James Felsen: Science and public health: Who decides? (Opinion) | Op-Ed Commentaries

Daily, media is saturated with articles describing the current societal chaos, concern, conflict and confusion over the nation’s application of science and public health. Absent workable, universal definitions of each of these terms (and who defines them), there is little resolution.

The dispute is really about how communities apply these concepts to control social commerce.

A recent Wall Street Journal interview of British science writer Matt Ridley, titled “How Science Lost the Public’s Trust,” elucidates how science has both a philosophical and an institutional definition. The same is true of public health.

Ridley defines science, as philosophy, as “the primacy of rational and objective reasoning.” He notes science as an institution, “like all human institutions, is erratic, prone to falling well short of its stated principles.”

As a philosophy, public health is a process by which a community monitors its environment and surveils the health status of its population, instituting activities to reduce risks and protect, maintain and promote the public’s health. As an institution, it also is often erratic and falls short.

Fifty years ago, I learned and embraced these principles in a small American Indian community in Northwest Arizona. I was the general practitioner and health officer for the community. I learned there that success is all about trust. There is no way to earn it. It either will or will not be granted by a patient or community. The physician who replaced me lasted less than a month before the tribe demanded his replacement.

A recent Harvard Chan School of Public Health survey revealed that over 80% of Americans trust their personal physician but only 40% trust public health professionals at the local, state and national levels.

Returning to the reservation, the community instituted several new public health initiatives, such as cervical cancer screening day. Most were my suggestions, but I would never initiate a public health program without support of the local tribal health board. In fact, for the cancer screening event the health board (three women) volunteered to cook lunch for the participants, to encourage attendance.

They, and other tribal representatives, controlled social commerce in the community and guaranteed excellent attendance.

Historically, U.S. communities have employed various mechanisms to control commerce related to science and public health. Locally, often the chief executive and legislative authorities with the prosecuting attorney and health officer exerted such control. Over time, various boards emerged, and certain controls were relocated within other local, state and federal jurisdictions.

During the ongoing pandemic, various authorities have claimed authority over commerce for certain populations, but many such claims invited opposition and failed to stand legally.

Scientific and public health institutions consist of experts often prone to group think and tradition.

Remember, some advised the public that it would be as long as two years before a COVID-19 vaccine could be developed. This is not to denigrate the amazing and wonderful contribution they have made to controlling the pandemic but to note that, at times, they are wrong. Furthermore, their opinions as to public application are subject to political and ideological bias.

How can they regain trust?

It is not by mandates. It is by communication and education, especially with those influential in local societal commerce, and soliciting their support, possibly even by serving lunch.

James Felsen, of Great Cacapon, is a retired board-certified physician who specialized in public health.

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