Aligning academic public health to improve the health of the public

Colleagues,

On July 16, 1798, President John Adams signed into law the Act for the Relief of Sick and Disabled Seamen. The law, which was a response to a particularly bad outbreak of yellow fever among coastal communities, deducted 20 cents from the monthly wages of merchant seamen to build marine hospitals and cover the costs of care for patients. It was the first federal health law ever passed in the U.S. Its purpose was to make an immediate difference in the health of the sailors in need of care, and in the health of the new nation, which needed a robust merchant marine to sustain a healthy economy and a strong national defense. The act led to the creation of a network of marine hospitals, which, in turn, would be organized into the creation of the Marine Hospital Service, which would inform the evolution of the Public Health Service Commissioned Corps. 

This story exemplifies how public health institutions were created in this country, from the very start, with a focus on impact, toward making a difference at the level of individuals, communities, and the social and economic forces with which they intersect. Public health policy emerged as a practical solution to problems on the ground, its growth driven by its capacity to deliver tangible improvements in people’s lives. First came a need — the needs of sick and disabled sailors and of a nation that required a healthy merchant marine. Then came policy, and following policy came the makings of a public health infrastructure. The success of these efforts in justifying their cost led to more hospitals, more organization, and, ultimately, a key component of our national public health response. From the beginning, the pursuit of impact shaped the trajectory of public health in this country. 

This anchors my central point in this community note. I previously have articulated a 4×4 plan for moving ahead as a School of Public Health. In February’s note, I discussed the notion of Public Health Plus, or the centrality of an interdisciplinarity approach to all we do. Today, a focus on another element of this strategy — local and global impact. The ultimate goal of public health is the creation of healthier populations. Academic public health is perhaps unique in that our commitment as scholars to generating knowledge and communicating that knowledge to the next generation is accompanied by our commitment as public health professionals to thinking and acting in ways that create a healthier world. As a School of Public Health, then, we are motivated by the pursuit of local and global impact. What does this mean in practice? After all, we do not directly deliver services. Rather, we work in partnership with local populations and organizations that perform such delivery, that engage in the daily work of implementing policies and distributing resources that make a difference in communities. How can our school help to drive these efforts by supporting existing pathways to impact and building new ones? I would like to suggest we can do so in three ways. 

We will generate evidence that can lead to action. We should aspire to do work that makes a tangible difference in the lives of people and communities. In the context of population health science, I have long argued for a consequentialist approach to what we do. This means asking questions in our scholarship toward generating data that help us to intervene in pursuit of healthier populations. As a school, we can do this by thinking about our research in terms of its potential for making a difference in the health of communities. This does not mean that everything we do must lead direction to action, but it should mean that we pursue work that is relevant to generating a positive impact at the local, national, and global levels. As a school, we do this first by generating the data and ideas that can serve as a solid basis for policies that make a practical difference in the world. But we should not stop there. Evidence alone cannot generate impact. In the policy space, evidence intersects with local context, the unique policy concerns of a given place, and the often-complex politics of implementation. We should operate with an awareness of these factors, so that our evidence can better take root in the world of practical policymaking, to support local and global impact. This means encouraging and celebrating work that is done with an eye toward these pragmatic concerns, so it will be maximally accessible and impactful.    

We will translate our work so it will be familiar to those who work in the implementation space. It is important to remember how much of a gap there can be between thinking and doing, ideas and their practical effect on the world. There also can be a gap between our understanding of public health evidence and that of policymakers, who may not always share our fluency with the data and its implications. It is on us to be able to communicate our data so it can be understood by the full range of stakeholders who are part of the pipeline from ideas to implementation, including policymakers, the media, and communities. By promoting greater awareness and understanding of our work, we can succeed not just in achieving the implementation of favored policies, but in cultivating the public trust and community buy-in that are so important to our efforts at every level. 

We will build partnerships to catalyze action. The capacity of any one individual or community to have an impact will always be less than what it could be in partnership with others. Even the entire field of public health, working on its own, cannot achieve nearly as much as when it works with other sectors and partners with communities, rather than engaging with them as a matter of charity alone. It is important to remember that, even as we aspire to change systems, the success of our efforts depends on forging partnerships with individuals, communities, and organizations. It is not enough to have the ear of influential decisionmakers, or funding from foundations and institutions. The essential building blocks of our success are the constituencies we are able to activate at all levels in pursuit of a healthier world. 

Building partnerships means reaching out, creating a big-tent movement, engaging with those with whom we disagree as much as with those whose ideas align with our own. It is our job to publish, to write, to promote ideas and to partner, listen, and elevate the ideas that generate health. This aligns well with a recent essay in the Chronicle of Higher Education by Chancellors Martin and Diermeier reaffirming academic freedom of expression — creating space for all ideas — as a core principle underlying all we do. Leaning into this means that we should be unafraid of “going out on a limb” with our ideas. This can mean both pushing the boundaries of progressive policy (can we, should we, talk about reparations? About safe injection sites?) and engaging with more conservative-coded approaches when the moment seems to call for it (can we move beyond an abolitionist paradigm in our approach to policing? Can we, without denying the reality of climate change, recognize the role of fossil fuels in keeping energy accessible for low-income communities?) All of this takes courage. It is not easy to make new connections, to engage with new ideas. It can place us in positions of vulnerability, of discomfort. And that is OK. The reward is building a school, and a field, that do not alienate, that bring people in, toward the creation of networks that can operationalize the ideas that support a healthier world.     

In recent weeks, the importance of local and global impact has only grown, as the actions of the new administration have taken shape. With uncertainty over the future of federal investment in health, local and global organizations whose job it is to preserve and promote health are becoming ever more important. Our role in the academy is to double down on our commitment to this work, to shape durable pathways to impact that are rooted in wide networks, a solid base of public support, and the data and ideas that inform responsive, cutting-edge public policy.   

Also, of note

I would like to draw attention to three convenings the School of Public Health is co-hosting with partners locally and globally.

The “Business for health: Finding business and public health convergence towards reducing and managing Noncommunicable Diseases (NCDs)” global dialogue, is being organized in partnership with the World Health Organization and the Olin School of Business at WashU. The event will take place virtually March 27-28, 2025, from 8:30-10:30 a.m. ET; 1:30-3:30 p.m. CET. Registration is here. 

Coincident with the 78th session of the World Health Assembly, we will be hosting a Washington University ideas event, “Listening to people to improve health systems: Post-COVID trends in public attitudes on healthcare,” in partnership with the Alliance for Health Policy and Systems Research. The event will be May 22, 2025, in Geneva, Switzerland, 12-1:30 p.m. ET, 6-7:30 p.m. CET, and also will be livestreamed. Registration is here. 

We are hosting our annual public health convening on Science for Health Systems, in partnership with the QuEST network. The meeting will take place in St. Louis, Mo., October 29-31, 2025. The meeting will focus on new research on the measurement and improvement of health system performance. There are limited spots available for registration, and discounts for early-career professionals. Program details and registration are here. 

Thank you for passing these along to anyone who might be interested.

As I conclude, a reminder that if you would like to receive regular updates on the more procedural side of the work we have been doing to build the School of Public Health, you can sign up for weekly notes here. I look forward to continuing the conversation about how we can shape a community that makes a difference in this moment and in the years to come.

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

Vice Provost for Interdisciplinary Initiatives

Washington University in St. Louis