What is the public health equilibrium? It’s a term I coined to describe the balancing act that is public health, which I’ll describe in this blog. This is my perception, vision, thinking and not anyone I work for or consult for.

This blog was inspired by one of my recent tweets:

I don’t think the pandemic politicized public health. It just showed how nasty it can get. Politics is always involved in public health because much is about finding an acceptable equilibrium between protecting the health of the population and encroachment on personal liberties. 

To understand this equilibrium, we have to go back to the fundamental difference between medicine and public health. One (medicine) addresses health issues at the individual level, so fundamentally there is more freedom involved. Particularly more freedom of choice when it comes to treatment and care. The other (public health) addresses health issues at the population level, where we don’t live in silos and our actions potentially impact those around us. Thus is the nature of being part of society. So before we dive into a debate about a particular intervention, we should ask ourselves if it is a medical one or a public health one. Once we understand that, it’ll help us better assess its need as well as risks vs benefits.

Unfortunately, I see many experts on social media, including doctors, journalists and scientists with no public health experience, confusing the two, which carries over into how they communicate to the public about the intervention. Sometimes they use coercion, shame, lead with their egos or think their expertise carries over into the field of public health when it does not. They, albeit inadvertently, end up angering and/or isolating large portions of the population and hurting their own cause. It’s a big problem since so much of public health is communicating with the public. Therefore, if you pollute the streams of communication and distort the public’s perception of public health in a negative way, you can do serious, long-term damage.

Since I’ve been a part of several public health initiatives, I want to give an overview of how one works. Almost every public health intervention that is funded by the government begins with political will. Legislators are ultimately influenced by a body of voters, lobbyists or advocacy groups and designate funds for a specific public health intervention. From there, public health experts take over. First and foremost, there is a budget, and someone manages that budget. Historically, these budgets aren’t much, hence the country’s uphill battle with prevention. There is usually a technical lead, or someone who serves as the “chief strategist” for how the intervention will reach fruition given the budget, timeline, and staff…, a project manager to deal with contractual elements, and then depending on the nature of the intervention…, public health analysts, epidemiologists, researchers, health communication specialists, data scientists, a creative team and more. Often due to budgetary constraints, public health people wear multiple hats. Let’s say the intervention is a communication intervention to vaccinate a particular population. A huge part of that intervention will be understanding how to connect to that population. So before any content or materials get made, there needs to be research. This research can include a rapid community assessment; focus groups comprised of members of the community you are trying to reach, followed by a qualitative analysis and reports; surveys followed by quantitative analysis and reports; key interviews with trusted members of the community. Once the research is conducted, usually an analyst or two will analyze the results and make a recommendation for how best to communicate with the population. This recommendation may include area of focus; what issues to avoid; what words to use and not to use; what photos to use and not use; what colors to use or not use, and what mode of communication (TV, digital, print, etc.) to use. Then the creative team steps in and designs a few message options. Next, if the budget allows, there is message testing. This can be in the form of a focus group or survey. I’ve done message testing with surveys, so I can speak to that. Basically, the population being surveyed, ideally representative of the folks you want to reach, provides feedback on the message options. (And usually, you partner with a contract research organization that does surveys and has access to various populations). The survey participants answer a series of questions. Then you get a bunch of data back from the company and make sense of it with statistical analysis. Guided by the results, you make recommendations for which message is best to use, when to use it, where and how. The data is often very rich and revealing, in the sense that you often find things that are counterintuitive. Then, boom: One or two of the message options (perhaps with tweaks and after an official clearance process) will see the light of day. You still aren’t done, however. Usually someone on the intervention team is tracking the success of the campaign, whether it be through number of clicks; number of sign-ups for something; or a particular action taken. Given budgetary constraints, if a campaign isn’t connecting for some reason, it will need to be stopped, tweaked and/or trashed.