Monograph Menu Report Home Director's Foreword Table of Contents Tables and Figures Acknowledgements Abstract Prologue Introduction Navigating Health Futures Valuing Conditions Crafting Conditions Perceiving Dynamic Conditions Reorienting Public Health Work Transforming Conditions Reflecting on Public. Health. Work. Glossary References About the Author Download Full Report (PDF-8.9Mb)

Valuing Conditions

Characterizing Public Health Work

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Whereas patients need a doctor’s care only occasionally to treat sickness and regain health, people must work all the time, occasionally with help from professionals, to guard against affliction and enhance their well-being (sometimes understood as health-related quality of life) (Centers for Disease Control and Prevention, 2000a). Such work requires individual effort as well as collective organizing and action to reduce threats to health in whatever form they come. Although particular ventures to address particular health problems may be temporary (e.g., quarantine to slow the spread of an infectious disease, or emergency aid and psychological counseling after a disaster), the overall enterprise to assure healthier conditions must be sustained over time in a concerted, vigilant, and pragmatic way. This is part of the reason why thinkers who are concerned with the health of whole populations emphasize the importance of institutionalization and sustainability: themes that are comparatively absent in writings that focus on the care of individuals (see, for instance, Annie E. Casey Foundation, 2002; Goodman, McLeroy, Steckler, et.al., 1993; Hancock, 2000; Hodge, 1996; McMichael, Smith, Corvalan, 2000).

If we could predict the future, this task of assuring healthful conditions would be far easier. But anyone who has accidentally taken a wrong turn knows what Arthur C. Clarke meant when he asserts that the “future is not to be predicted, but created” (quoted in Laszlo, 2001:ix) Often, it is our own perceptions and decisions about how to move in the world, rather than the influence of truly exogenous forces, that shape our experience. Even without perfect knowledge or absolute power we can, in most cases, learn enough through observation and research to help us chart the roads ahead.

Investigations on the long-term effects of smoking (Office of the Surgeon General., 2004) or of adverse childhood experiences (Felitti, Anda, Nordenberg, et.al., 1998), for example, demonstrate just how much we can in fact discover about the future consequences of particular behaviors or exposures. Such inquiry also prompts us to explore and create new alternatives in the present. It helps open options and expand navigational choices, for we cannot pursue healthier directions if we cannot see them.

Another thing we know about the future—particularly the next three to five decades—is that it will bring significant transitions: demographically, environmentally, economically, culturally, geopolitically, and otherwise — Lonnie King (McNeill, 2000; Meadows, Meadows, Randers, 1992; United Nations, 2002; Woodward, Hales, Litidamu, et.al., 2000; World Commission on Environment and Development, 1992). Our experience of past transitions of similar scope (such as the shift from a primarily agrarian to a primarily industrial mode of production) reminds us that they carry both grave threats and remarkable opportunities for the public’s health. However, in truth, several trends with great significance for the public’s health are unfolding in the 21^st century that have no good historical analogues whatsoever (e.g., environmental change, population growth, increasing speed of communication and transportation, exhaustion of petroleum reserves, spread of genetic and biological technology, and others).

Some of these changes will take us by surprise (perhaps because we have not paid enough attention to warning signs), while others can be more easily anticipated. For instance, the health consequences of phenomena like an aging population (Centers for Disease Control and Prevention and Merck Institute of Aging and Health, 2004; National Research Council, 2001), global environmental change (McMichael, 2001), and increasing urbanization (Galea, Freudenberg, Vlahov, 2005; McMichael, 2000; United Nations, 2002) are examples of issues that are already being studied closely. And even the most welcome transformations—like regime changes from dictatorship to democracy—will nevertheless cause dislocations and disruptions that may destabilize or undermine the conditions for health. Regardless of the specific nature of the changes in store, the stance that health leaders must maintain is one of keeping pace with changing times, preparing for surprise, and being clear about the conditions we are working to create as well as the legacy that we will leave behind (Bazerman and Watkins, 2004; Foege, 1987; Levins, 1995).

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Page last reviewed: January 30, 2008
Page last modified: January 30, 2008

Content source: Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion