When Abdul El-Sayed won the Democratic primary for the U.S. Senate in Michigan this week, much of the coverage focused on what his victory meant for Democrats and the midterm elections. But I found myself thinking about something completely different:
He’s an epidemiologist.
Health professionals are certainly not new to Congress. Many physicians have served, including Bill Cassidy and Rand Paul, who are perhaps two of the most recognizable ones at the moment, though for very different reasons. And they are among a cast of 20 or so physicians who are current members of Congress. Nurses and physician assistants too have become increasingly active in elected office at many levels of government.
But what about public health professionals?
I honestly didn’t know. So I took to reviewing Congressional backgrounds myself, and I found lots of lawyers. It seemed almost as if Congress had reserved seats specifically for the law profession. But I also found many educators, business executives, military veterans, and farmers. And still, by my preliminary count, there may be more members of Congress who are radio talk show hosts than who have careers in public health. 
Seeing so few public health professionals in Congress is maybe a little surprising. Not because a public health background makes someone a better elected official, but because public health is fundamentally about public policy. While clinical training begins with individual patients, public health training begins with populations. As a result, public health professionals spend much of our careers evaluating how laws, regulations, and public investments shape the health of populations.
Still, it seems that relatively few people with that background ever become the ones voting on those laws. In other words, public health professionals spend much of their careers implementing policies written by people never trained in public health.
Legislatures are critical public health institutions
Elected officials at all levels make decisions about housing, education, transportation, environmental protection, farming and food, healthcare, and countless other issues that influence health long before anyone walks into a doctor’s office. Many of those decisions aren’t typically labeled “health policy”, but public health professionals know they are.
As we see it, they are the political determinants of health.
Take wildfire smoke. Imagine you’re a legislator during another difficult fire season. A thick gray smoke settles over the state and communities you represent. Schools and recreation centers debate whether to cancel outdoor activities. Parents wonder whether it’s safe for their children to play outside. Emergency departments begin seeing more asthma.
A legislator might rightly ask how much emergency funding is needed to fight the wildfires and then to help families recover. Another might ask if schools should close, for how long, and whether to open community centers for evacuees. Public health professionals in Congress might ask an entirely different set of questions:
- Why don’t more of our schools have better air filtration?
- What neighborhoods have the worst exposure and how do we protect them?
- How do we slow the environmental changes contributing to these wildfires?
None of those questions belong to a particular political party. And rather than try to solve today’s emergency, all of those questions try to prevent or reduce harm from the next one. Every profession develops its own way of thinking, and that prevention framing leads to a useful set of questions for every legislative chamber.
Public health is very good at advising policymakers
Most public health institutions teach students to understand policy. We teach the major tools of legislative work, including policy analysis, advocacy, community engagement, and program evaluation. Graduates often go on to careers in health departments, state agencies, nonprofits, and healthcare systems, where they shape and implement policy.
Yet, we rarely (if ever) talk about running for office. Maybe that’s because public health has traditionally viewed itself as a science-driven, advising profession rather than a governing one. Public health professionals by tradition and practice produce evidence and inform decision-makers. And staying neutral offers credibility that is indispensable.
But perhaps that’s not the only mode d’être for public health practice. Maybe the next challenge is producing a few more public health professionals, like Abdul El-Sayed, who are willing to buck tradition, leave the comfort of local practice, and take responsibility for a larger set of communities. Maybe more will become policymakers.
This one primary victory may ultimately have little influence on these broader questions. Or maybe, years from now, this epidemiologist’s campaign–alongside the apparent sliver of other public health professionals in Congress–will have invited the next generation of public health professionals to imagine another career path and run for office.
Gregory Stevens