A historian looks at the past and future of public and population health

In the early 1920s, C.E.A. Winslow, the President of the American Public Health Association, gave his classic Presidential Address. In “Public Health at the Crossroads” Winslow argued that public health had to move beyond any narrow definition of its role as a sanitary science and preventative discipline rooted primarily in bacteriology. Winslow implicitly called for public health to integrate social and political issues into its mission. Resistance to this broadening definition has sometimes threatened the harmony of Annual Meetings. Partly in frustration some are adopting the newer term, “population health,” a term that encompasses the spirit of the World Health Organization's 1948 constitution, which defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

If Winslow challenged public health practitioners in the 1920s to broaden their field to include health care, (and that it took the APHA 22 more years to even organize the Medical Care Section) new issues have further forced a rethinking. SARS, avian flu and monkeypox may fit into traditional scope of the field. But global warming, environmental pollution, health disparities between rich and poor, environmental damage from pollution, war and resulting displacement and migration, endocrine disruptions due to bisphenyl a or other plastics and plasticizers, vinyl chloride exposures in everything we touch, general threats from industrial lead poisoning from auto emissions and paints that continue to poison children decades after they were produced, fast foods and obesity, accidental shootings, and a host of other issues challenge the profession. This brief presentation will lay out some of the underlying tensions that have affected American public health. It will outline the new crossroads that we are now encountering and which we will continue to encounter as we try to redefine the field once again.