Reflecting on our past to inform our future

“Public health is what we do together as a society to ensure the conditions in which everyone can be healthy”

The field of public health is evolving. In our work, we know it as Public Health 3.0 – a shift that complements existing public health services with addressing the full range of root causes that shape conditions to ensure health and wellness. This is an important moment as colleagues are affirming the conversation that has been occurring since (as early as) 2006 in Louisville with the founding of CHE. While healthy behaviors are important to individual health, public health patterns are more impacted by the conditions of our community which means prioritizing resources around behavior change will not be enough to improve health outcomes.

Pro tip: by overemphasizing individual behavior, an implication is made that adverse health outcomes are a “culture” or “biology” problem – rather than a symptom of structural inequity.

As a field, our public health origins are often traced back to the work of Dr. John Snow. As the story goes, in the 1800s, cholera was a highly fatal disease that many health professionals assumed was an airborne illness. However, Dr. Snow conducted research to prove cholera was being transmitted through bodies of water. For a permanent solution, Dr. Snow developed a water pump which fundamentally improved the sewage system. As a result, his creation improved health outcomes and emphasized the importance and necessity of systems-level work to improve population health. Even today, LMPHW continues to play a role in healthy sewage systems.

Among the many lessons to learn from our roots, it is critical to understand improving public health has always required identifying the root causes, or thinking at the systems-level, to recognize the complexities of needed resources and infrastructure, policies, and economics.

Public Health, Root Causes, and Power in the United States

Working at a systems-level often allows for a higher level of efficiency to collectively address largescale (or population-level) problems. Throughout history, collective work has led to the building of cities and sustainable development of public goods. Public goods are “goods and services created through collective choice, paid for collectively, and supplied without individual charge to recipients.” Institutions shaping the root causes of health often produce or build systems around public goods that can support community health. Familiar examples of public goods include fresh air, parks, street lighting, and more. Because public health outcomes are significantly impacted by our collective experiences with policies, collaborations, and institutional public goods, our work requires systems-level designs that create conditions for all of us to thrive.

However, data continues to show persistent quality of life differences across communities, including race, income, sexual orientation, gender, dis/ability, immigration status, and more. As Public Health 3.0 institutionalizes the importance of addressing root causes, Human Impact Partners (HIP) also calls for public health to prioritize an understanding of the (inequitable) systems of power which have shaped these health inequities across communities. Inequitable systems of power are the explicit and implicit discriminatory impact that accompanies -isms and -phobias. HIP reminds public health colleagues that inequitable power dynamics have unfairly advantaged some communities – resulting in a concentration of power – and unfairly disadvantaged others – resulting in a concentration of scarcity. Understanding power and its role in systems asks us to consider the history and ongoing reality of structural oppression, its impact on the design of institutions, and the necessary visioning for transforming systems to support all of us.  

Public Health 3.0 provides an opportunity to tell a different story about the avoidable, unjust suffering communities are experiencing. We know that people are ready for healthy lives and to leave these health inequities in the past. But it is going to take transformative work – some of which we’ve never seen before - that requires moving resources and strategy towards fundamentally changing the root causes while prioritizing institutional design grounded in equitable systems of power. CHE is ready and thrilled to bring the conversation everywhere we can in Jefferson County and across Kentucky to ensure all residents experience the community they justly deserve.

If your organization or coalition is interested in trainings, workshops, or deeper conversations related to public health transformation, how systems of power shape health outcomes, or ways we can partner in this work, contact us at healthequity@louisvilleky.gov for more information.