How Should a Leader of Public Health Think?

How Should a Leader of Public Health Think?
Following a challenging week, reflecting on how we prepare students to serve populations.
The job of professional and graduate schools is to convey to students a systematic way of thinking about characteristic problems in their chosen field. Law school leaders, for instance, call this “learning to think like a lawyer.” As a school of public health, do we teach students to “think like a public health leader?” If so, can we define what such habits of thought include?
Other professional schools have specific methods of instilling their kind of professional mind in action. Law students learn by the Socratic Method through an instructor’s directed questioning and out-loud reasoning around actual judges’ opinions. Business school lecturers use case studies and examples of the economy to teach critical thinking about personnel, marketing, and finance. Medical schools still mandate enormous amounts of memorization, but early courses in “Becoming a Doctor” are followed by hospital ward immersion, trying to impart the framework of a medical culture. In each of these illustrations, the professional’s critical thinking is applied to an individual: a plaintiff, a company, or a patient.
For public health students, critical thinking must be applied to more than just individual examples. Public health applies to groups of individuals—a population, a public. And so public health thinking always requires an additional component: Who constitutes that population?
This question is not trivial. The public health student recognizes—but also analyzes, measures, reconsiders—that people have multiple, interdependent identities, which embed across multiple populations. At a basic level, every person knows they are simultaneously an individual and a member of a family; they are also part of a neighborhood, city, state, and nation. But every person also recognizes that we all have many other diverse identities that define who we are, that connect us with others. To ignore any one of these is to ignore important aspects of one’s identity and to look away from an ethos fundamental to public health: Public health is an orientation toward each other. We all have an ongoing set of commitments and actions that exist in relation to others.
What are the methods we use then to create a public health mind in action? A public health student’s thinking demands a store of relevant information, a mastery of certain skills, and an ability to analyze scientific evidence and complex societal problems. But the public health student’s eye on populations and, in particular, the prevention of health problems in a given population—which often includes an attempt to identify broad policies to address the problem at hand—becomes inculcated in a public health professional. The methods of public health thinking must take on populations, prevention, and policies.
For other professions, where critical thinking is applied to individuals, there is an ethical demand to do no harm, even if the patient’s or plaintiff’s values are anathema. The consummate professional must overcome such mismatches in values. The characteristic problems of the public health profession are population-based, yet similarly, the do-no-harm ethos means that a public health professional’s responsibility is to our most vulnerable persons, including populations whose behaviors, views, or beliefs we may not agree with.
We expect our national leaders to be excellent in this way of thinking as well, even as the Congressional hearings and other federal actions of this week leave us in doubt. We expect them to be not only clear-sighted and clear-headed, but also evidence-based and even-handed. Despite the challenging moment we are in, we will continue to train the next generation. Today’s public health students give me hope. They will be our leaders soon enough; the future protectors for the health of us all.
Michael Stein, MD
Dean Ad Interim
Boston University School of Public Health
mdstein@bu.edu
Previous Public Health Matters are archived at: https://www.bu.edu/sph/news/articles/category/public-health-matters/
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