Overcoming Public Health’s Perception Challenges

As the field concerned with society’s organized efforts to improve health at a population level, public health relies on myriad partnerships to achieve their goals – with healthcare providers, with the public, and with many other sectors such as schools, non-profits, and legislators.  

One of the biggest challenges in forging these partnerships? Helping people understand exactly what public health is and isn’t.

By Lawrence C. Loh*

Adjunct Professor, Dalla Lana School of Public Health, University of Toronto, and Director of Programs at The 53rd Week Ltd

Overcoming Public Health’s Perception Challenges


As an early-career public health practitioner, I’ve had the great fortune of learning very early on that partnerships are critical to the success of public health initiatives.

I’ve also learned that while many members of our workforce come through training for the acute healthcare system (one thinks not only of physicians, but public health nurses, research methodologists, analysts, epidemiologists and statisticians among others), our business is very different from that of healthcare and the extent of our partnerships carefully circumscribed to a large extent.

Beyond our connections to healthcare, I have also witnessed the importance of partnerships with other sectors beyond hospitals and clinics that truly drive health at a macro level – such as working with planning and transport departments on building healthy, complete communities, or with legislators in enacting laws that change context, such as successes with smoking bans, or targeting childhood obesity through healthy eating in schools. In all cases, the overarching health of the public is our primary focus and the context of our community our ultimate tapestry.

This need to partner means that encountering someone outside our field makes it refreshing and easy to start a conversation. Too often, though, public health experiences various challenges in sharing our goals and why we do what we do – mostly due to perceptions that sometimes seem pervasive. This commentary explores, from anecdotal but frequent experiences, some of the key perceptions encountered when working with healthcare partners and non-healthcare partners or the general public.

Healthcare misperceptions

Besides being occasionally forgotten altogether (such as the time when Canada’s Society of Obstetricians and Gynaecologists released a new website to help people find places to get tested for sexually transmitted infections—without including links to any of public health’s sexual health clinics) healthcare provider views of public health commonly encompass several broad themes:

  • Public health as catch-all / safety net: Perhaps reflecting the subspecialized nature of healthcare fields, some providers often think of public health as a potential venue for issues they have identified that don’t seem to have an immediate “owner”. At planning tables, I’m often asked if it’s public health’s responsibility to raise awareness around medical assistance in dying, or to assist with smoother transitions of care between community settings and the hospital, issues that are more appropriately and already adeptly handled by palliative care and healthcare administration colleagues respectively.
  • Public health as “anything that isn’t clinical”: Another common heuristic among clinicians is that anything that isn’t clinical is public health practice. I often hear stories, excitedly recounted, about how folks are “getting more into public health” as a result of crunching data from their clinical trials, teaching medical students, or sitting on a hospital committee. The most common example is the confusion between healthcare administration and public health, the former of which involves the organization of the healthcare system to improve system outcomes; the latter which involves working with partners to organize society to improve health.
  • Public health as “advocacy, and it’s easy… anyone can do it”: The other tack is that public health’s vast mandate to address issues that impact on community health means that its name is famously co-opted by advocates to describe their work on a specific issue of importance to public health. While certainly making important contributions, too often clinician advocates ascribe a certain ease to balancing “public health” and their clinical career owing to their various pet projects. This viewpoint occasionally presents a difficult starting point for a partnership, especially if contexts limit just how far the public health practitioners can push towards the ideal vision put forward by the single-issue clinician advocate.
  • Public health as “just another provider”: Still other clinicians assume that because public health provides some services (healthy sexuality clinics, breastfeeding supports, immunization clinics) that public health is simply another service provider. This challenges public health to work to broaden their perspective, helping them understand that the services they are familiar with are one part of the overall strategies being deployed to tackle community health issues.
  • Public health as “this is an important issue”: Finally, one of the most commonly used misperceptions around “public health” is using the name as an adjective to draw attention to an issue. One good example is human trafficking, which is being touted by some as a public health issue. An alternative take: human trafficking certainly leads to individual myriad health issues for those involved, which presents burdens on the healthcare system, and is largely driven by illegal activities and societal inequities. This means that the considerations to address the phenomenon actually lie outside of public health’s scope and expertise. It’s a serious issue to be sure, but calling it a “public health” issue links it to a field that lacks the levers, expertise, and resources to effectively address the factors driving this phenomenon.
Public misperceptions

