Harvey Fineberg and the IOM staff recently posted a thought-provoking discussion paper, Deadly Sins and Living Virtues of Public Health. In it, Dr. Fineberg posed seven deadly sins of public health—sloth, greed, gluttony, ignorance, complacency, timidity, and obstinacy—and his colleagues propose additions to the list. There may be cause for disagreement with the proposed sin of ’obstinacy’—the refusal to accept evidence on best practices and the refusal to change practices or customs that are familiar— resonate. Far from obstinate, the ever-shrinking funding for public health has practitioners clamoring for evidence on the best way to apply their scarce resources. Yet, the evidence base is admittedly thin. Far too little is known about how to improve population health over time, and how to measure that improvement, particularly in response to co-morbidities and other, new health challenges. A proposed sin that is a call to action for the research community is ‘duplicity’—deliberate deceptiveness… misrepresentation of facts. That and ‘silence’—not actively contributing to the public discourse—are reminders that rigorous, transparent generation of knowledge should go hand in hand with the movement of knowledge into action. While we’re focused on conducting rigorous research, we also need to stay focused on doing relevant and timely research, and on bringing actionable results to the practitioners and policymakers who use findings to make informed decisions. The more tools (evidence plus skills for communicating that evidence) public health has to make its case, the stronger and louder the messages will be. At the conclusion of the paper, Dr. Fineberg suggests there may be living virtues, serving as counterweights to the deadly sins, and calls upon the community to submit suggestions. Here are two suggested virtues for consideration:
Open-mindedness: Public health tends to be insular, functioning within a silo. But the Affordable Care Act’s call for applying a population health lens to health reform implementation can serve to tear down the walls between health care and public health. It also casts a wide net, expanding to include other influencers of health, such as transportation, agriculture, education. In the future, to achieve an integrated health system, public health may be re-defined, re-structured, re-organized. In being open minded to change, public health can seize this opportunity and take a leadership role in creating a new system of health for all populations.
Curiosity: It's science 101, right? It’s the first step in the scientific method: define the question. As a field, public health services and systems research has done an admirable job of defining what we don’t know.* But our curiosity cannot stop there. We have to continue to ask hard questions and seek reliable answers. Across the spectrum—from researcher to practitioner to policymaker—we must remain curious, asking How? Why? When? … as well as What if? and Why not? For example,
- Why does this intervention work with this population but not that population?
- What would happen if we forged that unique partnership?
- How can we communicate the science to influence behavior change?
*Research agendas include: Public Health Systems Research: Summary of Research Needs Public Health Systems Research: Setting a National Agenda Advancing Public Health Systems Research: Research Priorities and Gaps National Coordinating Center for PHSSR: Research Agenda