Public Health Practice: Transcending the Known

Abstract

Unabashedly, I confess to being a recovering former state and local health official. During my recent transition into academia, public health practice has continued to be my reference point for making meaningful contributions to the broader public health field. This issue of the Journal on the “business” of public health has only served to reinforce the vigor of my long-held views. Moreover, this occasion presents an opportunity to share some developing thoughts on how public health practice might better be incorporated into this venerable publication, while still preserving its appeal to a wider public health audience. Supreme Court Justice Potter Steward may have said it best: “I know it when I see it” (Jacobellis v. Ohio, 378 US 184 [1964]). Although he was referring to pornography rather than public health practice, the same test may still apply. Altogether too often, when we describe public health practice, our focus tends to be limited to that of the governmental sector. To be sure, it remains a critical unit of analysis as public health moves forward to embrace a national voluntary health department accreditation model. However, as we have recently learned through experience with the National Public Health Performance Standards Program (a product of the Centers for Disease Control and Prevention and 6 public health practice partner organizations; available at: http://www.cdc.gov/od/ocphp/nphpsp), much of what we generally recognize as public health practice is accomplished in tandem, with the public health sector interacting as partners with health care, education, transportation, and others to create the larger public health system. The shared development of strategies and interventions designed to promote and protect the health of communities (Turnock BJ. Essentials of Public Health. Sudbury, MA: Jones & Bartlett; 2007) is public health practice writ large. If the ultimate goal of public health practice is advancement of community health, then the talisman is improvement of health status indicators. Yet, this linkage between public health interventions and downstream health outcomes has often proven elusive. Given the complex environment in which public health is only one of many actors, this paucity of demonstrable impact is understandable; however, the dilemma is compounded by the relatively limited use in public health of an evidence-based approach. Prestigious medical journals, like New England Journal of Medicine and Journal of the American Medical Association, make a concerted effort to translate research findings into everyday practice relevant for their readers. Although they are not uniformly successful, I applaud the worthy attempt. They do literature reviews of contemporary science, summarize it, and outline lessons for practical application. Alternatively, at times, authors hone in on a specific (more narrow) clinical problem, and update the state of the art. Both models may have public health parallels. The equivalent approach in public health might involve soliciting the work of leading public health system researchers as well as other scientists, and encouraging translation of their findings to the public health practitioner at all levels. There are also extremely important transforming events taking place in the larger public health field. Stated more succinctly, the remodeled Government, Politics, and Law Department of the Journal will emphasize the metamorphosis that public health practice is undergoing—focusing on what it can become.