The third era is an exciting time to be in public health. It means not just badgering individuals about their health behaviors, but working across sectors to ensure the conditions in which people can pursue health. And it recognizes health as a resource for everyday living. But while the third era of public health has great ambitions, it’s also a call for humility in how we get there.
The first era of public health controlled infectious diseases. We identified the sources of pathogens in the environment, and created great infrastructural projects to ensure safe water; great regulatory architecture to ensure safe food, air, and soil; and great vaccination campaigns to ensure low contagion. This era created the conditions in which infant and maternal mortality plummeted, many diseases were contained or eliminated, and life expectancy skyrocketed. The world we live in today was made possible by the first era of public health.
The second era tackled the much more challenging problems of chronic diseases. It was an era when public health persuaded a reluctant medical establishment that health behaviors are more than just private matters between physicians and their patients.
The third era recognizes the importance of well-being and the relevance of multiple sectors in ensuring well-being. The third era incorporates the first two but also looks to the justice system, education, urban planning, transportation policy, and many other things for help in ensuring the conditions in which people can achieve well-being.
But here’s the thing: In transitioning to the third era, we’ll have to work with other sectors to enlist their help in meeting health goals. But that means we’ll also have to get modest with our ambitions. If we expect those in education or juvenile justice to embrace health goals in what they do, we’ll also have to recognize that health may have to take a back seat sometimes to educational goals or juvenile justice priorities. If we want to work with local restaurants and food writers to promote healthy eating, we’ll have to recognize that, as Julia Child and Jacques Pepin have said, the fat police have ruined American meat. And bike helmets are great (I always wear one while biking); but let’s not let that become a dogma that trumps people just getting around town on their bikes.
In the third era of public health, ensuring the conditions in which people can pursue health will mean backing off on insisting on health above all. And the freedom that brings is pretty exciting.