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What Are We Selling in Public Health?

There isn’t a week that goes by where someone doesn’t call me a “Pharma Shill.” They claim that I must be getting paid by “Big Pharma” because I dare say that vaccines say lives and counter the claims of antivaxxers on social media. (“Claims” is a gentler way of saying “outright lies.”) As of the writing of this blog post, I have not received any money from any pharmaceutical company for any of my vaccine policy advocacy. Heck, I don’t even invest in any pharmaceutical company, though I’d like to. I would make a killing choosing the companies that are aggressively pursuing treatments and therapies for the biggest or most urgent public health problems.

I also noticed that a lot of classes at the School of Public Health were somewhat business oriented, or they shared characteristics similar to classes one would take while working toward a business degree. For example, I took a management course where I learned about motivating people. They even taught us how to fire an employee or reassign staff who aren’t being productive. And they taught us about customer service. Certainly, a lot of what goes into a successful presentation in public health is borrowed from a successful presentation on how to sell something.


And don’t get me started on how many times I’ve been told to prepare an “elevator pitch” about my ideas, my projects or my dissertation. Elevator pitches are those very quick (the time it takes to ride an elevator) summaries of what you’re doing and what you’d want your audience (hopefully one Warren Buffett on his way to the penthouse) to do for you with the information you’ve provided.

So what are we selling in public health?

Are we selling ideas? It certainly seems like most of the time we are trying to convince people to do something that is beneficial to public health or to not do something that is detrimental to public health. To convince people about this, you have to implant an idea in their minds that the behavior (which is also seeded in their minds) needs to change. This is easier said than done, right? And, admittedly, some ideas are better than others.


The best idea.

Are we selling a product? We kind of are because we want you, the public, to use vaccines, seat belts, helmets, and, if you’re in the healthcare business, we want you to use gloves, masks, aprons, and goggles. That is, we want you to invest in things that will keep you and others safe. We won’t make any money from these recommendations. I don’t. But we still try to tell you about all the benefits of these products. We want need you to get them and use them.

Are we selling vaporware? (Vaporware is software, or hardware, that is promised, hyped and even commercialized but never delivered.) How long now have we been promising a vaccine against HIV? We’ve been doing that since the 1980’s. Most vaccine trials have not even reached Phase II, and very few are on Phase III. But we in public health keep hoping for a breakthrough, and we keep advocating for more money to go into research for this vaccine. Because it’s that important.

The final question I’m working out in my brain, and delivering to you, dear reader, is whether or not public health should be done by public agencies. That is, should we privatize public health? In the time that I worked at/with different health departments, two things always stood out. First, how efficiently they did their job. In case you haven’t noticed, budgets for public health are not exactly plentiful. That things like outbreak investigations and responses or tracking of childhood immunizations get done with how little people are getting paid has always amazed me.


True story.

On the other hand, there are some inefficiencies. Once someone is hired by the government, it’s incredibly difficult to get rid of them. There were a handful of people I met who admitted that they were leeching the system, and they were okay with that. Also, many of the people at the higher echelons of authority within public health are not trained in handling budgets and/or managing people. Many are physicians, or other public health professionals with doctoral degrees, who were introduced to the overall concept of leadership and management but they have no business being either. They might as well be making sandwiches.


Or being sandwiches.

Maybe, just maybe, a private organization handling the big, huge databases that public health agencies handle would be better, especially if such an organization had a proven record of handling such things. Maybe a well-seasoned CEO would make a better Secretary of Health at any level of government than someone who reached the position more out of seniority or by political appointment than by their ability to do the job.


I believe that the next few decades are going to see a big shift in public health. We had the era before Germ Theory when we dealt with public health issues through witchcraft and snake oil. Then Pasteur, Snow and Jenner came along and shifted the paradigm. Penicillin replaced snake oil. Viruses were discovered and vaccines improved. Things like smallpox, polio, and other infectious diseases did not threaten millions of us anymore… Though some still do. We started to live long enough to get other diseases.

Victory against infectious diseases made us “soft.”


This soft.

We progressed to the point where we could afford more calories per dollar than ever before, and live to see the consequences. We got things like diabetes and heart disease. If you live long enough, odds are almost even that you’ll get cancer or develop dementia. We went from the era of germs to the era of chronic disease… And we’re about to go into the next one, which I’m wagering will be the era of mental health. But that’s for some other post at a later time.

As that change happens, we in public health will need to adjust along with the public. The next challenges will need new ideas, or the evolution of old ideas. We’ll need science. We’ll need money. And we’ll need a better way to be more efficient with our resources (human and otherwise). Whether or not that efficiency will require a privatization of what has historically been done by the government is up for discussion, especially now that more and more consulting firms and such are doing the work for them.

Thanks for your time.

Header photo by Axel von Wuthenau on / CC BY

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René F. Najera, DrPH

I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
About History of Vaccines: I am the editor of the History of Vaccines site, a project of the College of Physicians of Philadelphia. Please read the About page on the site for more information.
About Epidemiological: I am the sole contributor to Epidemiological, my personal blog to discuss all sorts of issues. It also has an About page you should check out.

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