I have spent some time interacting with people concerned about the health of communities. The topic of the definition (and utility) of public health as we know it has been broached many times, and whether my conversation has been with students, peers or friends there tends to be agreement that when certain circumstances arise public health is critically important and worthy of attention. We also agree that soon after the situation passes, like waning immunity, public health fades from memory. Truth is, the "situation" never really passes because health and the factors that impact it are ubiquitous and long-lasting.
This piece is for anyone interested in defining or redefining their role in public health and social impact. It is an invitation (or even a challenge) to engage in a deliberately diverse way. It starts with a nostalgic look back, and ends leaning forward with an eye to the future (think Leo DiCaprio at the front of the Titanic, but leave the ice-berg part out).
All the talk about the upcoming NBA All-Star Weekend in New York made me think back to my first exposures during summer trips from London to Brooklyn in the early '80's The place was so different, and I found every sense stimulated by something new. Bright lights, Viper car alarms, incense, and a host of flavors I was not accustomed to, made it an epic urban adventure. Little did I know it was also my first exposure to public health.
Besides being in the city running the streets with my cousins, these trips were a chance to experience foods I did not get to eat at home. From beef patties at the Jamaican joint, to cheese straws and tamarind balls from the Trini shop, and brown paper bagged wine-coolers from the bodega, I had an array of food options that my teenage palette took to very quickly. Salt, sugar, and fat just taste so good. But it was the cheapest thing that made a lasting impression on me - my Aunt's Kool Aid.
Yes, Kool Aid…that magical diabetic powder with the portly logo. Ten for $1! To make it, you needed a big jug, a big spoon, a big bag of white sugar, water, and one tiny Kool Aid packet. My Aunt would pour the sugar into the jug straight from the bag. She never used a measuring cup and I assumed that she just had some mystery muscle memory that granted her the skill to know when she had dispensed exactly "2 cups" of sugar as called for by the instructions. She would then add the crayola-color contents of the packet and open up the faucet.
The big spoon came next. Usually metal and well worn from banging around many a cast iron "pat" (that's Guyanese for "pot"), she would take her strong right arm and start to stir. The stirring was supposed to stop when the grating sound of the sugar in the jug stopped, but that never happened because all the sugar never dissolved. Being in the midst of some serious scientific discoveries in school at the time I knew why this was, it was called saturation, and it could be rectified can by simply adding more water to the mix...but why would you do that? Everybody knows, Kool-Aid tastes better with a nice layer of partially dissolved sugar on the bottom.
Years later, wanting to improve the health of communities, I have familiarized myself with a few concepts beyond saturation. I understand how our health is impacted by a complex mesh of factors that involve our entire day. From the neighborhood we wake up in, to how much sleep we can get there, "what's (for) breakfast?", and where we go to work (if we have a job), it all impacts our health and well being. Public health teaches us how unbalanced diets and a lack of physical activity impact obesity and cancer statistics. We see how inequities in education, housing, socio-economic status and access to transportation contribute to poor community health. We realize the price of some goods makes them very attractive (particularly when the funds are low), and how maintaining one’s health is forced down the priority list under the weight of taking care of shelter, clothing and the next meal.
My experiences from providing care in emergency departments to oversight of a coordinated case management operation and leadership of health agencies makes me clear that while public health is about surveillance, emergency response, vaccinations, and soda bans, it is also the ultimate “dot-connector” for all social-impact endeavors. New collaborations between unusual partners like social impact investor Goldman Sachs and community-facing social service providers via social impact bonds, or innovative healthcare finance partnerships between investors and health insurance companies seeking non-medical living environment interventions to help improve the outcomes of asthmatic children. These options represent upstream approaches to population health problems. Problems that require public health's involvement to provide strategic engagement plans, design, monitoring and evaluation, systems-level thinking, and adaptive leadership. Our relevance in the next era of population health is as the cogs in innovative social engines that will reshape communities and how we live.
But before we break out the beverages, we have a few things to do. At a time when public health is in the spotlight for another outbreak (measles), it may be considered challenging to make the case for engagement beyond the emergency but this is the time to do just that. As unfortunate as any outbreak is, this one was predictable. Our work with schools and providers to spread a wide vaccination net only worked for as long as we vaccinated enough people. When that number waned so did our community protection. Measles was going to come back. We were successful because we engaged partners in healthcare and education to bring a public health measure to a population we knew were at risk. What if we took a similarly collaborative approach to childhood obesity through collaboration between healthcare providers, an after-school soccer program, a wearable technology provider, and a school of public health? In that scenario we might find a solution worth taking to scale, a new program approach could make it’s way to more inner-city school children, exposing them to their full potential as scholar athletes and members of a team. The wearable tech company might place this on their corporate- social responsibility platform helping them with their double-bottom line and potentially contributing to a dent in an important disease index.
How about using a design-thinking process team to facilitate a problem-solving session for a local a group of researchers from a diverse group of disciplines so they can better integrate with the communities they serve? I will stop stirring now, and leave it to you to decide where this takes you as you consider how to engage in creating new, diverse, interdisciplinary teams and approaches to changing population health outcomes. I think we can drink to that, just not Brooklyn Kool Aid.
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