Public Health is Boring
There’s a great post by Dr. Kumar over at Healthcare and Public Health directed at public health mavens. I’m not sure what a public health maven is specifically, but I’m willing to bet that anyone who reads a blog post proclaiming, “public health is boring,” probably fits that description. So you’re in the club, too.
Dr. Kumar says that public health’s message is important, but it gets lost. No, scratch that. It doesn't get lost, it gets ignored. He asks:
So why don’t we, the general public, really hear your message?
I posit that the answer is simple: public health is boring. And I say that as someone who has worked in public health for more than eight years. As someone who holds a senior-level position in a health department in a major city in the US, and who is charged with communicating public health to the great masses. I have quite literally seen the enemy, and he is us.
I know that we’re boring because I’m complicit in it. I run our website. (BORING.) I manage our social media accounts. (SNORE.) I regularly review public education materials. (YAWN.) And doing those things makes me look like I’m in the top five percent of most UNboring public health workers. At least to other public health workers.
The thing is, though, that of everyone that I work with, I literally am THE MOST BORING PERSON THERE. I do nothing. I create nothing. I save no lives. I play around on Tumblr and hit the RT button with alarming alacrity.
Others here teach women how to breastfeed, saving their already poor families thousands of dollars and hours of time. Others track down insidious bugs that prey on the weakest among us, killing indiscriminately. Others are healthcare providers of last resort. Kill disease-spreading mosquitoes. Monitor the very air we breathe. Give vaccines. Help people quit smoking. Help people get health insurance. Shut down unsafe restaurants. And then train the people that work at those restaurants how to do it safely in the future. You want heroes? I can’t even count how many we've got.
So how, when you take all of those stories, all of those heroes, can public health still be seen as boring?
It’s easy, I’d argue. It’s because we’re an insular, disconnected field that talks to ourselves. Masturbatory, one might say (and yes, the public health double entendre is intended). Dr. Kumar lays it out so well:
The message of public health is not reserved for academic settings. It’s not just for conferences or journals. And it’s not for public health experts.
And yet.
Have you looked at public health outreach and education materials? Websites? Social media accounts?
Who are they written for? Even if you avoid the dichotomous groupings, general public versus gentrified academics and place these materials on a continuum, almost without fail more will fall on the academic, BORING side.
The reasons we’re boring are myriad and long-standing. First up is our field’s fetishization of John Snow. Additionally, we’re gun-shy thanks to a big miss in disease forecasting way back in 1976. AIDS played a role, and now age is slowing us down even further.
First things first. John Snow, father of epidemiology. Famous for removing the pump handle from the Broad Street pump to help hasten the end of a cholera outbreak in Soho, London in 1854; his map of confirmed cholera cases in relation to the public water pump is widely considered one of the first examples of using data to convey information about disease spread. He’s our rockstar. He’s our reason for being. Wind beneath our wings and all that.
I find no fault with Dr. Snow. He was a smart man (and a smart dresser) who did something innovative and world-changing. My problem, though, is that public health, as a field, has seen his success and tries to emulate it. Exactly. We collect data. And present it (sometimes even in map format). And then we wait for our decision-makers to emulate the St. James parish authorities and heed our advice, removing the pump handle. Dr. Snow’s data was powerful enough to stimulate action. As we feel our data should be. Instead of taking time and making effort to make our data digestible and understandable, we still want to put on our John Snow jammies and cape and save the world, just like he did, marketing be damned.
Then 222 years later, on the other side of an ocean, we freaked out about some pigs. Well, maybe freaked out isn't exactly right. But that’s the way the public remembers it (those few who actually do remember it). For those of us who don’t remember it, in February 1976, four soldiers at Fort Dix, New Jersey were hospitalized with a novel type of influenza A (H1N1). One of the soldiers died. And public health authorities, knowing that it had been more than a decade since the last influenza pandemic, sounded the alarms. Between October and December of that year, more than 40 million Americans were vaccinated against this swine flu. Including President Gerald Ford:
But there were problems with the vaccine. The most notable were cases of Guillain–Barré syndrome as a side effect. The vaccine program was halted in December because of the GBS. All told, about 500 cases of GBS were blamed on the vaccine, with 25 deaths. The flu? One death, out of 20 sick.
