Now What for Public Health?
The U.S. election this week sent shock waves through the field of public health—not just domestically, but internationally as well.
For many in public health, like me, the prospect of national leadership by individuals with an established track record of ignoring the evidence is deeply disconcerting. This has led to anxiety (and even feelings of loss and sadness). So much is unknown about the future of this field—from policies like routine vaccinations, to the impact of falsehoods moving mainstream, to the resources available to hold up an “invisible shield” for the public’s health.
What is becoming increasingly clear is that we are entering a new world. As we put one foot in front of another, we must remember there’s a difference between what we can and can’t change, and sometimes, there’s a difference between what is easy and what is needed.
This will be a different world
While we in public health are all too familiar with the cycle of panic and neglect, this terrain is different. The leadership choices are categorically unreliable for scientific narrative.
RFK Jr. will have more influence with his cast of characters, who have a history of opposing evidence-based public health practice. For example, RFK Jr. founded Children’s Health Defense, a well-oiled machine responsible for 1 in 4 low-credibility Tweets during the pandemic, leading to a large profit. His influence also led to a Samoa outbreak of measles that caused more than 80 deaths, mostly among children.
Tweets shared by users geolocated in the U.S. that link to a low-credibility source. Source: Nature
Similarly, the Washington Post reported that Joseph Ladapo—the Florida Surgeon General—is on the shortlist for the Secretary of Health and Human Services. Although a doctor, he has a well-documented history of falsehoods about Covid-19 vaccines and went against the standard of practice guidelines for a measles outbreak at a Florida school.
Leadership matters. Ineffective or dangerous health policy decisions can be driven by mixing reasonable ideas with falsehoods and/or not accurately identifying what is causing us to be unhealthy and “fixing” that. For example, RFK Jr. said his first move would be removing fluoride from water—this is not grounded in scientific evidence, and reflects a fundamental misunderstanding between a hazard (that something could potentially cause harm) and a risk (the probability of something happening).
Importantly, all of this unfolds after 5 years of public health being through the wringer. And, in an already shifting landscape: general amnesia of vaccine-preventable diseases, loss of trust in institutions, and a changing information landscape fueled by social media. This has led to policies like the following:
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Last month, 6 counties in Idaho outright banned the availability of Covid-19 vaccines.
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Texas doesn’t allow public health departments to educate about Covid-19 vaccines.
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Missouri has removed the ability for public health departments to report data to WHO (and thus, CDC).
How we navigate this new world will matter
We will all overcome this together, and we will do so through thoughtful and clear communication.
For individuals, this will mean consuming information with a healthy skepticism. For trusted messengers, like physicians, faith-based communities, and businesses, your jobs are more critical than ever. For institutions, this means we need your courage to protect those who are speaking truth. For public health leaders, it’s time to be proactive.
How we navigate this changing landscape will matter if we want to ensure that public health is still guided by values that are important to all of us. This does not mean surrendering our mission but rather finding balance.
For public health (and all of us), this means:
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Building bridges instead of manning the barricades by finding common ground, which requires active engagement and humility. (It always helps me focus on one fact: No one wants to die. Then I move from there.)
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Recognizing what you say matters. That is, if you want people to hear you. Through literally the words we use, the framing, and the approach.
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Communicate with empathy, as anger and shame will only drive people further away.
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Listening (not simply hearing) so we can respond better to the needs on the ground. Americans need their questions answered, not to be told what to believe.
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Making strategic choices about which battles to fight, at what time, and at what level of government. Political capital is as scarce as financial resources—and needs to be allocated carefully.
I think our biggest challenge will be fighting for the truth.
In this new world, there is a good chance that falsehoods and rumors will be broadcast from the most powerful office in the nation. This will drive even more confusion, anxiety, and questions that will have a direct, negative impact on Americans who genuinely have questions and are interested in making evidence-based health decisions.
We need to elevate reliable narrators to provide a counterweight. Unfortunately, voices that provide unbiased, evidence-based information are increasingly vulnerable, have limited capacity, and are in a fragmented world. Some Good Samaritans are holding up the front lines of science communication, but only with band-aids, hope, and very limited funding (if at all).
Bottom line
We are entering an uncertain and unfamiliar public health world. We must adapt effectively while keeping true to our mission—to protect the public’s health—as our North Star.
One thing is for certain: The entire YLE team will keep showing up. We will continue sharing accurate, honest, and reliable public health information regardless of politics. And we will still be here to empower you all to make evidence-based decisions to keep yourselves and your loved ones healthy. That won’t change.
Love, YLE
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Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. The main goal of this newsletter is to “translate” the ever-evolving public health science so that people will be well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support this effort, subscribe here.