Forecasting the Future

Rollins leadership share insight on what public health issues may take center stage this year.  

By Kelly Jordan

No one can say with certainty what 2024 will bring, which unknown illnesses will emerge, or where we will see unexpected triumphs or failures. What we do know is that this is a presidential election year, COVID is still very much with us, and public health will continue to hold a prevalent place in news headlines. In looking at the current public health landscape, Rollins leadership shared insights into the public health topic areas where they see the greatest movement and that we can expect to hear a lot more about in the media—and on the debate stage—in the months ahead. 

M. Daniele Fallin, James W. Curran Dean of Public Health 

As we enter an election year, I think it is important to look at candidates' platforms through the lens of health. All societal issues have health relevance from transportation to education to the environment to criminal justice to health care. In each sector, we should be thinking about the consequences of particular policies on a community’s health. Our work at Rollins this year will be to generate and communicate evidence that informs this lens through our research, education, and practice activities.

Robert Krafty, Rollins Professor and Chair, Department of Biostatistics and Bioinformatics 

I think we will continue to see more in the infectious disease space and coming from a couple of angles.

1. One is thinking about how we respond to COVID, track it, utilize data from varied sources, and update our knowledge in ways of achieving that. Aside from COVID, we've learned a lesson about needing to forecast, as well as help convey the variability and uncertainties in our prediction in the infectious disease space. 
2. Artificial intelligence (AI) and machine learning are pervasive. One of the big challenges with this is in the world of causal inference. If you mine massive data sets and you run big convolute neural networks to learn things, you're learning things. But it's not clear if you're getting to scientific causality or if you're just understanding patterns. And one of the big challenges for statisticians and informaticians, is ensuring that we can actually form causal inference. 
3. A third area we’ll see more emphasis and development is understanding how to use multi-omics data (genomics, proteomics, metabolomics, and microbiome) to answer major public health questions.

Tim Lash, Professor and Chair, Department of Epidemiology 

If I was a high stakes better, I’d bet on something I won’t talk about here because that tends to be the thing that gets the headlines and for good reason. But, in terms of what’s safely predictable?

What should be in the headlines, and hasn’t changed much, are topics like tobacco prevention, vaccination uptake, weight gain prevention, maternal child health, and the opioid epidemic. If we could make progress on just those things, public health would be much better off. Beyond epidemiology, on the broader public health side, health care access remains critically important. This is all U.S. centric, but of course water, sanitation, and hygiene remains a major area of concern in areas with low resources. 

In terms of preventing premature morbidity and mortality and encouraging wellbeing, prioritizing all of these things is key. 

Joe Lipscomb, Professor and Interim Chair, Department of Health Policy and Management

There are multiple policy debates, and anticipated actions, at the federal and state levels in 2024 that will no doubt influence health care quality, access, and costs. Below are some major topic areas—as informed by conversations with HPM faculty:

• Pharmaceuticals: Reigning in costs to patients, insurers, and ultimately taxpayers, while maintaining adequate incentives for research and development by industry. 
• Maternal and Child Health: At the state level, and especially in Georgia, how to effectively address high infant mortality and maternal mortality through expanded insurance coverage (Medicaid) and greater access to important health care providers at all levels (including doulas, perinatal care managers, and community health workers). 
• Public Health Workforce: There is a compelling need to grow the maternal mental health workforce in Georgia and beyond. Authorizing Medicaid to reimburse perinatal support workers could make a critically important difference.
• Mental Health: The mental health crisis, including anxiety and depression among youth and young adults, is a problem that has worsened over the past decade, for multiple reasons. Addressing the problem successfully will require improved access to better mental health treatment while also acknowledging and responding to important social determinants of health (family structure and stability, housing, and much else).  
• Telehealth: One big issue the Medicare program will need to address is how to continue paying for telehealth visits once current coverage vehicle, the Public Health Emergency provisions (enacted during the COVID crisis), expires this year.
• AI: There are major questions about whether and how to regulate the use of AI in health care in ways that promote safety, effectiveness, and equity of access to care.  

Yang Liu, Gangarosa Distinguished Professor and Chair, Gangarosa Department of Environmental Health

 I wouldn't be surprised to see a stronger and closer coupling of climate change and health. COP28 put health as a central theme for international climate negotiations that should motivate a lot of new studies—previously all the policy scenario analysis in the climate change space did not include health at all. My second observation or forecast from the environmental health perspective is the closer and more extensive engagement of community-based approaches. We've seen multiple major funding agencies getting into this space and calling for community participation in climate adaptation and building resilient communities.

 In addition to research activities from the Inflation Reduction Act and the infrastructure bill, there are major resources allocated to community investment and actually building up community resilience against climate change instead of assessing or identifying vulnerable communities. 

I think we’ll see the general public, and probably policymakers, start to accept this reality that climate change is here. It is happening. It is hitting us. It is harming us. It's not a hypothetical thing down the road anymore. 

Don Operario, Rollins Professor and Chair, Department of Behavioral, Social, and Health Education Sciences

I think we’ll see a lot of issues raised related to themes under the behavioral, social, and health education sciences umbrella. Reproductive rights and sexual health services definitely will be one. Issues around health inequities among minority populations, migrant populations, and access to health services for people who are outside of social safety nets will continue to be prevalent. Collective conflict in major parts of the world and the mental health and physical and structural health issues related to accruing conflict-related traumas will be even more concentrated when they enter media discourse.

Usha Ramakrishnan, Chair and Distinguished Richard N. Hubert Professor, Hubert Department of Global Health

Global conflict and humanitarian crises will remain a major public health concern in 2024 as we look at the effects of war on populations around the world. These health impacts include increased infectious diseases, starvation, longer-term generational impacts, and rates of intimate partner violence, in addition to injuries caused by the direct violence of war. On a related note, immigration will continue to be a part of the political discourse. 

With the continuation of COVID, but also RSV, flu, and other infectious diseases, vaccine development and distribution will be an area of focus, particularly in a global context where low-income countries are not receiving vaccines at an adequate level. Tuberculosis and diabetes remain prevalent and are major causes of illness and death, globally. 

In looking at community health and disease prevention, access to water, sanitation, and hygiene, and nutritious food are issues that affect not only low and middle-income countries, but also communities in the United States. 

Maternal health—globally and in the United States—will continue to be a major topic of discussion.