By Leslie E. Wolf
With our recent (and continuing) experience of the devastating COVID-19 global pandemic, one might think that our collective appreciation for public health efforts and the people advancing those efforts would be high. Instead, public health officials have been vilified and attacked, and public health laws have been weakened, leaving us vulnerable to the next public health emergency.
So, how do we move forward? An essential first step is to refocus on the “public” in public health. Public health efforts and public health law depend on community support.
Now is the time to actively solicit input from different populations to learn about their experiences, needs, and concerns from the pandemic. The pandemic highlighted the structural inequities that persist in the United States and their continuing impact on health. People from historically marginalized populations experienced disproportionately high rates of illness and death, often the result of structural inequities that increased exposure. Shutdowns curbed exposures, but also increased economic stress, particularly for those in lower-paying, hourly jobs. When vaccines became available, distrust — rooted in historic abuses that go well beyond the infamous Tuskegee syphilis study — impacted uptake. But so did choices regarding how to distribute vaccines; for example, mass vaccination sites typically were inaccessible to those who rely on public transportation.
The pandemic also underscored that, as the World Health Organization has stated, health is not simply the absence of disease. Shutdowns undoubtedly saved lives. But they also had costs. Students have lost educational ground. Social isolation has led to a mental health crisis. And we may never know the full morbidity and mortality impact of policies that kept family from visiting loved ones in hospitals or long-term care facilities. We may not have learned that my mother was not eating while in long-term care had she not developed inflammation that required outside medical care.
Understanding how public health “worked” from the community perspective can and should inform public health efforts moving forward. What works in one community does not always work in another. Public health officials should learn from those experiences.
And while it is often easy to focus on what went wrong, public health officials should also focus on what went right. There are multiple examples of successfully collaborating with faith communities, barbers and hairstylists, and other trusted community members in public health campaigns. Some communities successfully deployed those techniques in the pandemic. For example, in Clarkston, Georgia, a community with a large refugee population, the Georgia State University Prevention Research Center hired trusted community members, translated education materials, and operated vaccine sites at schools, churches, mosques, and other easily accessible spots to achieve the highest vaccination rate compared to similar cities in Georgia. These examples demonstrate what can be achieved when we listen to what the community needs.
Engagement should never be a one and done affair. The term “helicopter research” connotes studies that fail to involve the community in their planning, execution, or results, which may contribute to distrust. The same concept can apply to public health, for example, if officials come to a meeting once and are never seen again. All engagement should be directed at developing and maintaining ongoing relationships within their constituent communities. Public health needs a mechanism for regular community communication that can help officials assess how a proposed policy will impact different communities and allow changes to adopt policies that are more equitable and more acceptable. HIV researchers have long looked to community advisory boards to get critical input on proposed studies. The Congressionally Directed Medical Research Programs incorporate community input into its peer review process. Based on my personal experiences, both approaches have steered researchers away from strategies that will be unacceptable to the impacted communities. With similar input, public health can select among the options — and there are always options — and direct its efforts in ways that advance public health goals, but are more likely to obtain community buy-in.
While listening to communities is an essential first step, these interactions also provide an opportunity to communicate about public health. Before the pandemic, public health typically operated in the background — invisible to most. In this sense, I often commented that public health was a victim of its own success.
Now, people may associate public health only with the pandemic and divisive mandates. Indeed, it is easy to point to the politicization of public health measures during the pandemic as the cause of the lack of trust in public health — we are all familiar with the disputes over mask wearing, vaccine mandates, and when and what businesses to reopen. But accepting that response is too simplistic and ignores a history that requires further investigation if we are going to restore faith in public health.
Helping people understand all that the field does to support the public’s health and well-being would lay a foundation on which to restore trust. People should appreciate that public health is responsible for inspecting restaurants and investigating food outbreaks, monitoring air and water quality, improving workplace safety, planning healthy cities, providing preventive care, among other things; all of this improves our collective quality of life. And as we build the support from the public for fundamental public health efforts, we can begin to work toward reinstatement of public health law’s essential tools.
Leslie E. Wolf, J.D., M.P.H. is Distinguished University Professor and professor of law, with appointments in the College of Law and the School of Public Health at Georgia State University.