One of the biggest lessons learned from that episode was for us not to get too excited about things. Slow down. Disease forecasting is an inexact science, at best, and when you mess up and people die, you naturally get gun-shy. This isn't particularly a bad thing, but it’s another reason why we don’t get all excited and excitable about our work.
A few years later, as a new disease known as the 4H disease (homosexuals, heroin users, hemophiliacs, and Haitians) became GRID (gay-related immune deficiency), and finally became known as AIDS. The stigma associated with the disease, and the fact that this was primarily a public health concern lead us to further internalize our desire to stay out of the news and away from trumpeting our work. Far from there being no benefit to our crowing about our work, doing so could now very much harm people.
Today it’s not so much high-profile failures that keeps public health from standing proudly and tell the world what we do, it is our demographics. We, as a field, are old(er). In 2008, it was anticipated that 250,000 new public health workers would be needed by 2020 to replace retiring employees. What is implicit in those figures is that retiring employees are usually old. And, research has shown us that as we age, we become more risk averse. We avoid new things, we shy away from innovations, we cringe when some young punk comes in and says we should be more open about what we do.
The combination of all of these things, most good, most natural and expected, is a toxic soup that shields public health from the public. Allows our messages to be ignored. So maybe it’s not that we’re boring. Maybe it’s that no one knows that we exist outside of our boring charts and graphs and walls of text written at a twelfth grade reading level in journals that charge to read those words and on websites that are nigh inscrutable (and don’t render on smartphones). We still have public health messages, and we still publish innovative thinking and ideas, we just don’t do it in public. Thinking back to Dr. Kumar, his quote comes into play again:
The message of public health is not reserved for academic settings. It’s not just for conferences or journals. And it’s not for public health experts.
Except that that’s where we talk. And that’s who we talk to. And that’s where we tell our stories.
And that’s a real shame, because today, more than ever in the history of the world, we have the ability to tell our stories in an unfiltered way thanks to things like social media. We don’t have to depend on the mass media to pick up our message and hope they get the word out. We don’t have to hope that the right someone is in the right place when our tri-folds are placed on a folding table. We don’t have to be boring anymore.
But, the fear. The risk aversion. The once bitten, twice shy. The particularly not-bad idea of, “let’s not over-hype everything.” Those things still exist. Those things still make public health boring.
But they need to stop. It’s okay to be nervous, we all know that the internet is forever. But until public health, as a field, gets over those fears, we will continue to be shouted down by those who understand that the permanency and virality of the internet and social media is useful to their cause.
We must compare how our field communicates with the Jenny McCarthy’s and the Dr. Mehmet Oz’s and the other modern-day snake oil salesmen who are exciting and easy to find and easy to understand and whose ideas are easy to share with our friends and family. When we do that, then we will see how we have been found wanting. And then, I believe, will we finally understand the answer to Dr. Kumar’s original question:
So why don’t we, the general public, really hear your message?
Public health, as a field, needs to undergo a radical realignment and re-envisioning of how we communicate. The status quo is not just, “not good enough,” anymore, it is now harmful.
So where do we go from here?
Students, administrators, public health mavens: enjoy your biostats classes, and your program eval classes. Understand and embrace the social determinants of health. And then take all of that knowledge and then don’t talk to another public health person for an entire year. Don’t mention an odds ratio or the transtheoretical model during that whole year.
Instead, take that year and learn how to use Instagram. Learn to code. Understand what lead generation and conversion rates are, and how to track them. Like Coca-Cola’s Facebook Page and steal all of their good ideas. Become a guerilla marketer. Blog, tweet, Vine. Learn how to tell a story. Learn how to sell.
Then, come back to public health. Take all that you've learned and teach public health how to not be boring. Pull us out of our doldrums and circle jerks and poster presentations. Give us our pride back. Make us cool.
…and heard.
