Public Health and Marginalized Populations: A Public Health of Consequence, October 2019

Public health practice builds on what we know from the population health sciences to improve health and reduce or eliminate disease. There are abundant rewards in population health science and public health practice, but the privilege of being part of an enterprise that aspires to generate good health for millions of people-whole populations-must be one of the most compelling aspects of the work. We create the evidence base that can change and inform policy-policy that creates changes that affect many. Creating opportunities for exercise will provide that opportunity for whole cities; changing the age at which cigarettes can be purchased means that a whole generation of future adults will smoke less, improving the health of whole countries. Striving for evidence-based policies informs many of the decisions we make in our science and practice. It pushes us to think about what matters most, for example, focusing on ubiquitous forces that influence the health of many in populations and communicating the importance of population health science to change the public conversation. And yet, the goal of making population health improvement central to our mission is balanced by other principles that also should inform the work of public health. Central to these is a concern with social justice. In many ways social justice is at the heart of the work of public health. Health is socially patterned and population health is interlinked, influenced by shared circumstances, by transmission of behaviors and of pathogens, suggesting that the health of one is inextricable from the health of all. Therefore, we simply cannot do our work in public health without paying attention to the underlying structures that shape that health and the principles of social and economic justice that structure a world that affects the health of all. This concern with the foundational principles of public health has implications for, and brings nuance to, what might otherwise be a utilitarian approach to public health-the promotion of the health of as many as possible over and above all other considerations.