Health as a private and public responsibility

Government and industry both have a role to play in shaping a healthier world.

Why does health matter? In many ways, answering this question is the central preoccupation of these essays. I have written a number of pieces that attempt to define the meaning of health—why health is something worth pursuing as individuals and collectively. Fundamentally, I see health as mattering because it creates opportunities for us to live rich, full lives. It is a means, not an end, and that end is living a good life, one that is full of time with friends and loved ones, full of the experiences that define what it is to be human. A world where everyone can be healthy is a better world indeed, one worth striving for.

Given the importance of health, given its role in supporting so much of what gives life meaning and value, it makes sense that we should be centrally concerned with asking where the responsibility for promoting health lies. Is it primarily the responsibility of the public sector? Or should the private sector, with its capacity for innovation and scalability, play a larger role? I argue that the achievement of health is both a public and private responsibility, and, as such, we should behave in ways that reflect this. For public health to be most effective in this moment, it should engage with both sectors—finding synergies at the intersection of industry, government, and public health teaching and research—towards shaping approaches that create healthier populations.

What does it mean for health to be a public and private responsibility? To answer that, let us tackle each in turn.

Let us start with our engagement with the public sector and its role in supporting healthy populations. If health is about the conditions that keep us healthy, we should recognize that we need to engage with the public sector to influence these conditions. Health is shaped by factors like economics, regulation, infrastructure, the safety of communities, and the accessibility of education. Such factors are largely the business of the public sector—in particular, the federal government. The state of our economy depends on actions taken at the federal level—from the setting of interest rates, to the amount of money we print, to the companies we subsidize. The government sets regulations affecting everything from workplace safety, to what and where we build, to the cleanliness of our environment. Federal investment is also core to the physical integrity of our roads, bridges, neighborhoods, and cities and to the systems on which we rely, including our public health infrastructure. This is to say nothing of the policies which address the conditions of war and peace, the changing climate, and the dignity and wellbeing of populations nationally and globally, all of which are inseparable from our collective capacity to live healthy lives. Some issues and challenges are simply too big to be addressed by anything other than the federal government, and it is at this scale that much of the work of population health takes place. For public health to be effective, then, it must engage with the public sector, and it has. We have long worked with policymakers at the local and national level, and within global organizations like the UN and WHO, to create policies that support health. This engagement has given us significant influence, supporting our capacity to drive positive change, and we have been, by and large, comfortable with our role in the policy space. There have, of course, been some downsides to this engagement, which we saw during COVID. Engaging with politics made us vulnerable to the politicalization and polarization of the moment, as did the perception that we were more aligned with one political perspective at the expense of good faith engagement with people and policymakers of all political persuasions. But, broadly speaking, we have been effective in our engagement with the public sector and we are at ease with our involvement there, recognizing the essential role of the public sector in shaping the health of populations.

This has not always been the case when it comes to our engagement with the private sector. We have long partnered with policymakers to promote initiatives and investment that help create healthier populations. But we have not been as quick to work with actors in private industry. This hesitance is due, in part, to the at times antagonistic dynamic that has existed between public health and private industry, a legacy perhaps of our friction with the tobacco industry, fossil fuel companies, sugar-sweetened beverage producers, the firearm industry, social media companies, and other industries that have profited from products that have not always been good for health. Without denying the harmful effects of some corporate practices, nor the necessity of calling them out, it is important to acknowledge that the very fact of these deleterious effects—the fact that our fights with industry were worth having at all—reflects the tremendous influence the private sector has on the health of populations. It is also important to acknowledge that this influence can be as positive as it is sometimes negative. Corporations play a significant role in driving innovation, supporting cutting-edge science, shaping culture through advertising and the production of entertainment media, and improving the quality of the food and beverages we consume. Corporations can help channel the future of technology in positive directions, revolutionize our capacity to implement the data and devices that improve health, and create a sustainable, humane capitalism that can improve quality of life for vast numbers of people by broadening access to the goods and services that support health. This is all to the good, and worth encouraging.

In a sense, the role of the private sector echoes the role of individual responsibility in shaping health. Individual responsibility is not, in and of itself, good or bad, but simply a force to be acknowledged and engaged with, towards maximizing its potential for good and minimizing its potential for bad. Just because individuals can make choices that are bad for health does not mean we should not reach out to encourage them to make better decisions. Likewise, as I have written about in the context of the commercial determinants of health, just because the private sector sometimes falls short of its potential to be a force for health does not mean we should not engage with it in recognition of its essential role in shaping the health of populations.

How, then, can public health partner with the private sector to improve the health of populations?

There are a range of areas where public health can forge partnerships with the private sector. For example, public health research yields large data sets, which could be applied to designing and implementing policies that can do much good for health. But we do not always have the capacity to scale up these initiatives to put our data to the best possible use. The private sector, however, has lots of experience operationalizing data at scale. Partnerships between public health research institutions and the private sector can help leverage our data towards more effectively supporting the health of populations. The private sector can also help to encourage pro-health action and innovation by meeting the universal demand for health with products and services that support our capacity to live healthy lives. Public health can help the private sector identify areas where the demand for health could spur such innovation, to orient industry towards approaches that support a healthier world for all.

I realize that this represents a departure from more “traditional” public health, and a leaning into a newer conception of the field, one that pushes research and scholarship, teaching and practice, in a very particular way—embracing, perhaps, a fuller role in the world. Such an approach recognizes that there is room for public health to evolve in this moment, that there is potential for innovation, partnership, and growth we have not yet tapped. This does not mean abandoning partnerships and approaches that have worked for us in the past. Rather, it means integrating into our approaches new voices, new ideas, and new initiatives to build better pathways to impact in a changing world.

Public health should be a big tent movement, welcoming a diverse range of perspectives and experiences. Just as this is true of the individuals and communities we welcome into the fold, it should be true of the sectors with which we engage. Government and industry both have much to offer our pursuit of a healthier world. And public health has much to offer these sectors. Just as we have applied our data and analysis to advising policymakers, we can offer new ideas and a wealth of knowledge to partners in the private sector. Creating a healthier world, then, is the responsibility of both the public and private sector. Health is too important not to be supported by the best of each, and it is up to us to help bring out the best in our partners just as they have the potential to bring out the best in us.

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Also this week

New in Social Science & Medicine, our study looking at the intersection of mental health and individual vs household ownership of financial assets. Thanks to Dr. Catherine Ettman for leading this work.

Thoughts in Observing Science, with Michael Stein, on how transdisciplinary research can foster scientific innovation.

Pleased to share that Washington University in St. Louis is launching the Food and Agriculture Research Mission (FARM), the first of our Innovation Research Networks, led by Dr. Morven McLean. FARM aims to address challenges in agricultural production, food distribution and access to nutritious foods by developing practical, scalable solutions for global impact.