Public health cuts across all sectors. In most cases, health threats around the globe emerge from areas outside of the health sector. A few of these include the complex global situations of obesity and food insecurity, and continuing tobacco use. A regional example is the Hantavirus outbreak in the US Yosemite National Park this past summer. Major players in the former two health threats include the food, tobacco, and advertising industries, which are influenced by governments as well as by private corporations. Meanwhile, the Hantavirus outbreak was primarily of environmental origin – human contact with a rodent-borne virus. The role of public health systems is to identify health threats such as these and then to plan and implement solutions to safeguard the public’s health. But, what if health became a priority for all sectors?
Example – the western food industry
Outside of the health sector, planning for health is often ancillary, if thought of at all. Speaking broadly, the food industry is one example. In a situation seemingly contradictory to the goal of food provision for the population, profits are often prioritised over delivery of healthy diets in this sector. Supermarkets are lined with processed and packaged foods, despite their lack of nutrients and quality calories relative to whole, unprocessed foods. The resulting issues of over- and under-nutrition are largely left for public health to solve and are exemplary of the forces often stacked against this sector. While strategies to influence the food choices of individuals are a key part of public health interventions for diet and obesity, any real change must also involve the government and industry to alter the food environments in which individual people must operate.
Can we learn from our past successes?
Perhaps previous successful partnerships between public health systems and other sectors can be drawn upon in solving our current public health problems. Well known examples include the eradication of smallpox, the gains made against tobacco use in many countries, and the improvement of water and sanitation systems around the world. Although these public health threats are of varying natures and correspondingly require different methods to reduce their risk in the population, a theme in the management of all is the need for partnerships across sectors. This variation in health threats and their origins highlights the fact that all large-scale human actions have effect on our collective health and well-being. With this understanding, it’s simply frustrating how time and time again health consequences emerge when they could have prevented through public health planning in early stages.
Tackling the root causes of ill health
Of course, the most desired situation would be where all organizations and sectors recognize this fact and consequently incorporate health into planning. This achievement would hopefully help in solving many of the structural “root causes” of ill health and health inequalities brought upon by policies and actions. Some health threats include those not typically thought of as in the realm of health, such as income inequality. Evidence from several countries shows that life expectancy varies by different economic indicators, where more affluent men and women are consistently found to have longer life expectancies than those who are deprived. The ill health effects associated with income inequality are less well recognized than the more obvious economic implications, and this is a problem that many societies have not even begun to address.
So, what can we do? Despite some successes, several areas of society are bad for health and could benefit from partnerships with public health systems. Some gains are being made with obesity – for example, Michelle Obama’s work displays political will to address the problem and is a first step – although we are far from the point where health is a genuine priority for many food industries and for several other sectors. Another striking example is that of climate change and ozone degradation – recently, melanoma has been discovered in wild fish living under the Australian ozone hole. Clearly, our impact is moving beyond just humans, which is extremely troubling given that we have a moral role to uphold the health of other species and our shared environment. We need to identify current health threats, including those not conventionally considered, and be innovative in public health partnerships and in incorporating health planning from the very beginning. Of course, a great amount of will and capacity will be required to achieve this extremely long-term goal, but I hope it’s one we can become closer to in the 21st century.
Photo credit: Paul Wash