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The exodus of public health: What history can tell us about the future

Public health today often associates itself with objective science. Clinical and laboratory based, its focus is on curing individuals and encouraging personal responsibility. Public health often sees little role for itself in advocacy, and distances itself from class or racial analysis, and from engaging with corporate or political power.

This article makes the case that public health emerged in the 19th and early 20th centuries from a very different understanding, one that saw social, labor, and environmental reform as the key to improving health. Early health reformers focused on transforming conditions related to housing, working conditions, the environment, inequality, poverty, and racial segregation. They allied with labor and housing organizations, as well as others, which provided them with a political base. In short, they saw themselves as social activists.

The authors argue that the move from social activism to a science-based approach, which they trace through the early and mid-20th century, left public health “unwilling or uncertain about how to use science to challenge powerful corporate interests, deeply entrenched moral beliefs, or profound social inequalities linked to gender, race, and class.” Public health professionals have “defined their mandate ever more narrowly and shrunk from political engagement with power interests such as corporation and business that created unhealthful environments. They failed to confront medical specialists interested in defining preventive interventions as clinical and hence reimbursable.” This transition left public health ill-equipped to advance health and racial equity.

The authors, though, believe that public health is positioned to return to its origins and must do so. “We can either accommodate the status quo or confront political and economic power in the name of the public’s health.” Public health must “find ways to align with constituencies, lend our science and our knowledge, and create a base of power for progressive social change.”

By tracing this history and reminding public health of its roots, this paper is an excellent resource for those thinking about the public health transformation required to truly embrace its focus on health and racial equity. It also serves as a hopeful reminder that the field has gone through major shifts, and that it can do so again.

Use this resource to:

  • Make the case for public health to conduct advocacy, partner with others working toward social justice, and work to build power in order to advance equity
  • Facilitate discussions about the roles of public health and public health activities to support social justice


Related Resources:

Let’s Talk: Public health roles for improving health equity

Let’s Talk: Advocacy and health equity


See other resources related to power, health, and equity.


Fairchild, Amy L., David Rosner, James Colgrove, Ronald Bayer, and Linda P. Fried. “The EXODUS of Public Health What History Can Tell Us About the Future.” American Journal of Public Health 100, no. 1 (January 2010): 54–63.

Tags: Power, Journal Article