Seeing Public Health as an Investment in People and Communities

In this blog, we’ve discussed many of the challenges facing the public health system — declining health outcomes, burnout among public health professionals and the chronic lack of capacity in many public health agencies. Nearly 40 years ago, the Institute of Medicine’s Future of Public Health report warned that the system was in “disarray” and “chronically underfunded.” Those warnings remain just as relevant today in the wake of the expiration of pandemic-driven federal investments in state and local public health and job cuts at federal health agencies, which threaten to further weaken an already lean system.  

Given these persistent challenges, how do we, as public health leaders, effectively communicate the value of public health? Of course, we need to highlight data demonstrating our impact and at times draw on health and economic theories to make the case for investment. But data alone isn’t enough. Public health must feel relevant to people’s everyday lives. We need to tell stories — our own and those of our communities — that show how public health has shaped lives for the better. In this post, I share a personal story about why public health matters to me. 

My Story — The Impact of Tobacco on My Family and Community  

For me, the value of public health isn’t just theoretical — it’s personal. My mom died from a preventable cause at age 53, losing about 25 years she could have spent with family and friends. My kids never got to have a relationship with their grandmother, something that saddens me every day. They ask why they have a grandma on my wife’s side but not mine, and there’s no easy way to explain it. 

While her death certificate lists cancer as the cause of death, the real cause was a lifelong addiction to tobacco. She started smoking in seventh grade, at a time when the dangers of tobacco weren’t widely known. Although there were laws restricting the sale of cigarettes to minors, enforcement was weak, and it wasn’t uncommon for young people to smoke. The Surgeon General’s landmark report on smoking and health had only recently been released, and tobacco was still deeply woven into American culture. 

My mom was first diagnosed with cancer in her 40s. I was a junior in college. Thanks to medical advancements, she lived another ten years — a success by medical standards, where five-year survival is often the benchmark. Those extra years meant she got to see me graduate from college and get married. But they were 10 hard years filled with chemotherapy and everything that comes with it — hair loss, weight loss and a loss of the will to keep going. This still haunts my family to this day even though we lost her more than 10 years ago.  

I’m grateful for those extra years, but the real success would have been preventing her from ever starting smoking in the first place. 

I’m not sure how easy it was for my mom to get cigarettes, but I know when I was a kid, getting tobacco was pretty easy. I never smoked, but a lot of my friends did. One of our corner stores would sell cigarettes to them when we were as young as fifth or sixth grade. They’d even let them smoke while we played pool in their back room. Another store kept its chewing tobacco right next to the candy, within easy reach of kids who had no trouble pocketing a tin.  

Several of my childhood friends were already smoking or chewing almost every day by the time we started high school. It didn’t have to be this way.  

These stories are part of a much larger public health narrative. Public health efforts to reduce tobacco use have saved an estimated 8 million lives since the Surgeon General’s report in 1964. This accounts for about 20 extra years of life for everyone who would have likely died from the effects of tobacco addiction without the efforts of public health. But the impact of public health goes beyond reports and policies. It goes beyond warning labels. Public health is actively engaged in building healthier communities. Policies to curb indoor smoking are becoming more widespread and were first advanced by state and local public health leaders. Public health leaders are making sure that stores aren’t selling tobacco to youth, and that they aren’t putting tobacco products where youth can get to them. These are all examples of how public health leaders have changed the culture around tobacco use and helped improve health in this country, one community at a time.  

So, when you ask me what the value of public health is, it’s the ability of people to come together and create a better community for their kids. It’s the power to have more robust solutions. It’s the power to keep families connected across generations. Public health isn’t just about preventing deaths from tobacco — it helps communities bring their true vision forward in countless ways. It reduces premature deaths from chronic disease. It ensures every baby can have a healthy start to life. It prevents children from suffering lifelong brain damage due to lead poisoning from their homes where they should be safe. It ensures communities can fight disease outbreaks, even when no cure exists. Public health does all these things and more.  

As public health leaders, we can share stories that help policymakers see investments in public health as investments in people and communities. At its core, public health is about ensuring that fewer families have to experience the kind of loss that mine did — and that’s an investment worth making.