We have a toxic culture, one full of myths that blind us to how the society really works and for whom. American Exceptionalism indeed! It tells us that we are blessed with unlimited opportunities to better ourselves, and that if we fail to do so, it is solely our own failing. By promoting individualism and materialism at the expense of community solidarity, it damages our mental health. That culture is what shapes the behavior of everyone in the society by teaching us how to see ourselves and the world, so it will not do for public health to promote better lifestyles for everyone while failing to identify and confront all the socio-cultural influences adverse to its goals. To do so is implicitly blaming the victim. 1 The failure to provide the full story is an oversight unacceptable from an agency like the CDC tasked with the missions of prevention and promotion, as well as from agencies like the National Research Council of the National Academy of Sciences whose mission is to inform citizens. 2 

The dysfunctional nature of our culture is evident in the depreciation of our communities. Too many of our cherished myths promote “free enterprise” without reference to the value of investing in the community that sustains us. Success in our society today results from a competition that separates us from our fellows. Our lives are fragmented – no longer do they track the kinds of lasting social relationships we used to have. It is increasingly difficult for us to find the meaning and purpose in our lives on which our wellbeing depends.

And it is children who suffer most from adverse childhoods in that culture when they lack consistent emotional connections to caregivers. They develop without the social sense and the empathy that would connect them to others. They often don’t learn the values that empower us to care for ourselves and for others.3 For these reasons, public health must place greatest priority on improving the quality of life for families. That can only be accomplished through everyone’s efforts once everyone sees all that is to be gained and all that must be done. I think that is the goal for public health: To reveal the ways in which wellbeing may be achieved. We cannot avoid seeing that society is our patient.

The public health ethic is one that seeks fundamental social change. It seeks a society that maximizes the human capacities to flourish of each and every one of its members, but that can only be achieved through empowerment of the community that supports them. Healthcare workers can incentivize individuals to meet certain goals, but communities can incentivize them to live better lives. Community derives its strength from a commonality of interests that requires a measure of social and economic equality.

Public Health Practice: Informing the Debate

Public health must identify all of the impediments to good health no matter how far upstream they are found. Its moral voice is needed more today than ever before in its history. When will we stop pulling babies out of the stream and make our way all the way upstream to the spring into which they are being dumped? That’s the spring we all have to drink from.

I want public health to regain its integrity by returning to its mid-nineteenth century roots and confronting the barriers to social justice in their political context. I think it may be more willing to risk doing that if it sees itself standing on the shoulders of giants. Public health’s key tool is epidemiology, and that epidemiology is political. Most of all, its obligation is to explain to its patient – the society – how power and privilege are distributed and used to drive agendas that oppose health and well-being for all.4 If it fails to do this, it remains part of the conspiracy opposed to greater equity and to the health improvement for all that can only be realized through greater equity.5

The greatest triumphs of propaganda have been accomplished, not by doing something, but by refraining from doing. Great is truth, but still greater, from a practical point of view, is silence about truth." – Aldous Huxley, Forward to Brave New World (1946)

It does take our whole village to correct this, but our village cannot do so without first understanding what is happening and who is responsible for it. It is happening well upstream of the health system, which is where public health must go to reveal the pathology of our dominant political and economic ethic, and to reaffirm its responsibility for showing the way toward wellness for all. Public health has always had an important story to tell, that of the human condition, and to fulfill its own ethic, it must complete the story.

Submitted by John Steen