My Public Health Truths (a "living" thread).

There are few "truths" in public health, but the following include those I have observed in quantitative & qualitative studies, community engagement, and program implementation independent of socioeconomic or geographic contexts.

In the immediate term, you cannot educate someone out of being hungry or needing a place to sleep.

Given a choice between clean and dirty needle, someone will always want to inject with a clean one.

Risk for infectious diseases is not evenly distributed across a population.

If you ask someone to do something that you wouldn’t be willing or able to do if in their shoes, the program is doomed.

If public health facilitates the public to make good decisions with resources, education, empathy, and empowerment, most will.

Except in the most extreme examples, no one wants to infect anyone else with an infectious disease.

A program that doesn't pay attention to disparities in individual and structural risks is virtually guaranteed to reinforce them rather than mitigating them.

Individual choices are often determined by network and structural contexts.

If you ask someone to do the impossible, don't be surprised with the outcome.

When designing a public health program, lived experience can never be replaced by academic expertise.

People often will not do what you think is in their best interest to do and shaming them for this will only make meaningful engagement that much harder.

The actual impact of public health interventions will be limited by how well they are implemented responsive to sociopolitical and economic contexts and population-specific needs.

Study fatigue is real--if you keep asking people questions and testing them for things without providing a service, they will eventually tell you to get lost.

Public health programs are far more effective if conceptualized, designed, and implemented with communities rather than just delivered for communities.

If public health is relying on police to help them implement an intervention strategy, something has already gone very wrong.

Using an equity lens for your program design and implementation won't guarantee, but will increase the likelihood that you achieve the desired impact.

Public health programs never work just as they were envisioned to. That's ok. Iterate until they do.

In public health programs, try and show people why you think something is beneficial rather than just telling them to do it.

Take the time to understand the lived realities of the proposed benefactors of your public health program and design accordingly...or they will vote with their feet.

There is no such thing as a "free" public health intervention.

All interventions require resources from the system (human, $$, institutional) and from the user (energy, trust, $$).

Balance the resource needs against the potential benefits as there are also opportunity costs.

The overall number of people affected by a risk factor or health condition provides relevant insights into the appropriate scale of a program, but less so into the content of that program.

Having a framework (organized approach) facilitates responses to both clinical and public health emergencies.

In clinical emergencies, measures of success are clear-- preserving limbs, heart, brain, and life.

In PH, worth spending an hour to define success before implementing.

In public health, if you try and develop an intervention that serves everyone, you end up serving no one.