What Is Public Health? Telling Our Own Story

In this issue of AJPH, which is being issued in alignment with National Public Health Week, Former Governor John Kasich(R-OH) makes a compelling case for the need for a more lucid and effective effort to enhance the public's understanding of what public health is and how we all benefit. The COVID-19 pandemic has exposed not only the weaknesses in the organization, infrastructure, and core resources of our public health system but, more importantly, the loss of basic trust and public support for proven public health measures and the practitioners that use them. [...]it is quite common for people to take these protections for granted, and although they all want someone to protect them, they don't know that when they are protected it is because of public health's efforts.

Integrating Social Determinants in Decision-Making Processes for Health: Insights from Conceptual Frameworks-the 3-D Commission.

The inclusion of social determinants of health offers a more comprehensive lens to fully appreciate and effectively address health. However, decision-makers across sectors still struggle to appropriately recognise and act upon these determinants, as illustrated by the ongoing COVID-19 pandemic. Consequently, improving the health of populations remains challenging. This paper seeks to draw insights from the literature to better understand decision-making processes affecting health and the potential to integrate data on social determinants. We summarised commonly cited conceptual approaches across all stages of the policy process, from agenda-setting to evaluation. Nine conceptual approaches were identified, including two frameworks, two models and five theories. From across the selected literature, it became clear that the context, the actors and the type of the health issue are critical variables in decision-making for health, a process that by nature is a dynamic and adaptable one. The majority of these conceptual approaches implicitly suggest a possible role for data on social determinants of health in decision-making. We suggest two main avenues to make the link more explicit: the use of data in giving health problems the appropriate visibility and credibility they require and the use of social determinants of health as a broader framing to more effectively attract the attention of a diverse group of decision-makers with the power to allocate resources. Social determinants of health present opportunities for decision-making, which can target modifiable factors influencing health-i.e. interventions to improve or reduce risks to population health. Future work is needed to build on this review and propose an improved, people-centred and evidence-informed decision-making tool that strongly and explicitly integrates data on social determinants of health.

Health Inequity From the Founding of the Freedmen's Bureau to COVID-19.

Following the US Civil War, newly freed Black Americans had significantly poorer health than Whites. Founded in 1865, the Freedmen's Bureau offered a range of support (eg, food, health care, shelter, legal aid) to try to improve health among the newly freed. The COVID-19 pandemic has exposed the persistence of racial health inequity in American life. Ethical obligations to address it exist now, just as they did in 1865.

Ensuring health equity during the COVID-19 pandemic: the role of public health infrastructure.

The COVID-19 pandemic has significantly stressed public health systems around the world and exposed the gaps in health care for underserved and vulnerable populations. In the context of the social determinants of health, focusing on health system preparedness is paramount for protecting the health of all of society. Faced with old threats (e.g., re-emergence of measles), disruptive new technologies (e.g., electronic cigarettes), increased challenges (e.g. drug-resistant organisms), and new threats (e.g., the current pandemic, climate change, politicized misinformation), our health systems must be robust and resilient. The response must include those who now suffer disproportionately-the poor and the vulnerable. Current World Health Organization priorities call for infrastructures capable of detecting, monitoring, and responding to health emergencies, such as COVID-19, and the health impacts of climate change in the context of health for all. Health care infrastructure can be better prepared and more equitable if systems are strengthened by building on core competencies and following the recommendations made for leadership, stakeholder involvement, accreditation, data collection, and funding resources. Ensuring health equity in a pandemic requires robust and resilient public health infrastructure during normal times.

La pandemia de COVID-19 ha sometido a una gran exigencia a los sistemas de salud pública de todo el mundo y ha puesto de manifiesto las deficiencias de la atención de la salud de las poblaciones desatendidas y vulnerables. En el contexto de los determinantes sociales de la salud, es fundamental centrarse en la preparación del sistema de salud para proteger la salud de toda la sociedad. Frente a las viejas amenazas (p. ej., la reaparición del sarampión), las nuevas tecnologías perturbadoras (p. ej., los cigarrillos electrónicos), los mayores desafíos (p. ej., los microorganismos resistentes a los medicamentos) y las nuevas amenazas ­la pandemia actual, el cambio climático, la politización de la información y la desinformación sobre la salud­ nuestros sistemas de salud deben ser sólidos y resilientes. Su respuesta debe incluir a quienes ahora sufren de manera desproporcionada, los pobres y los vulnerables. Las prioridades actuales de la Organización Mundial de la Salud requieren infraestructuras capaces de detectar, vigilar y responder a las emergencias sanitarias, como la COVID-19, y a los efectos del cambio climático sobre la salud en el contexto de la salud para todos. Si se fortalecen los sistemas de salud reforzando sus competencias básicas y siguiendo las recomendaciones formuladas en materia de liderazgo, participación de los interesados, acreditación, recolección de datos y recursos de financiación la infraestructura de atención de la salud estará mejor preparada y será más equitativa. Para garantizar la equidad en la salud en una pandemia se requiere una infraestructura de salud pública sólida y resiliente en épocas normales.

Em todo o mundo, a pandemia da COVID-19 tem colocado ênfase significativa nos sistemas públicos de saúde e exposto as lacunas nos cuidados em saúde para populações carentes e vulneráveis. No contexto dos determinantes sociais da saúde, o foco na prontidão dos sistemas de saúde é fundamental para a proteção de toda a sociedade. Diante de antigas ameaças (por exemplo, o ressurgimento do sarampo), novas tecnologias disruptivas (por exemplo, cigarros eletrônicos), maiores desafios (por exemplo, organismos resistentes a drogas) e novas ameaças - a atual pandemia, as mudanças climáticas, a politização da informação/informação sobre saúde - os sistemas de saúde devem ser robustos e resilientes. A resposta desses sistemas deve incluir grupos que agora sofrem de forma desproporcional, os pobres e os vulneráveis. As prioridades atuais da Organização Mundial da Saúde exigem infraestruturas capazes de detectar, monitorar e responder a emergências de saúde como a COVID-19 e aos impactos das mudanças climáticas sobre a saúde no contexto da saúde para todos. A infraestrutura de saúde estará mais bem preparada e será mais equitativa se os sistemas forem fortalecidos com base em competências essenciais e seguirem recomendações com foco em liderança, envolvimento das partes interessadas, acreditação, coleta de dados e recursos de financiamento. Garantir a equidade na saúde em uma pandemia requer uma infraestrutura pública de saúde robusta e resiliente, mesmo em tempos normais.

Rebuilding the ties of public health: a Q&A with Georges C. Benjamin, MD.

To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a health care thought leader. The September issue features a conversation with Georges C. Benjamin, MD, executive director of the American Public Health Association.