent of the system and build power outside the existing structures of state control, is reduced by the complicity of our own agency. 

Still, another path is possible. First, we must accept that we cannot organize against this rising power in isolation. And it is imperative to reach across disciplinary borders and build relationships with other sectors of the field. We need to set clear commitments to challenge social injustice and outline our shared responsibility as public health intellectuals. Allow for community leaders to emerge and take directive action to align our work with the principles and priorities of the populations we serve. Reduce dependency on government systems and elite institutions that keep us from organizing ourselves in this way. Accept that we are living in another world now. The game board has changed and the sooner we start moving the pieces, the greater our chances to win.

Where do we start?

As with any intellectual engaging a new topic: Review the Literature!

Most of the news I read is concerned with HIV and the direction of sexual health clinics, until I realized that is exactly what MAGA leadership wants me to do- focus on what concerns me. If I am unaware of the issues facing others, then I cannot support them; and in the absence of community connection, vulnerabilities become much easier to exploit. I need to do more as a public health professional to stay informed about issues we face as an interwoven community. 

Everyday, the media is reporting on new ways government and corporate interests are actively working to dismantle health infrastructure, defund programs, and design policies to deconstruct the research and development out of which public health innovation is built. This blitzkrieg is purposefully overwhelming. Rapid, systemic assaults targeting the foundational structures of public health have devastated each of our areas of work and forced our focus away from the larger war that is underway. Our attention is on safeguarding the work we do , and that is just and good; but it must also be in service of the work others in our field do. We have to be aware of the different struggles, and shared experiences, others are having in the field. It is paramount that we stay informed about all the ways public health is attacked. 

By filtering through the cacophony of media distractions and reporting on clown kings, tech giants, and the scandals of wealthy elites, the drums of a war on public health can be loudly heard. We have to break through the noise and listen to the voices telling us what is next and how we resist. We have to start thinking outside ourselves. By keeping up with developments across domains, we can recognize hidden connections, avoid siloed thinking, and collaborate more effectively. 

We must expand the topicality of our media consumption to include everything that affects public health. There is more we can do in solidarity in our field than alone in our focus areas. Read and research other’s issues and share them in your communities. By building coalitions across all of the health and human services sector, we build power; and all of this begins with being interested in public health areas outside your own.

Knowledge is power. Power is how we fight back. Solidarity with all public health workers. Unite for a healthier world.