I’ve been really struggling lately with my MPH classes.

Specifically: how little our courses invite critical assessment of the role that public health professionals play in harming the public’s health.

I don’t think we are inherently good. Our profession to a large extent aims to control the health decisions of large populations as well as the allocation of their health resources. With that kind of power, the better assumption is that we are dangerous, rather than helpful.

This is esp true given the conflicts of interest between:
-the need to address fundamental causes / structural determinants of health (esp wealth inequality, racism)
v.
-how public health professionals receive funding

Speaking as a former grant writer, the overarching pitch for grants is:
Here is this problem.
The solution is unknown.
You should give me money so I can produce data/info/products
That will ultimately solve/mitigate the problem.

But many of the problems in public health *have* known solutions. A big one is wealth redistribution. We don’t need another grant-funded study. The problem isn’t assessment. It’s implementation. And when it comes to fundamental causes like poverty, implementation means politics.

And herein lies the rub: political activism doesn’t pay a salary for most. And PH professionals aren’t trained to do activism. In fact they’re often warned *not* to bc of potential threats to our orgs (via 501c3 status) and ourselves (esp our reputation as it=>prof advancement).

But we *are* taught how to write grants. And are rewarded professionally (personally) for doing so. So where does that leave our profession?

It leaves us heavily incentivized to keep writing grants that address downstream causes bc (we tell ourselves) we are still helping ppl (even if to a far lesser extent). But what we are really doing is helping the public only when doing so aligns w/ our professional advancement.

And worse, through our grant writing, we are gaslighting impacted populations: to pretend sexy new solutions are needed is to imply that old, known solutions (wealth redistribution, reparations) won’t work.

And that is a lie.

Our professional unwillingness to engage in advocacy and activism actively undermines those who *are* working for change - often the very populations whose health is most harmed.

Often the very populations we claim to serve.

By not joining them, we - the professional PH class - stand with their oppressors. That is our legacy every bit as much as modern sewage treatment and vaccines.

We are *not* benevolent actors. Given the parens patriae power, we are suspect & paternalistic actors. Viewing ourselves this way can only improve what stories we tell in our grants, whose experiences we prioritize in team composition, and which policies we espouse.

Finally, viewing ourselves this way should prompt us to question in any given situation whether the public’s health would be better served by more data/deriving new solutions or more activism/demanding old ones.