Thread by @FLAHAULT

1/18 - “There was a time, at the start of the 20th century, when the field of public health was stronger and more ambitious.”
theatlantic.com/health/archive…

2/18 - “A mixed group of physicians, scientists, industrialists, and social activists all saw themselves as part of this giant social-reform effort that was going to transform the health of the nation.”

3/18 - “They were united by a simple yet radical notion: that some people were more susceptible to disease because of social problems.”

4/18 - “And they worked to address those foundational ills—dilapidated neighborhoods, crowded housing, unsafe working conditions, poor sanitation—with a “moral certainty regarding the need to act,” Rosner and his colleagues wrote in a 2010 paper.”
ncbi.nlm.nih.gov/pmc/articles/P…

5/18 - “A century and a half later, public health has succeeded marvelously by some measures, lengthening life spans and bringing many diseases to heel.”

6/18 - “When the coronavirus pandemic reached the USA, it found a public-health system in disrepair. With its overstretched staff, meager budgets, crumbling buildings, and archaic equipment, it could barely cope with sickness as usual, let alone with a new, fast-spreading virus.”

7/18 - “Public health has actively participated in its own marginalization. As the 20th century progressed, the field moved away from the idea that social reforms were a necessary part of preventing disease and willingly silenced its own political voice.”

8/18 - “By swimming along with the changing currents of American ideology, it drowned many of the qualities that made it most effective.”

9/18 - “Although the old public health “sought the sources of infectious disease in the surroundings of man; the new finds them in man himself,” wrote Hibbert Hill in The New Public Health in 1913.”

10/18 - “This revolution in thinking gave public health license to be less revolutionary. Many pract. no longer felt compelled to deal with sticky, sweeping problems such as poverty, inequity, and racial segregation (or to consider their own role in maintaining the status quo).”

11/18 - “As public health moved into the laboratory, a narrow set of professionals associated with new academic schools began to dominate the once-broad field. It was a way of consolidating power: If you don’t have a degree in public health, you’re not public health.”

12/18 - “Public health began to self-identify as a field of objective, outside observers of society instead of agents of social change. It assumed a narrower set of responsibilities that included data collection, diag services for clinicians, disease tracing, and health educ.”

13/18 - “Epidemiologists now searched for “risk factors,” such as inactivity and alcohol consumption, that made individuals more vulnerable to disease and designed health-promotion campaigns that exhorted people to change their behaviors, tying health to willpower.”

14/18 - “The pandemic has proved what pub health’s pract understood well in the late XIXth and early XXth: how important the social side of health is. People can’t isolate themselves if they work low-inc jobs with no paid sick leave,or if they live in crowded housing or prisons.”

15/18 - “They can’t access vaccines if they have no nearby pharmacies, no public transportation, or no relationships with primary-care providers. They can’t benefit from effective new drugs if they have no insurance.”

16/18 - “Public health is now trapped in an unenviable bind. Public health gains credibility from its adherence to science, and if it strays too far into political advocacy, it may lose the appearance of objectivity.”

17/18 - “But others assert that public health’s attempts at being apolitical push it further toward irrelevance. In truth, public health is inescapably political, not least because it has to make decisions in the face of rapidly evolving and contested evidence.”

18/18 - “The field in the late 19th century was not a narrow scientific endeavor but one that stretched across much of society. Those same broad networks and wide ambitions are necessary now to deal with the problems that truly define the public’s health.”