By Rachel Sasaki Seeman
Defining Public Health
The focus of public health has evolved in recent decades from a community effort to a global endeavor. Public health, in its current incarnation, has an expanded focus on not only the health outcomes at the level of local communities, but on solutions that transcend national boundaries and cultural lines, and that take an interdisciplinary approach. These varied approaches emphasize policy solutions, direct treatment, and preventative work to improve the quality and efficiency of health care. Professionals within the field of public health recognize that achieving goals requires both monetary and physical support. This support leads to an intricate web of public health that includes countless professionals, community health workers, and volunteers, who treat, analyze, plan, build, and manage a broad array of initiatives directed at a common goal. Amy Lockwood, Jocelyn Kelly and Dr. Mary Jacobson are three professionals that take managerial, preventive, and direct care approaches respectively to diminish challenges standing in the way of public welfare.
Public Health, the Management Perspective
Amy Lockwood has administrative e xperience in global public health and focuses on improving the efficiency of health care by developing and implementing context specific programs. Lockwood, who received her MBA from Stanford, believes that the future of public health relies on collaboration with other fields and acknowledgment of past mistakes. From an organizational standpoint, as former Executive Director of Project Healthy Children and Clinton Foundation Deputy Country Director for India, Lockwood acknowledges and attempts to resolve the issues faced on the ground level of public health on a daily basis. However, she didn’t always know that people without medical experience could contribute to public health: “I really felt like for a long time that if I couldn’t save people, [then] there wasn’t a role for me in public health, but there is so much to do.” While working for the Clinton Foundation, Lockwood oversaw health initiatives within 33 countries. She recognized patterns between countries and implemented blanket solutions, which were adjustable according to the needs of each location. Lockwood bridges the gap between health care and business to make care more effective. Her goal is to make the job of individuals in direct care more effective and simple. Both her professional and educational experiences have helped her realize the occasional overwhelming complexity of global health challenges—complexity that requires well-informed, comprehensive solutions. After describing the domino effect that health, poverty, safety, nutrition, access to care, and maternal health can have, Lockwood explained, “All of these issues exist in one person and in all of humanity: [public health] affects everything and everyone.”
Public Health, the Advocacy Perspective
Jocelyn Kelly, Gender-Based Violence Research Coordinator of the Harvard Humanitarian Initiative and Harvard MPH graduate, has devoted her life to reducing incidents of sexual violence in the Democratic Republic of Congo, both by researching the issue and working on-the-ground in counseling roles.
She sees public health as bridging the gap between the many layers that separate the advocates and the policy makers, through a continued integration of technology into the field. Kelly’s work focuses on violence prevention in the unstable environment of the DRC and the solutions she proposes, rather than being broad and general, are tailored for that specific environment. In searching for a remedy to prevent further violence against women, Kelly investigated “the root causes of the violence through gathering a wide variety of experiences and opinions from perpetrators, bystanders and victims alike.” Bi-annual visits to the DRC allow Kelly to recognize that the issues she combats in the DRC “illuminate all of the different facets of public health.” She develops counseling programs to target the social causes of violence against women, setting a precedent for initiatives with a dual-pronged approach that encompasses both prevention efforts and responsive strategies. Her work illustrates the importance of public health solutions that acknowledge and address the multi-faceted complexity of health challenges.
Public Health, the Clinical Perspective
In addition to policymakers, managers, and researchers, clinicians play a vital role in public health efforts. Dr. Mary Jacobson is one such individual. Dr. Jacobson focuses on counseling patients to ensure that both the patient and the issue are treated. She believes that the improvement of public health through direct care relies on the rationality of insurance companies and the unity of doctors in promoting a legislative agenda that facilitates rather than impedes direct care. She recognizes that public health focuses on improving outcomes for groups of individuals, while she as a healthcare practitioner focuses on individual patients. “[I feel] pressured to see patients within a certain amount of time,” says Jacobson, reflecting on some of the challenges that she faces as a result of the monetarily pressured field of public health. She feels that she must “…direct care to the problem instead of the patient…because of time constraints.” Dr. Jacobson sees this challenge stemming from decisions made by insurance companies that place constraints on the amount of time doctors can allocate to caring for their patients. As a doctor, she believes that an increased focus on preventive treatment and a unified effort of physicians to push the health agenda in this direction, rather than insurance companies driving the agenda for monetary reasons, will create positive change to the field of public health overall.
Challenges of Public Health
Challenges abound in the ever-evolving field of public health. The complex, interconnected web of public health means its challenges are equally complex and interconnected. Amy Lockwood became so frustrated that people in Africa were dying from the preventable disease of HIV/AIDS that she wanted to become part of the driving force to help prevent its further spread. Jocelyn Kelly expressed her concern on the lack of collaboration within the field in the past: “[it is important] to decrease the many layers that separate the advocates and the policy makers… [in order to] make the link more direct so as to combat problems more efficiently.” Kelly believes that the responsibility of a doctor, a researcher, or a volunteer serving a community in which some of the individuals lack a political voice is to, “bullhorn the voices of the community to the UN, to policy makers…” Creating a stronger connection among the many professionals within the field is crucial in the progress of public health.
Public Health Moving forward: An Interdisciplinary Effort
Public health is defined by its diversity of perspectives and approaches, perspectives that sometimes clash but that reveal the complexity of this truly global endeavor.
Amy Lockwood stated, “public health includes every issue in some form, and that is why it is a global issue.” In the future, Lockwood believes that public health must address and share the mistakes that have been made in order to progress. Dr. Mary Jacobson expressed her opinion that the positive future progress of public health relies on the move toward “more preventive medicine rather than more reactionary medicine.” The future of public health—a future in which the field learns from its mistakes and comes together to collaborate on multi-faceted solutions—is rife with complex challenges that need addressing. Lockwood, Kelly, Jacobson, and others embrace this complexity rather than becoming daunted by it. Public health is defined by the tireless work of individuals who recognize that health is a universal human right to which every individual is entitled.
Jacobson, MD, M. T. (2011, April 4). Assistant Residency Director, Course Director, Stanford University School of Medicine. Interview.
Kelly, MPH, J. (2011, March 18). Gender-Based Violence Research Coordinator, Harvard Humanitarian Initiative. Interview.
Lockwood, A. (2011, March 29). Deputy Director for Global Health, Stanford University Center for Global Health. Interview.
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