What’s “success” in public health?

Last week I attended an award’s dinner sponsored by the Minnesota School of Public Health honoring individuals and organizations who advance public health. Award recipients varied in their backgrounds, expertise, and roles in public health, and their accomplishments were certainly worthy of recognition.

But, what exactly does it mean to advance public health? What does success look like?

The question isn’t anything new for those in public health. It’s one of the first hypothetical quagmires every public health students wrestles with during their education (and ideally well into their careers as practitioners, researchers, policymakers, or educators).

To paraphrase one of my professors from when I attended George Washington University, success in public health is when nothing happens. The goal is for people (or, populations, if you like public health speak) to remain at their highest attainable level of health and quality of life. When nothing happens there are no disease outbreaks. There’s adequate amounts and distribution of nutritious food, water, etc for all. There’s access to affordable, safe housing free of health risks for everyone. Transportation is safe and transportation systems are design in a way that prevent exposure to hazardous chemicals. I could go on, but you see the point.

It sounds straightforward, right (however elusive these conditions remain)?

Let’s throw a wrench into this little thought experiment.

A couple years ago I found myself at a World Health Organization conference on chronic diseases in Moscow, Russia. Though most of my time was spent in hotel ballrooms or cocktail receptions, I gleamed one invaluable piece of context for my budding career in public health.

I just mentioned this notion of the “highest attainable level of health” for populations. Well, to translate, this often means trying to increase life expectancy, particularly when it comes to preventing “avoidable” diseases (some would argue many chronic diseases fall into this category, for example) or addressing “premature” mortality.

Now here comes the kicker. What if people themselves don’t actually want to live longer? This was the situation I heard about for many aging Russians. They didn’t want to live longer because that meant continued struggle and limited opportunity. Not ideal if we’re talking about quality of life.

And here in lies one of the fundamental tensions in public health. We celebrate adding years to life, but sometimes overlook what comprises those years.

There may not be a better way to capture this entire concept than with the brilliant and timeless thoughts of Seneca, in the book On the Shortness of Life. He says:

“So you must not think a man has lived long because he has white hair and wrinkles: he has not lived long, just existed long. For suppose you should think that a man had had a long voyage who had been caught in a raging storm as he left harbour, and carried hither and thither and driven round and round in a circle by the rage of opposing winds? He did not have a long voyage, just a long tossing about.”

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