Public Health (PH) is an anticipatory science. Being observant of trends causes us to predict. Our science – epidemiology – causes us to be detectives and our protection extends everywhere. We are observant enough to include as disparities those things as complicated as the children in our communities with enough adverse experiences in their lives that there is a social cost; and those as simple to count as infant mortality. We are that connected as a discipline to the streets of America.
PH interventions bump up against individual rights of choice. Americans do not want to be passive subjects in their health care; neither do they accept ‘helplessness’ about being healthy. PH ‘s challenge is to learn how to promote health, create health promoting environments while respecting self -governing. No government can guarantee health; neither can it fix it so that your health is equal to another.
In considering the legal ramifications of PH interventions and the policy considerations that underlie such interventions, New York City presents a great case study. Since the ‘stop and frisk’ approach was stopped in 2012, violent crimes have increased 43%. Minnesota and Mississippi present other dilemmas: one state has a long history of healthiness and the other is seemingly always at the bottom. Is it policy? Is it culture? Is it a combination of both or perhaps another determinant?
In the 20th Century we went far to uncover and describe the components of complex systems. We have 85 years left in this century to find out how to fit all the pieces together for overall better health, making the 21st century the century of healthiness.
For PH, the place where ‘health’ happens, shifts. Prevention requires us (we, you, me) to do something. It is not just relegated to the doctors to fix. Each of us individually plays a critical role in health, being healthy, and maintaining health; much more so than the story which has been told and acted on.
The narrative and the laws are in contrast to where healthful impacts occur. For PH, facts do matter and what we see is more important than what we feel.