Abstract
This year, I had the privilege to begin my role as Editor-in-Chief of the Journal of Public Health Research and to bid goodbye to six years first as member, then as Vice Chair, of the World Health Organization Ethics Review Committee. Both functions have allowed me to follow population-based health research on a vast array of topics, using multiple methodologies, and spanning the entire globe. Every day, I look forward to learning something new, and to engaging with colleagues from all over the world.
Although I see a multitude of fascinating research projects being conducted across continents, I am also overwhelmed by the number of public health-related challenges facing us now and in the future.
When we passed into the new millennium, 25 years ago, there were many reasons to be optimistic about global health. Treatment for people living with HIV was becoming widely available, international aid and collaboration were (apparently) flourishing, and overall health-related trends were headed in the right direction. Indeed, in the years that followed, life expectancy increased in many parts of the world, maternal and under-five mortality rates dropped significantly as did tobacco and alcohol use. It seemed we were headed in the right direction, especially when all UN member states approved the Sustainable Development Goals in 2015.
But other, less reassuring patterns were emerging simultaneously: overweight and obesity were on the rise just about everywhere—including in countries where hunger persisted; “vaccine hesitancy” emerged as a concept to describe an ensconced phenomenon; insufficient attention was being paid to the health effects of increasing screen exposure, and mental health was too narrowly appraised in terms of psychiatric diagnosis (or absence thereof).
And then what happened?
Covid!
The pandemic that most of us had been warning was bound to occur (to too many nonbelievers)—actually did.
Although most countries had some level of pandemic preparedness, governments and health authorities were (surprisingly) taken by surprise, be it in terms of logistics or communication. Morbidity and mortality patterns were driven by interactions among biological, socio-economic, and environmental risk factors. It almost never been unusual, alas, for residents of poorer neighborhoods to experience greater communicable disease burden. But what was novel were the higher case-fatality rates observed among people with pre-existing chronic conditions, including obesity. When one adds into the equation air pollution and ageing populations, one has all the ingredients for synergistic phenomena which played out differently within societies and across countries.
Lockdowns and overall restrictions fueled the digital modus vivendi, paving the way for pervasive social media and remote human interaction, and marking a revolution in the way we work and learn. The extent of vaccine hesitancy and distrust of health authorities took on unprecedented proportions, and we missed a critical opportunity to shift towards a more sustainable way of life, notably by reconsidering our use of air travel and other environmentally damaging conveniences.
Historically, pandemics—such as the plague, cholera, typhus or influenza—have led to—or, in any case, coincided with—major societal and/or political shifts. And Covid-19 is no exception.
In the aftermath of the pandemic, social inequities have deepened, mental health problems such as anxiety and depression have risen sharply, unhealthy foods have become more accessible/affordable, and life expectancy has dropped. There are insufficient numbers of healthcare workers (even in those countries where there used to be an abundance), healthcare costs continue to rise, international aid and research funding have shrunk, and political tensions (including conflicts and large-scale wars) are at an all-time high. Although climate change has long been in the making, its effects have become particularly salient since the pandemic, reminding us of the urgency not only to curb environmentally damaging practices, but also to plan ahead for inevitable, large scale natural disasters.
Some would say the outlook is bleak . . .
But far from being discouraged, we should seize what is—in my opinion—a unique opportunity: never before have public health professionals, such as ourselves, had such a vital and pivotal role to play.
When people ask me what I do and stare blankly at me when they hear “public health,” I like to explain my profession in the following terms: “Physicians study and treat disease in their individual patients. Public health practitioners study the occurrence of disease, and ways to prevent it, at the population level. In other words, physicians doctor their patients; we doctor entire populations.”
And that is why our calling has never been greater. We need to come together as a community who share the same humanitarian values—preserving life and reducing suffering—to argue strategically in favor of healthy living environments, access to healthy foods, health promotion, and prevention from the womb to the tomb, as well as knowledge sharing and generation through international exchange and collaboration.
“That’s all very well,” I hear you say, “but how do we even begin to do so in face of shrinking funds for research and programs?”
