What is the role of critical public health in crisis? by Tamar Antin
If you’ve been reading the news, you know that public health in the United States is under direct threat from our own government. Since day one, our new administration has attempted to gut public health infrastructure through widespread layoffs, dismantling of programs, extensive defunding, collapsing our public health data systems, and the list goes on.
Just to give you some local examples, in communities where our research team works, one local nonprofit that provides food and propane for heating in rural mountainous communities has been defunded, so they aren’t sure how they will keep people warm this winter. School districts have lost federal funding for lunch programs serving students from low-income families. Doctors are unable to access crucial resources for care from the Centers for Disease Control because data has been removed or altered for political purposes, and websites have been taken down.
Not only is the public health infrastructure being dismantled, but public health has become increasingly politicized. For example:
- Extensive misinformation campaigns have been coming directly from our government officials – this has been especially prominent during our most recent measles outbreak, which is now the largest measles outbreak we’ve seen since the disease was declared eliminated in 2000.
- Federally funded scientists and public health organizations have been pushed to censor scientific work related to diversity, equity and inclusion, through both direct and indirect forms of coercion. And research teams (including our own) have lost funding for studies that focus on the health and well-being of people who are LGBTQ+, BIPOC, and/or women.
- We’ve seen direct evidence of discriminatory policies, framed as promoting the public’s health, that restrict women’s health care and gender-affirming health care.
So now what?
Given all of the chaos and heartbreak of our current crisis, it is hard to remember how to put one foot in front of the other and keep moving forward. But one hopeful thought that I’ve been reflecting on recently, is that space might be opening up for a corrective to longstanding problems with trust that we’ve had in public health in the US.
Public trust in government, science, and institutions has been eroding for decades—long before our new administration was elected. But for people who are currently asking “How did we get here – again?” the [disorientation of the] present political moment can open the door to the kind of critical self-reflection that we need to address these trust issues effectively.
This is where a critical public health can step in—not just by critiquing power (which we should also continue to do), but also by examining public health’s share of responsibility for growing distrust in public institutions.
Some questions that we should be asking are:
- In what circumstances has public health spoken at, rather than spoken with, the publics?
- What approaches have we pursued that have harmed the very communities we intend to serve?
- Who have we systematically neglected in public health programs and policies?
- When is public health more aligned with systems of power, rather than the communities for whom we work?
- When has public health promoted the status quo, overlooking alternative ways of knowing?
At the moment in the United States, there is public appetite for this sort of critical analysis, in part because we are not seen to be sufficiently serving the public. The tragedy is that this critical analysis is not coming from critical scholars; it’s coming primarily from politicians trafficking in conspiracy theories.
But a critical public health can fill this appetite –not with conspiracy theories and political bias, but with multiple forms of evidence and ethical inquiry.
In order to do this and be heard, we are going to have to make trust repair a central part of our practice. When we talk about building trust, especially in public health, there are five important principles:
- Credible Commitment
Public health must be accountable to the interests of the people it serves. We need to recognize that the publics that we work for are not monolithic; various groups may think about health quite differently and define public health problems in ways that do not conform to . To be responsive to their interests, we have to be willing to understand them and then act upon that understanding. - Benevolence
Trust grows when people feel that public health genuinely cares about them. That means centering compassion in our policies and programs, not shame or punishment or fear or dogma. Whether it’s vaccine communication or crisis response, people deserve a public health that acknowledges their own realities and experiences. - Honesty
We must be transparent about what we know, what we don’t, and why decisions are being made. In a climate of misinformation, clear and candid communication is a radical act of trust-building. Honesty also means acknowledging where we have fallen short and being transparent about how we can pivot to do better moving forward. - Competency
Good intentions aren’t enough; we have to show that our efforts are actually improving people’s lives. People need to feel like the information or services being provided are working for them. When you meet people where they are, not where you want them to be, you are more likely to demonstrate competency. - Fairness
We must direct resources and attention to where the harms have been greatest and to the communities who have been marginalized by public health. We must reflect on our biases and think critically about whether our programs are fair.
[Kim, S.-E. (2005). The Role of Trust in the Modern Administrative State: An Integrative Model. Administration & Society, 37(5), 611–635. https://doi.org/10.1177/0095399705278596%5D
I want to leave you with a quote from a book that came out post pandemic – Dr. Sandro Galea is the Dean of the WashU School of Public Health and a distinguished professor there. He wrote:
“If we ignore the ways we are falling short because we do not wish to help our foes, we simply help them in a different way—by making ourselves weaker through our inability to speak freely, self-correct, and think for ourselves. This does no favors for the populations we serve.”(Galea, 2023; pg 11)
This is excellent advice in our current landscape.
In times of crisis, the instinct to stay quiet can feel protective. But if we can’t speak freely or self-correct publicly, we lose the credibility we need most. And that ultimately harms the very communities we’re trying to serve moving forward.