Defining Public Health

Me: “I’m moving to New York City and getting my MPH at Columbia University!”

Friends, family, victims of small talk: “Wow, Columbia. Very impressive, Jordan! What’s an MPH?”

Me: “I’m going to be a Master of Public Health.”

Them: “Right on… what is public health?”

After a 3,000 mile relocation and a New York City culture shock, you would think I would have a calculated response. It’s a question that all MPHer’s inevitably encounter.

What is public health?

Without an answer, I loaded up with panic and self-doubt. What do I want to spend my life doing as a person in this vast, collaborative field? Rather than stagnate with worry, I chose to embrace the uncertainty. I was familiar with the scripted definitions of population health and epidemiology, but I had faith that a more fundamental meaning of public health would come naturally at Mailman, and it has.

Our health is the foundation for every other aspect of our lives: financial prosperity, professional success, and even starting a family. These qualities of life are best appreciated by a healthy person. And while public health acts to protect the health of the people, I’m learning that we also have to identify the many threats to health. The Core Curriculum at the Mailman School is teaching me that disease is a disturbingly reliable indicator of social inequality. Disease is the unavoidable proof of an individual’s financial and social constraints.

There are connections between health and social status. I assured myself that I had a rational and comprehensive understanding of these connections before coming to Mailman. But after only 3 months in the immersive experience of our demanding academic regiment, I know that my original understanding is insufficient. There needs to be action.

Public health is about viewing problems as a system of complex interactions, not in isolation..

Public health has the privilege and the duty to ask: What are we going to do about the social inequality that drives poor health? Public health professionals cannot simply identify causes and give advice.

I am sensing a collective understanding that we must enter our profession with a sense of adaptability in collaborating with professionals from every imaginable field. Whether an epidemiologist or a sociomedical scientist, MPHer’s also get to wear the hats of a policy maker, of a social activist.

Dr. Amy Fairchild gave my favorite definition of the field when she said simply, “Public Health is an argument.”

After stewing over her terse answer to my career-defining question, I think I now understand what Dr. Fairchild meant. Public Health is an argument of what is moral, what is fair. We debate where to intervene in the lives of our people, and we deliberate on how to get people to do what we think is best for them. Public health is society, it is politics, it is people. Our field is faced with arguments of morality that require the poking and prodding of cultural paradigms which many would rather leave untouched.

Why has Ebola killed thousands in Africa, when the epidemic would have been more effectively controlled in developed nations? Why did it take Ronald Reagan years, while his citizens were dying, to even utter a four letter acronym, “AIDS”? Why do poor people get sick and die sooner than rich people? Why do people insist on ignoring issues until they are personally affected?

The answers to these and many other questions, I believe, constitute the true definition of public health.   Leaders of the world are tasked with providing opportunities to maximize human potential, and no one can reach their full potential in poor health. First world public health has to find ways to improve the health of people with too much: too much food, too much free time, too many ways to lead a sedentary and lethargic existence.

But we must not forget about the millions of people with nothing, and that their health will likely never improve unless their circumstances do. In my opinion, this should inform every action of the public health professional.

You may be asking, “What does this first year grad student know?”

I know that I am thankful for my education thus far here at Mailman. I know how to approach the questions that once pushed me into professional uncertainty, and I know that there is much more to learn, and much more to do. Public health is sticky, it is tangled, and the tasks ahead of us are monumental. But with a reassuring mix of optimism and determination, I know that someone’s got to do it, and I know it might as well be us.