To begin with, we need to change our mindset. Traditionally, we have been seen as less “important” and less “prestigious” than our clinician counterparts. In my case, for example, the Public Health Department of the Nice University Hospital is located. . . in the basement. Worse still, many clinician colleagues do not understand what we do or see it as important. As a profession (I am tempted to say “as a guild”!), we must therefore have the ambition
Crucially, we need to advocate in favor of public health by tapping into those resources at our disposal. We lack funding to carry out a local intervention? Why not explore which private companies might be interested in helping us? Why not engage students who are willing to volunteer time in exchange for academic recognition? Why not get the community involved? Why not call on local media channels?
Or: a hospital lacks sufficient nursing capacity? Why not conduct an analysis with human resources to determine how much of the problem might be solved by task-shifting? Are qualified nurses actually required for the least qualified tasks? Can we bring in other hospital personnel or non-nursing students to carry out those tasks?
And why shouldn’t high-income countries in the global north look to the global south where countries have successfully trained community health workers for a large variety of activities. . . for decades?
Such examples are rife. Indeed, never has the adage “think global, act local” been more timely. The problems we face may be universal, but they must be tackled at the micro level according to specific environments, cultures, values, social, and health determinants.
That said, here and there, today as in the past, we will be able to drive positive measures for population health only if we can demonstrate to decision-makers overall cost-saving and increased productivity through a myriad of channels, including healthier workforces.
The notion that preventing is preferable to treating is as much a scientific challenge as it is a political and even psychological one. 1 As such, we academic researchers cannot merely sit back, pursue science and exchange with those who share the same convictions as we. We cannot presume that the evidence we produce is “evident,” and that decision-makers will automatically act upon it.
For instance, there is a huge evidence base connecting overconsumption of junk food and overexposure to screens with overweight and obesity in young children; nevertheless, efforts to limit children’s access to those goods and behaviors—where they exist—are relatively timid. Similarly, the basic requirement that all countries have access to essential medicines (as defined by the WHO) has required gigantic lobbying, especially where neglected diseases and populations are concerned, and although such access has improved, there is still a long way to go.
So the question I wish to ask you as my health sciences colleagues with a vested interest in population health, wherever you may be based and regardless of your area of specialization, is the following: How can we, collectively, produce and advocate for research agendas which will actually help drive the right actions for population health? What kind of research should we be prioritizing in order to demonstrate meaningfully to decision-makers and the public alike the importance of investing in health promotion and prevention? And, once we produce such evidence, how do we communicate our findings outside the academic world?
In order to begin looking for answers to these and other questions, I would like to launch the idea of creating a consortium of public health practitioners across the world, whose “ambassadors,” “first secretaries,” and “attachés” would represent not countries but health challenges, patient groups, vulnerable populations. . . We might call it “Health Diplomacy Beyond Borders.” The aim of such a consortium would be to drive research that can truly contribute to improved population health and patient group outcomes and communicate beyond academia by engaging with the media, internet and public events.
But before I get carried away by these and other exciting prospects (which we can make happen if we really want to), let me come back to the essential building block—producing and communicating scientific evidence via the Journal of Public Health Research.
My wish list for the Journal of Public Health Research in 2026 includes greater disciplinary diversity in study conception, design and interpretation, fewer purely descriptive studies and more evaluation, programmatic and implementation research, and innovative conceptual frameworks and methodologies for tackling contemporary and future population health challenges. I also hope to see greater regional spread of authors and study locations—be they in high-, middle-, or low-income countries or humanitarian/crisis settings.
A few announcements by way of conclusion.
In view of the rising number of publications, in the future the Journal will be aiming to develop geographical sub-sections, with a special section for manuscripts beyond borders. Looking ahead, we will be running two annual article awards to spark your imagination and reflection. One award will be for the best “Perspective” essay on a predefined topic. The other will reward the image or photograph that illustrates the most patently—without words—a public health need or achievement. Please stay tuned for these announcements next year!
Wishing you a healthy and productive 2026!