Public health also manages parallel misperceptions among their non-healthcare partners and the general public. This tends to fall more along a spectrum:

  • Blissfully unaware: For the most part, if public health is doing its job right, most people don’t even recognize or know that it’s public health. This has led to various campaigns such as This is Public Health, which aim to highlight how every day, common sense interventions in our communities have actually made a difference in the health of populations.
  • Public health is healthcare: The average person who has some inkling around the field often links public health to its larger, better resourced healthcare partner. The presumption is that since there are doctors and nurses involved, there must be some sort of clinical care that is happening – and that must form the bulk of public health’s work.
  • Meddlers / health “nannies”: In some cases, familiarity breeds contempt. While many partners have positive views on learning about public health’s goals and modus operandi in promoting, protect, and optimize the health of the population—typically apart from the healthcare system—still others see the work of public health as treading outside of its scope. This is seen in resistance where public health advocates for better transit or cycle trails despite not being urban planners, or where calls to address poverty or improve social services are just another example of big government types meddling with free society.
Managing misperceptions and moving forward

In an era of healthcare cost containment, climate change and environmental health threats, greater polarization in society, rising chronic disease, emerging infectious diseases, among others, the role of public health in preventing disease and keeping people healthy and protected is even more important.

Effective public health practice holds some promise towards relieving the burden on our healthcare system partners and to improving overall societal, economic, and community outcomes. This is what makes managing various perceptions of public health so crucially important to our work as practitioners.

While there are few other fields that can compare for the number of ways its members are misunderstood—perhaps insurance and financial planners come to mind—public health practitioners must learn what they can that is relevant from their parallel challenges while figuring out how best to navigate our own unique challenges in perception.

A growing interest in public health and prevention among students, young professionals, and partner agencies also represents a first step to having those conversations to really share who we are and what we hope to accomplish together.


*Dr. Lawrence C. Loh is Adjunct Professor, Dalla Lana School of Public Health, University of Toronto. The views expressed in this piece are his alone and do not necessarily represent the views of the University of Toronto or any other organizations that Dr. Loh might be affiliated with.


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Nutrients’ Strategic Functions in Preventing Tropical Diseases

...it sounds as a prerequisite to create an organized code of micro - and macronutrients with a proper diet that should be applied to children in developing countries to decrease the risk of infections and tropical diseases...

By Adrian Boruch

Project Manager, ALVO Medical, Poland

The Strategic Functions of Nutrients in Preventing Tropical Diseases


The aim of this article is to discuss the relationship between decreased macro- and micronutrient intake and tropical diseases with a special focus on malaria illness. As the authors of the books and publications that I refer to in my arcticle claim, an essential prerequisite to the prevention of malnutrition in a community is the availability of food for the nutritional needs of people. As the human body has the ability to resist almost all types of organisms or toxins that tend to damage the tissues and organs, it is worth researching how the immunity can be enhanced be intaking right nutrients. It is an obvious function of our immune system to form antibodies and sensitized lymphocytes that can attack and destroy the dangerous forms of organisms or toxins. At the same time a further question may arise what can be done in nutritional human science to stimulate antibody production. Unfortunately, we do not have all the equal access to nutritional food and dietary deficiency diseases may reduce the body’s resistance to infections and affect our immune system. It certainly should start with proper global education at the earliest school level how to harvest, store, transport and process food and afterwards which nutrients should be chosen by men and women.

The authors of ”Malaria and nutritional status among pre-school children: results from cross-sectional surveys in Western Kenya” were trying to discover in their study whether undernutrition could be associated with increased or decreased malaria attributable morbidity. They point out that relatively few studies have examined the association of malaria with protein-energy malnutrition in areas with intense perennial malaria infection. Nevertheless, they write about studies conducted among severely malnourished children in refugee camps that proved that undernourished children experienced more malaria and malaria-associated morbidity. Protein-energy malnutrition affects millions of children in the developing world. The relationship between malaria and protein-energy malnutrition, that is most common in sub-Saharan Africa, is still controversial. Recent updates indicate that almost 1 million children die each year of malaria and according to ”Report of the Disease Control Priorities in Developing Countries Project” more than a half of these deaths are preventable.

