You cannot practice public health without engaging in politics

We are living in extraordinary times. 2021 brings the covid-19 mortality to >2 million deaths worldwide and to >100,000 deaths in the UK. Steely eyed scientists are finding themselves the topic of political debate, independent government advisors are accused of succumbing to political pressures, and academics (particularly women) are subjected to vitriolic abuse on Twitter. 

In an effort to stem the casualties of the covid-19 pandemic, politicians have increasingly desperately turned to public health officials, doctors, and academics for solutions and scientific legitimacy. Yet public health practitioners engaging with policy have a delicate balancing act; to ensure best practices are put forward while maintaining good working relationships with their political masters. The excruciating sight of the then US President, Donald Trump publicly asking Dr Birx, physician and eminent global health diplomat, if heat and light, or injecting disinfectant could help cure covid-19 was a fleeting (albeit extreme) glimpse into the challenges that come with having to traverse both the political and the scientific. A more typical example was seen in recent months, where the UK government has increasingly diverged from the advice presented by SAGE, it’s independent advisory board.

Part of the problem is one of communication and perspective. Martin McKee, Director of the European Observatory of Health Policies and Systems, summed it up clearly in a recent lecture for the IWG HSS: “We with a health background far too often preach to the choir and fail to engage with those who are the real decision makers in society. If we don’t understand where politicians, those in finance, and those working on the environment are coming from and how they think, we will continue to be considered largely irrelevant.”

For those working in this space this is difficult; we are still in largely uncharted territories in managing the current pandemic and yet we cannot fail to turn our attention to the future; to carve out spaces in political and policy circles and to understand how we will be relevant. Public health has a long history of subordination to political priorities and there are imminent political decisions to be made where the political will once again butt heads with the best practice of public health. Vaccine nationalism and reopening the economy are two examples.

Vaccines offer the best hope of a return to open society and while countries such as the UK, US, and UAE have made rapid progress in vaccinating their populations, only a handful of vaccines have been administered in LMICs. Recent tensions between the UK, European Commission, and EU member states have shown that vaccine nationalism is bubbling under the surface, a trend which will only extend the possibility for dangerous mutations. Many have decried the immorality of this—they are right. But moral imperative has so far failed to promote greater support for refugees or asylum seekers, while human rights abuses around the world are largely ignored due to economic ties. 

Those in public health therefore need to engage with the economic arguments to make progress. Recent research has found that even if their populations are fully vaccinated, advanced economies will bear nearly half of the 9 trillion hit to the global economy if vaccines continue to be hoarded by rich countries. With fractured global supply chains, financial markets experiencing turmoil, and demand side challenges all stunting an economic bounce back, an effective and fair vaccine distribution, as well as pursuing a zero-covid approach offers the most sustainable policy responses to foster growth, promote employment, and help economies build back better. If these arguments can be paired with the moral imperative to save lives and protect the most vulnerable wherever they happen to live, then they stand a greater chance of being enacted by decision makers and accepted by electorates.

In the medium term, governments are looking to rebuild their economies in the post-covid world. There will be significant investment—there has to be. The head of the International Monetary Fund recently advised countries to “spend as much as you can and then spend a little bit more.” As public health professionals we need to advocate for investment in health systems and public health infrastructure, in renewable energy and in education. Investments that not only provide good returns on investment, but also help to foster healthy environments and create sustainable jobs. Economic recovery could be our chance to move in a fairer and greener direction

Public health is inherently political, practicing it is complex and can be frustrating, especially under the harsh spotlights of social media. But if public health is to inform policy making, not just in relation to health, but to broader social and economic policy, then its practitioners need to embrace new perspectives. An understanding of how power operates in public health is crucial to achieve this—the power to drive forward change is political power. Emerging public health professionals need to explore how they will navigate the political landscape, bridging differing drivers that inevitably create conflict. We need to foster sustained and constructive engagement. If we are to truly make a difference we also need to be bolder, braver, and more determined. Amanda Gorman, American poet and activist, stated it beautifully in her poem

“For there is always light, if only we’re brave enough to see it. If only we’re brave enough to be it.”

James Coughlan: President, European Dental Students’ Association. Twitter: @JamesACoughlan

Laura Haywood: Public health speciality registrar. Twitter: @haywoodLaura1

Magali Collonnaz: Medical resident in Public Health, PhD epidemiology student . Twitter: @m_collonnaz

Competing interests: none declared

Acknowledgements: We would like to thank Professor Martin McKee. We would also like to thank our fellow European region IWG HSS team (in alphabetical order): Roubitha David, Meg McCarty and Meena Tafazzoli.