Academic journal article Public Health Reviews; Rennes

Public Health Research Priorities for the Future

Academic journal article Public Health Reviews; Rennes

Public Health Research Priorities for the Future

Article excerpt


The triumphs of public health in the last century have been nothing less than extraordinary. Prevention has been estimated to have contributed to 25 of the 30 years of life gained by the average American.1 Other developed countries have made even larger strides in years of life gained and the developing world is beginning to catch up, dominantly as a result of prevention and public health. Scourges such as smallpox, polio, yellow fever, typhoid, typhus, and measles that historically claimed many lives in the developed world have become so rare that young physicians sometimes cannot recognize them. Vaccination, water purification, and sanitation have greatly reduced the threat of premature death from contagion in many locales, saving millions of lives.

Public health has not only transformed the prevention of infectious diseases but also of chronic diseases. Just as breakthroughs in infection control involved identification of pathogen, vector, and host factors, breakthroughs in reducing chronic disease have occurred through identification of various risk factors. Identification of tobacco's role in lung and other cancers as well as cardiovascular disease and the identification of effective options for smoking cessation have saved hundreds of thousands of lives. The recognition that hepatitis B causes liver cancer led to the WHO- sponsored hepatitis B vaccination campaign. The enumeration of major risk factors for cardiovascular disease, such as hypertension and hyperlipidemia, allowed for the discovery of effective anti-hypertension and lipid lowering medications. The identification that the great majority of cervical cancers arise from a limited number of serotypes of human papillomavirus (HPV) led to the development of effective vaccines. The discovery of a connection between lead and childhood neurocognitive development led to elimination of lead from paint and gasoline in many countries.

While these successes have allowed many to lead longer, healthier lives, the future holds some of the greatest public health challenges in human history. Modern-day perils include emerging infectious diseases, obesity, Alzheimer's disease, cancer, and others. Today's science has made slow progress towards eliminating these threats.

To ensure a continuously healthier future requires that we need to constantly feed the engine of scientific discovery. Public health must find solutions through innovation. Whether it is scientists finding new solutions or business people developing and marketing advanced technology, or policymakers endorsing change and ensuring their applications reach those not yet benefiting, or populations adapting to public health challenges, unique ideas are the key to ensuring that we and our children will thrive.

In 2009, a committee representing the major societies of epidemiology in the United States envisioned the most salient future opportunities and threats to public health.2 Here I review and enlarge that vision. To this I add the element that I have come to believe is the most critical to the future of public health: innovation. I organize these thoughts into the broad categories of 1) content: some of the greatest health threats in the coming generation, and 2) context: the operational and institutional factors that must be addressed to maximize the pace of innovation.



A decade after the adoption by 190 countries of the United Nations Millennium Development Goals (MDGs), several assessments have concluded that some but not enough progress has been made toward achieving these goals.3,4 MDGs constitute a broad rallying cry for action towards a sustainable approach to global well-being. Examples include:

1. Eradicate extreme poverty and hunger;

2. Achieve primary education;

3. Promote gender equality and empower women;

4. Reduce child mortality.

The MDG statements did not outline a roadmap towards achieving these goals. …

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