The Contested Boundaries of Public Healt

There is a paradox in American public health. On the one hand, the definition of public health has been broadening. Historically, the definition focused on preventing diseases; today, an equal emphasis has been put on addressing the upstream factors that lead to poor health (including racism, sexism, economic and political inequality, and social injustice in general). Some people say, “Public health is everything.” On the other hand, in practice, the American public health system has been retrenching. At the start of the 20th century, the emerging American public health system was more ambitious — it identified itself with housing, sanitation, and labor reform efforts. Today, with local public health agencies “understaffed, undervalued, and uncertain about their mission,” most social reform agendas are out of the reach of American public health. Some people argue that public health must go “back to the future” to realign itself with social, political, and economic forces for deeper social reforms. Others believe that such an approach blurs the focus of public health and makes the field even more vulnerable. This course is structured around these debates. It examines the contested boundaries of public health in five realms—maternal and infant health, caring for the elderly, mental health, substance use disorder, and global public health governance. This course will also examine American public health from a comparative perspective, exploring what the United States can learn from other countries and the past.