The past 30 years have seen major public health achievements, such as the passage of the Affordable Care Act and smoking cessation initiatives, but the field is facing a pivotal moment in which it must address past failures and current challenges. And it can’t let previous failures dictate the future, panelists said at a National Public Health Week event hosted by the American Public Health Association.
National Public Health Week, in its 30th year, comes amid a backdrop of major change to public health in the US. HHS offices have been shuttered, and many public health employees have been let go. Anti-vaccine sentiments are growing as measles continues to spread, and the use of fluoride in public water systems, long heralded as one of greatest public health achievements of the 20th century, is now under review by the federal government, while some states and municipalities consider or pass legislation to end the practice.
Issues like these are an opportunity for public health officials to reach across the aisle, meet people where they are and better share what public health workers do to make sure Americans are safe, said epidemiologist Brian Castrucci, president and CEO of the de Beaumont Foundation. “It’s time to reengage. It’s time to talk to people, not to judge. … We have to get better at knowing what to say to people,” he added. “We have to be more like politicians than scientists, but politicians who have trust, who have evidence, who have facts.”
Rebuilding trust
It doesn’t matter whether public health leaders know how to talk to people, however, if people don’t have trust in the system. Panelists agreed that the field needs to rebuild trust, as it “is gained by drops and lost by gallons,” Dr. Georges Benjamin, executive director of the American Public Health Association, noted.
One way to do so is to acknowledge previous mistakes and share changes that have been made as a result, said Dr. Joel Bervell, who hosts The Dose podcast with The Commonwealth Fund. Communities of color have historically felt that they haven’t been included correctly, and building trust within those communities should be based on an understanding of “a legacy of mistrust and where that comes from,” Bervell added, highlighting issues around eugenics and the Tuskegee experiments. That means public health initiatives at the community level can be influential, with local people such as barbers talking with community members about diabetes or other topics they normally wouldn’t discuss.
Working with mayors and other local officials also can move the needle on trust. It’s difficult work, Castrucci said, but explaining the importance of promoting public health initiatives, showing up and collaborating with these allies in local communities over and over will help overcome distrust over time.
Telling the story of public health
The COVID-19 pandemic, for example, highlights how important it is for people to understand what public health workers do, as they often are seen as faceless bureaucrats that no one knows, Benjamin said. Those faceless bureaucrats were giving health advice, which changed over time and subsequently contributed to issues around trust, and disrupted people’s lives.
“The truth of the matter is that we had not built that trusted relationship, and in most cases … people did not come to us seeking our help,” Benjamin said, and added that public health has to do “a better job of telling our own story.”
That goes back to engaging with people at the community level, particularly before there is a specific reason or need. Benjamin reflected on public health leaders’ successes in gaining trust during the AIDS/HIV epidemic by going into communities and talking to people affected by it. “That’s one of the things we absolutely, certainly have to do and it starts now,” he said.
Reconnecting to science and communities
Amid massive change and challenges in public health, Castrucci underscored the importance of understanding where the field has failed, reflecting on how it can communicate public health’s ability to keep Americans safe from disease and other threats, and reengaging with the public.
“This Public Health Week is about reconnecting to what we are, reconnecting to our science, separating our science from our policy, allowing the policymakers to use our evidence, but we have to learn how to talk to everyone and we have to learn it fast because the next game’s going to be up and we need to be ready,” Castrucci said.