Public health saved your life today, but you probably didn’t know it.
That was one of the valuable take-home messages from Dr. Leana Wen, when she spoke to public health students and early career professionals at California State University Los Angeles. Dr. Wen was the culminating speaker in our semester-long series on public health leadership. 
This series–which also featured Dr. Chris Chanyasulkit of APHA and Jackie Valenzuela of the Los Angeles County Department of Public Health–was designed to support our department-wide read of Dr. Wen’s book Lifelines.
Here we offer our collective reflections on, and takeaways from, the general conversation with Dr. Wen and her book. Here is what we concluded:
Public health must sometimes set its own table
We think public health faces a real challenge. It must do its work proactively and often invisibly. And its successes are usually the absence of something. The absence of obesity and preventing the spread of disease, for example, are big public health successes. But they are harder to sell in a world that rewards the production of shiny new things. We more easily reward elected officials for building a bridge than preventing cases of COVID-19.
Dr. Wen wrote in Lifelines about the idea that public health saved many lives today, but most people don’t know it. As a result, we think that professionals in public health should prepare to speak more regularly about its value. We think, however, that we should start from a position of empathy. Public health should acknowledge that most of the public has more immediate, daily concerns. And we should avoid the blame game when the public doesn’t understand our perspective.
At Cal State LA, we wondered why our public health faculty and students were not at the table for university decisions about COVID-19. But learning from Dr. Wen, we realize that policy-makers regularly have many different stakeholders in their ears. Her work as the health commissioner of Baltimore city provided many examples of the various groups seeking a seat at the table on issues ranging from gun violence to opioids.
Instead of hoping for a seat at the table, we think public health should show what it can do. At our university, for example, the faculty and students could have crafted fact sheets about COVID-19. We might have developed videos and other health messaging tools, tested them and brought that expertise to the university administration. But public health must also speak the language of university administrators, talking about keeping students safe and learning optimally.
Find issues of consensus when politics and public health collide
When politics and public health concerns do not coincide, it can delay our work to improve health. We learned from Dr. Wen that public health professionals can find ways to work effectively regardless of the politics of the area. We all saw during the COVID-19 pandemic that some parts of the country had a general agreement about public health guidelines; other parts of the country, not so much.
Overcoming this division requires public health to focus on bipartisan issues and areas of consensus to help advocate for community health. For instance, the issue of mental health is gaining traction as a bipartisan issue. Minnesota legislators are currently considering bipartisan legislation to improve mental health in schools. And cross-cutting concerns (e.g., the mental health of veterans and assuring an adequate mental health workforce in rural areas) help to bridge political divides. Despite areas of contention, we think there are issues that can find political solidarity.
As public health professionals, we also recognize that it can be risky to hold partisan positions when seeking political support because policymakers may be deterred from working with us. We have to be especially careful about public platforms, as anything we publish could come back to haunt us. It is very difficult to take back your stance and say that your work is objective and nonpartisan. This is a difficult line to walk because we also need to be advocates for change.
Finding the right message and messenger to make progress in public health
Dr. Wen wrote in Lifelines, “If all we do is talk to people who think like us, we will never make progress or advance our priorities.” She is right. Public health needs to effectively communicate with policymakers who may not understand our work. We must learn about the issues that policymakers care about, and then talk about public health issues in their language.
We know how issues of interest to politicians–schools, jobs, policing, and crime–all tie into public health. But we cannot discuss policy using only traditional public health data. They will tune it out. If we talk about how studies show that addiction treatment decreases crime, however, they may turn their attention to the drug addiction issue because they care about crime.
We also need to find the appropriate messenger, and recognize that sometimes the messenger may not be us. In Lifelines, Dr. Wen described her Safe Streets [pdf] work in Baltimore, and how the city partnered with groups like Catholic charities to operate a violence prevention site. They did this even though the city was involved in a lawsuit about reproductive health care. We should recognize that we may need to work with partners who don’t agree with us, but with whom we may share a common goal.
In her book, Dr. Wen also recounts an attempt by the city to add labels warning about the dangers of sugar to vending machines and other places where sodas were sold. But the beverage industry pushed back, filling city council meetings with employees at nearby Coke and Pepsi plants. The policy was defeated, so the city took a different approach. Officials proposed changing the default beverage sold with children’s meals in restaurants from a soda to healthier alternative. That initiative succeeded. We can see that flexibility is an asset in public health. Instead of fixating on one strategy, we should be prepared with a range of strategies to solve a problem.
Concluding the series on public health leadership
This concludes the month long series on public health leadership. Each speaker in the series made it clear that we need leaders who are ready to act. We also need those who can network and build partnerships, and who can demonstrate the tremendous value of public health. It is true: public health saved your life today. It saved all of our lives, many times over. And it is up to our future public health leaders to make sure the world knows it.
Naeomi Chin
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