On the critical role of interdisciplinarity in population health
Colleagues,
Harry Hopkins, onetime director of the New York Tuberculosis Society and, later, an important adviser to President Franklin Roosevelt, once wrote, “The fields of social work and public health are inseparable, and no artificial boundaries can separate them. Social work is interwoven in the whole fabric of the public health movement, and has directly influenced it at every point.”
Public health and social work have been so intertwined throughout their history as to be twin braids of similar approaches. Many reforms that have supported health in the past century emerged from the Progressive Movement, which, with its focus on measures such as creating safer work environments, healthier food production, and the expansion of civil rights, did much to lay the groundwork for modern social work. These efforts were animated by a fundamental concern for social and economic justice, a concern that is also at the heart of all we do in public health. A healthier world is a just world, and creating such a world is the central aspiration of both social work and public health. Here at WashU, public health and social work have long intersected, with many scholars at the Brown School making important contributions to the creation of a healthier world. It has been a privilege to speak with many of them about their research as part of our ongoing Public Health Ideas series.
The deep link between public health and social work — through a shared history of scholarship, thought, and practice — reflects the critical role that a breadth of disciplines played in the evolution of thought in population health science and in the practice of public health. Public health is fundamentally interdisciplinary, living at the intersection of many fields. It is at its best when it is working in concert with a range of disciplines, toward a shared goal of excellence in pursuit of a better world.
Let us take the example of medicine. Medicine, of course, has long been the incubator of ideas for population health, while itself intersecting with the world of social policy. This was well captured by the 19th century doctor and biologist Rudolf Virchow, who said, “Medicine is a social science, and politics is nothing else but medicine on a large scale.” Virchow came to this realization through his work in Upper Silesia, where his efforts to address a typhus epidemic caused him to realize that the true roots of the problem were the suboptimal social, economic, and political conditions in the region. Virchow saw that, to make a difference at the population level, doctors must engage with politics, social work, and everything else that affects the context in which their patients live, and that are the true drivers of health and disease.
It could be said, of course, that the intersection of social work, medicine, and public health represents a fairly obvious pairing, but what about public health and the work of, say, the arts? In fact, public health and the world of art are closely connected. Art both reflects and influences the world around us, the conditions that generate health. It represents the moment and helps us to imagine new futures. I remember, for example, when I first saw Tony Kushner’s play “Angels in America,” I was struck by how powerfully it conveyed the reality of the AIDS crisis while also presenting the audience with a vision of a better, more humane future where LGBTQ individuals could live dignified lives free of stigma and bigotry. We are closer to such a world today in part because of the art that insisted, decades ago, that such a world was possible. This speaks to the key role of art in helping us to imagine and shape a better world by showing us the world as it is and then telling us how it might, must, be better.
Just as public health links to art, to social work, to medicine, it also links to business, philosophy, engineering, government, psychology, architecture, computer science, and much more. Public health exists, and emerges, very much from the interstices of disciplines. One of the joys of my career in public health has been to explore these interstices, engaging with individuals and organizations from many sectors. This has been perhaps most salient in my work on urban health, which has built on and drawn from a range of fields, including urban planning, architecture, design, sociology, and anthropology.
Public health’s essential interdisciplinarity is inseparable from its fundamental mission, which has been defined by the Institute of Medicine as “assuring conditions in which people can be healthy.” Assuring these conditions, be they economic, physical, or social, means drawing on a full range of disciplines and understanding how they inform and reflect the conditions that create health and disease. This means there can be no public health without interdisciplinary arbitrage, where we work across disciplines to identify ideas and insights that can inform what we do. Working across disciplines helps us to find solutions to the challenges of the moment and build a big-tent movement for health that brings people with many different backgrounds and skill sets together in our shared pursuit of health.
As an example, let us take the issue of over- and under-nutrition, of obesity and attendant noncommunicable disease such as diabetes and heart disease. Solving this problem requires epidemiologists and nutritionists, yes, but it also takes agricultural specialists, plant scientists, and lawyers who are experts in regulations that govern what goes into our food, to name just a few of the stakeholders who have a role to play in this work. Or take the issue of climate change and its consequences for health. To tackle this existential challenge, we need the input of atmospheric scientists, mental health epidemiologists, ecologists, biomedical engineers, business and political leaders, artists and philosophers, and many more. Finally, there is the example of addressing infectious disease. For this we need vaccinologists, biologists, medical professionals, social and behavioral scientists, communication experts, pharmaceutical executives — and this is just for starters.
Creating a healthier world, then, is a multisectoral, whole-of-society effort. In an academic context, this means engaging with different disciplines to promote the understanding that the work of many fields and departments does indeed overlap with public health, and that building a healthier future together is an extraordinary opportunity for us to pursue our mission in the academy of creating a better world. A great university such as WashU is ideally positioned to engage with this mission. It is no accident that many of the professions I have mentioned that are core to tackling challenges such as obesity, climate change, and infectious disease are represented in the work being done by WashU’s schools. As an academic community committed to local and global impact, the pieces are all here for making the interdisciplinary connections that elevate our pursuit of excellence within our individual disciplines, and as a whole, toward building a community greater than the sum of its parts.
Just as interdisciplinarity is core to the work of health, it is core to the work of building a great School of Public Health at WashU, a central pillar of our 4×4 plan for success. I have been calling this initiative Public Health Plus, and it entails forging partnerships across disciplines within the university to find synergies and areas for collaboration, including through the creation of interdisciplinary research networks at the heart of the school. I am looking forward to seeing how this propels us to catalyze interesting ideas in ways that may otherwise elude us, and how we can push ourselves to think differently indeed. Thank you to all who have engaged with this process, toward building partnerships that can help make this great university even better and the world healthier.
As I conclude, a reminder that if you are interested in receiving more procedural notes about what we are doing as we build the School of Public Health, you can sign up here. On all, I look forward to continuing the conversation.
Warmly,
Sandro
| Sandro Galea, MD, DrPH Margaret C. Ryan Dean of the School of Public Health Eugene S. and Constance Kahn Distinguished Professor in Public Health Washington University in St. Louis |