Syndemic Prevention Network: Monograph -- Purpose of this Document

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Introduction

Purpose of this Document

This report examines how public health work is transforming and reorienting in the context of contemporary challenges. It concentrates on several linked innovations in thinking and action, set against historical examples and current trends. With those directions in mind, the report then considers the pragmatic work that we must now do, as citizens of a pluralistic and increasingly fast-moving world, to assure safer, healthier conditions for ourselves and for generations to come.

The first section, Navigating Health Futures, delves deeper into what Richard Rhodes identified as the “directed” character of public health work. It regards the essential challenge facing those who value health, individually and collectively, as one of navigating among a variety of plausible futures: some that are fraught with excessive and unjust suffering, and others that are demonstrably safer and healthier. By considering the qualities that would-be navigators must possess, we counter the myth that effective navigation depends only on the efforts of those with special abilities or advanced credentials and instead locate the power for change within each citizen who finds the courage to become personally involved.

Acting in this way, in pursuit of one’s values, makes a person visible to the point where a story could be told about him or her as an individual. Extending this idea to the circumstance in which society is filled with many possible actors, all of whom react to one another, raises the question of whether it is, in fact, feasible to align or organize our efforts so that they create a demonstrably healthier future. The health of ourselves, our families, and our world seems to depend on this fragile dynamic: on the configuration of more than six billion individual stories, contributing as they must to the larger story of how well we navigate for health. Within that broad story also lies an important inner tale about the changing roles that trained health professionals have in the modern health protection system.

The section entitled, Valuing Conditions, asks us to think hard—as some Hawaiian children already have done—about what is most important to us and what we are willing to do to protect the things we value. Then, in a section on Crafting Conditions, we revisit a 150-year-old piece of public health lore: John Snow’s interruption of the 1854 cholera epidemic in London by removing the Broad Street pump handle (Frerichs, 2004). While acknowledging the importance of Snow’s pioneering action, we question what lessons are drawn today from his contribution and juxtapose those against insights from another form of public health work performed at a different time and place. Together, these examples set the backdrop for a section on Perceiving Dynamic Conditions, which examines the mismatch that occurs when actions borne of incremental, step-by-step thinking become the main avenues for directing system-wide change. That dilemma is then reexamined in a section on Reorienting Public Health Work, which presents the main facets of a syndemic orientation and explores the conceptual, methodological, and moral innovations that it entails (Milstein, 2002b).

The penultimate section on Transforming Conditions illustrates four of these innovations in action. First we revisit North Karelia, Finland, in the 1970s: epicenter of one of the most successful health improvement ventures on record (Puska, 1995). Looking anew at what the Finns accomplished, with their bifocal vision of people-in-places and their remarkably democratic approach to the work, we find clues indicating how the citizens of Finland successfully transformed the conditions that left them vulnerable to heart disease, stroke, cancer, and other related diseases in ways that their American counterparts still have not.

Moving beyond North Karelia, we examine how two complementary analytic methods—system dynamics mapping and simulation modeling—help to expand the questions that health planners may ask, as well as the tools that we use for learning in and about dynamically complex systems (Sterman, 2000, 2006). These methods, and others like them, open new horizons for better understanding some of our toughest, most counterintuitive dilemmas (Forrester, 1971). Two such problems, highlighted as examples here, are how to prevent and control diabetes in an era of rising obesity and how to craft an effective grantmaking strategy in situations where the pressures of multiple interacting epidemics are outstripping people’s power to respond.

Shifting from the virtual world of dynamic models to the real world of directed action, we conclude this section with the confession of a noted epidemiologist who sees an insidious problem in the way that he (and others like him) are trained to become health professionals in the first place. His perspective reveals several pitfalls of professionalism, while underscoring both the difficulty and the tremendous value of keeping our civic identities in the foreground as we work to protect the public’s health. In an era when science and professional expertise hold such high esteem, these insights illustrate how public-minded professionals can reframe their practice and create institutional cultures that allow serious public health work to flourish.

A final section draws these various themes together to reflect on the renewed meanings of each word in the otherwise wobbly and too-casually used phrase, public health work.

Ancient Greece, the mixed mythical and real-world backdrop for Hygeia and her family of gods and goddesses, was also the setting for one of the greatest voyages in literature—Homer’s Odyssey. It was also the birthplace of an imperfect but still-promising experiment in social governance called democracy. Stories illustrating these three themes—of Hygeia’s active stewardship of the public’s health, navigation through uncharted terrain, and governance through democratic organizing—are braided in this document. The ideas beneath these stories, and the many innovators who bring them to life around the world, are the stars in Hygeia’s constellation, inspiring and guiding us as we journey together into an evolving future, continually crafting and protecting what we truly value: the conditions in which all people can be healthy.

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