According to Michael C. Latham in his ”Human nutrition in the developing world”, protein-energy, vitamin A deficiency, iodine deficiency disorders and iron deficiency are most common serious nutritional problems in almost all countries of Asia, Africa, Latin America and the Near East. He applies the survey prepared by FAO and WHO that reveals that one of every five persons in the developing world is chronically undernourished, 192 million children suffer from protein-energy malnutrition and over 2 000 million experience micronutrient deficiencies. He studies another defence mechanism that should be taken into consideration in relation to malnutrition and that is of increased production of white blood cells and the destruction of bacteria by white corpuscles. Children with kwashiorkor show a lower than normal leucocyte response in the presence of an infection. When malnutrition is present , these cells, unfortunately, appear to have a defect in their capacity to destroy bacteria.

The authors of ”Malaria and nutritional status among pre-school children: results from cross-sectional surveys in Western Kenya” claim that protein-energy malnutrition has been related to poor cognitive and school performance in young children. They reveal evidence that protein-energy malnutrition places children under five years of age at increased risk for mortality. The shocking fact that they use in their publication is the rate of 56 percent of child deaths that can be attributable to malnutrition’s  effects. Malaria is holoendemic and transmission occurs throughout the year, though the are two rainy seasons in Kenya and the estimated number of infective bites ranges between 60 and 300 per person per year. It is often observed that malaria infection causes an acute weight loss and the authors of this publication struggle to relate symptoms such as diarrhea and abdominal pain to that infection as a consequence of malabsorption of nutrients and decreased intake of them.

How would it be possible to obtain more nutritional food in developing countries and decrease the cases of vitamin, minerals and protein-energy deficiency? Michael C. Latham estimates that about 25 percent of the grains produced are lost because of bad post-harvest handling, spoilage and pest infestation. Regarding losses of fruits, vegetables and roots, these have been estimated to be about 50 percent of what is grown. Furthermore, about 10 percent of food is lost in the kitchen. Special means should be taken to prevent food losses during harvesting, transportation, storage, processing and preservation. However, much malnutrition in the world is not only caused by shortage of food, but also by disease.  Thus, Michael C. Latham suggests that a modest increase in cereal, legume, oil and vegetable consumption by children will greatly reduce the cases of protein-energy malnutrition. In his book we learn that most food in the world comes from cereals and the second largest amount of food comes from root crops, followed by legumes and pulses. World produces about 2 000 million tonnes of cereals, 600 million tonnes of root crops, 60 million of pulses, 85 million tonnes of fats and oils and 180 million tonnes of sugar per year. Industrialized countries produce more foods of animal origin like meat, milk and eggs. Lots of this food is lost before it reaches the consumer.

More dramatic effect of malnutrition is illustrated in the book as the fatality rates of measles, which is a severe disease with a fatality rate of about 15 percent in many poor countries because the young children who develop it have poor nutritional status. Michael C. Lathan states that in Mexico the fatality rate for measles has been reportted to be 180 times higher than in the United Stated, in Guatemala, 268 times higher, and in Ecuador, 480 times higher. It has been revealed that during a measles epidemic in the United Republic of Tanzania that measles is related to vitamin A deficiency and thus it has been shown that giving vitamin A supplements to children with measles who have poor vitamin A status greatly reduces fatality rates.

According to Healthline.com :

...getting adequate amounts of vitamin A from your diet should also prevent the symptoms of deficiency, which include hair loss, skin problems, dry eyes, night blindness and increased susceptibility to infections. Deficiency is a leading cause of blindness in developing countries. In contrast, most people in developed countries get enough vitamin A from their diet. The recommended dietary allowance (RDA) is 900mcg for men, 700mcg for women and 300-600mcg for children and adolescents. Food high in Vitamin A is Beef Liver (713% DV per serving 100 grams) , Lamb Liver (236% DV per serving 100 grams), Liver Sausage (166% DV per serving 100 grams), Cod Liver Oil (150% DV per serving 100 grams), King Mackarel (43% DV per serving 100 grams), Salmon – 25% DV per serving 100grams, Bluefin Tuna, Goose Liver Pate, Goat Cheese (13% DV per serving) , Butter (11% DV per serving 100g), Limburger Cheese 11% DV per serving , Cheddar 10% , Camembert 10%,Roquefort Cheese – 9% DV per serving, Hard-Boiled Egg – 8% DV per serving 100g, Trout – 8%, Blue Cheese 6%, Cream Cheese – 5%, Caviar – 5%, Feta Cheese – 4%DV per serving, Feta Cheese – 4% DV per serving.

