Lessons for Public Health During Times of Change

By Shelby Crosier

As the second Trump administration begins and new cabinet members and appointees take up their positions across the U.S. Department of Health and Human Services, there may be changes in the public health landscape. Looking to experts who have led the field during past times of transition provides insights about how public health has evolved over time.  

In a special Luminaries fireside chat on January 14, James Curran, MD, and Anne Schuchat, MD, shared experiences from their years in public health leadership.

• Curran was dean of Emory University’s Rollins School of Public Health from 1995 to 2022. Prior, he served in leadership at the Centers for Disease Control and Prevention (CDC) for over two decades, leading the nation’s efforts in the battle against HIV/AIDS.
• Schuchat was principal deputy director of CDC from 2015 to 2021 and served twice as acting director. She also led CDC’s National Center for Immunization and Respiratory Diseases from 2006 to 2015 and played key roles in the 2009 H1N1 influenza pandemic, 2019 outbreak of vaping-associated lung injuries, and the COVID-19 pandemic.

Three big takeaways for the coming years are to be flexible, focus on communication and trust, and build coordination.

Be Flexible

Reflecting on previous transitions during her time at CDC, Schuchat pointed out that one thing they all had in common is that things did not go as expected. She noted that, “none of them were as good as we hoped, and none of them were as bad as we feared.”

The most important way to prepare is to remain flexible to respond to any need that arises. Although we may have preconceived notions about changes that may happen in public health, we cannot predict what the actual priorities will be. Schuchat recommends continuing to focus on your responsibilities and the work that needs to be done, because “there is a long-term importance to public health that does not change.”

Curran councils that public health advocates should also be prepared to be flexible in their approach to the work and how they frame important issues.

Focus on Communication and Trust

For Curran, the current landscape of mistrust in the U.S. is one of the most pressing issues that we can work to address within public health.

“We are at a lull in social capital in this country,” he said. “We don’t trust the government. We don’t trust institutions. We don’t trust mainstream churches. We don’t trust the press. Therefore, we don’t trust science, and we don’t trust anything.”

This lack of trust, along with rampant misinformation and disinformation found in online spaces, make it crucial to focus not just on the science of public health, but also how to effectively communicate it.

Schuchat believes that this should start locally, building up networks of support and care in our own communities increases trust. She also shared that academic institutions have an important role to play.

“Students and researchers have a huge opportunity to be both developing evidence and communicating it simply, clearly, and in ways that are persuasive,” she said.

Build Coordination

Siloes are a pervasive issue in public health, despite the multidisciplinary nature of the field. Curran and Schuchat both shared that continuing to operate within our own spheres will not lead to lasting change in the field.

Creating closer linkages between public health and clinical medicine is one key element, so that prevention and treatment can better work together. Health policy is a key way to link the two, especially when it comes to health care access.

Another important place to coordinate more and break down siloes is between academic and governmental public health and communities. Curran noted that, “we think that when we discover solutions, all we have to do is prescribe them and people follow them,” but that is often not the case. Public health practitioners must build the necessary skills to engage with the populations they are serving.