American Public Health Association
800 I Street, NW • Washington, DC 20001-3710
(202) 777-APHA • Fax: (202) 777-2534 •

Desiderata: Thinking Outside the Box

By John Steen




What is it that makes it so difficult to do public health in America? The answer lies in the culture of our nation, the foundation of all the social determinants of health. Our culture does not promote thinking, so our population does little of it, nor does it value scholarship, so inquiry is suspect. That makes it especially difficult to “inform, educate, and empower people about health issues,” an essential public health service.


What the culture does promote are myths that further corporate profit making interests in a class war while obscuring political, economic, and social reality behind a screen that effectively blinds the perception of the general public.1 And so we are necessarily involved in a war for people’s minds. Improvement of the public’s health depends on their seeing how corporate power is used against them, especially in the political system. To improve public health, we must improve people’s political sophistication, so that must become an integral part of our practice. Community health education requires civic education and involvement.


Health improvement is not just about describing power, but using it. The manifest aim of public health to empower people can only be achieved through their participation in power. When will we see that Martin Luther King, Jr. was a great public health leader for promoting exactly that?2




“Most people would rather die than think; in fact, they do so.”


                                                            -- Bertrand Russell (1872-1970)


Said about 90 years ago, I think Russell’s remark explains the power of culture over the lives people live. Culture – as the foundation for all the social determinants – exercises the most profound effects over how much control individuals have in living their lives. Culture influences people’s success in life as well as their health status, and it does so largely by determining how people perceive opportunities, and through the expectations it creates for the individual and the society.


I find a large part of the reason for our poor health in our poor education, in the fact that we teach marketable skills rather than teaching how to think, read, write, and learn throughout a lifetime. We learn how to make a living, but not how to make a life. The ultimate question for public health is really the Socratic question, “How should one live?” But this is the ultimate political question too.

The essential public health service to “inform, educate, and empower people about health issues” requires people who think for it to be successful. The lesson for public health: A smarter population is a healthier population.


Knowledge is power. Orwell wrote that, “Who controls the past controls the future. Who controls the present controls the past.”


Let us be aware of how societal health disparities are denominated in perceptions as well as in incomes. W. I. Thomas’s maxim that, “if men define situations as real, they are real in their consequences,” makes it clear that there is always a war for people’s minds. Above all, it explains how easily people are manipulated by all sorts of messages – from commercials, media commentators, politicians, business interests, religions, their family and friends – that disempower them and reduce their chances of living a healthy life. Manipulation of the public for profit making largely depends on keeping them unthinking and all the more subject to the fear that makes them more manipulable. They are unable to see or feel any dissonance with their true interests if they even know what they are. It is incumbent upon those of us in public health to seize all opportunities made available through our work to open people’s eyes to their true interests for living a better life in better health.


It is an aim of public health to empower people as a means to their well-being, and the most effective way to do that while respecting their autonomy is to teach them to expect to have their health protected by their government just as they already expect to have their life protected. That necessarily involves informing them about all the agents and forces that threaten their health, whether political, economic, or social. Much of what threatens their health arises out of the corporate-driven policies that have largely captured government agencies, so they must come to see that. They must see that health inequities are not accidental, but rather are the result of classes and interests that both cause and benefit from them. And then they might be able to see what civic and political action is necessary to help them gain greater access to and influence over their government and better secure their health.1


Health improvement is not just about describing power, but using it. The manifest aim of public health to empower people can only be achieved through their participation in power. I think that the highest goal for public health to aspire to in any nation is that of internalizing humane values in that nation’s politics. It is the way a nation is governed that has the greatest influence over the vision that inspires public health, the vision of all people living in a just society with equal opportunity to live a life that they find rewarding. To commit to that vision is to commit to a nation that governs by those same values that inspire public health.


I submit that good public health that promotes human rights founded on social justice is necessarily controversial. It is a role that can be fulfilled only by cultivating an enlightened population able to light its own way there. The public health ethic is one that seeks fundamental social change. It must realize social justice through a morally improved society, one that maximizes the human capacities to flourish of each and every one of its members.


It is time to see that being true to our mission requires that we promote the precept that public health is a human right, and necessary for social justice. It is time for us to acknowledge that Martin Luther King, Jr. (1929-1968) did more to advance public health than any public health leader of his time, and to see why and how he did it.2 Voltaire was correct when he wrote that “it is dangerous to be right when the government is wrong,” but we must be right and do right to be true to our calling.


1 I highly recommend a reading of Martin McKee and David Stuckler, “The assault on universalism: how to destroy the welfare state,” BMJ 2011;343:d7973. (Published 20 December 2011) The authors are public health academics who write about exactly what is missing in our major health policy journals – the political determinants of health, American Exceptionalism, and class war.

For a brief but outstanding history of the politically, economically, and socially regressive policies that have so impoverished our nation, see Douglas S. Massey’s “Globalization and Inequality: Explaining American Exceptionalism,” European Sociological Review; vol.25, no.1: 9-23 (published online 20 August 2008.


2 “…We as a nation must undergo a radical revolution of values.… A true revolution of values will soon look uneasily on the glaring contrast of poverty and wealth with righteous indignation.” Martin Luther King, Jr., “Beyond Vietnam: A Time to Break Silence” speech at Riverside Church, NYC, April 4, 1967. King’s unfinished agenda for achieving social justice for all peoples should now be public health’s.