The worth noticing and terrifying fact observed by Michael C.Lathan in his book is the result of an inter-American investigation of mortality in childhood showing that of 35 000 deaths of children under five years of age in ten countries, in 57 percent of the cases malnutrition was either underlying or an associated cause of death.

He points out that few children suffer from vitamin C deficiency as it can be easily obtained from fruits such as guavas, mangoes, citrus and from a range of vegetables. The most important minerals in our nutrition are calcium, iron, iodine, fluorine and zinc. Vitamin D is essential for the proper absorption of calcium, the result of iron deficiency is anaemia and iodine should be mostly absorbed with sea fish, seaweed and most vegetables grown near the sea. A proper diet full with nutrients could probably optimize the human immune system. Nevertheless, the main source of energy for most Africans are carbohydrates and they may constitute up to 80 percent of their diet in some cases. In industrialized countries, carbohydrates constitute only up to 50 percent.

Undoubtedly, more thorough studies should be performed to illustrate the strategic functions of fully nutritional diet in optimizing the human immune system and simultaneously in preventing serious tropical diseases. Still little is known about enhancing our immune system in severe conditions and it sounds as a prerequisite to create an organized code of micro- and macronutrients with a proper diet that should be applied to children in developing countries to decrease the risk of infections and tropical diseases. Taking into consideration the losses connected to harvesting, transport, storage and processing food, a possibility of delivering optional nutritional food products and nutritional food supplements to children in developing countries could be analyzed. Some brave attempts to reduce such losses might decrease the prices of grains, fruits, vegetables and roots, which would enable larger consumption of right nutritional products in developing countries. At the same time,  more emphasis ought to be placed on adequate school education about nutritional benefits for our health.

Looking for these outcomes, the commitment and accountability of national governments are essential. This comes as no surprise now that, as reported  …the current international directions and neo-liberal policies have critically impaired access to food in the resource-limited countries. Over the last 20-30 years, the World Bank and the IMF, and more recently the WTO, have forced countries to decrease investment in food production and to reduce support for peasant and small farmers. Under neo-liberal policies, state-managed food reserves have been considered too expensive and governments have failed to protect farmers and consumers against sudden price fluctuations. As such, the critics argue that the neo-liberal policies have destroyed the capacities of countries to feed themselves. And this occurs at a time when land grabbing and evictions as part of neo-colonialism policies, including for biofuel agribusiness, are on the rise in Africa and elsewhere under national governments complacency and a widespread corruption.



  1. Human nutrition in the developing world, Authors: Michael C. Latham, Food and Agriculture Organization of the United Nations https://books.google.pl/books?hl=sv&lr=&id=diGLEXZEGh8C&oi=fnd&pg=PR3&ots=znsrjUB_ud&sig=GDT6ULJRtTrnxKq-qL-D9lTrR5Q&redir_esc=y#v=onepage&q&f=false
  2. Malaria and nutritional status among pre-school children: results from cross-sectional surveys in Western Kenya, Authors: Jennifer F. Friedman, Arthur M. Kwena, Lisa B.Mirel, Simon K. Kariuki, Dianne J. Terlouw, Penelop A. Phillips-Howard, William A. Hawley, Bernard L. Nahlen, Ya Ping Shi, Feiko O. Ter Kuile. Publisher: The American Society of Tropical Medicine and Hygiene, Source: The American Journal of Tropical Medicine and Hygiene, Volume 73, Issue 4, Oct. 2005, p. 698-704      http://www.ajtmh.org/docserver/fulltext/14761645/73/4/0730698.pdf?expires=1518449165&id=id&accname=guest&checksum=8E88E266A805D64B3395BEE53E95E11E
  3. Nutrition, child growth, and chronic disease prevention, Ricardo Uauy, MD PhD, Juliana Kain, Veronica Mericq, Juanita Rojas & Camila Corvalan, published online: 08 Jul 2009 https://doi.org/10.1080/07853890701704683
  4. Healthline.com, https://www.healthline.com/nutrition/foods-high-in-vitamin-a
  5. Nutrition-related diseases in Southern Africa: With special reference to urban African populations in transition, Alexander R.P. Walker Ph.D., D.Sc. https://www.sciencedirect.com/science/article/pii/027153179500067S




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Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 272


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