The Struggle for Public Health: Seven People Who Saved the Lives of Millions and Transformed the Way We Live

Book Title: The Struggle for Public Health: Seven People Who Saved the Lives of Millions and Transformed the Way We Live

Author: Fred C. Pampel

Publication Details: Johns Hopkins University Press, 2024, 336 pp., $29.95 hardcover

The Struggle for Public Health is an anthology of public health innovations from the 19th and 20th centuries, discussed by reviewing the life stories of the inspirational innovators within the context of their times. The author, Fred Pampel, PhD, is a professor emeritus of sociology at University of Colorado Boulder, whose work examines themes of socioeconomic disparities, experimental methods of evaluating health behaviors, and public policy. He structured the book to be accessible to a wide audience. He does an excellent job establishing these individuals within the social context of their times and providing an easy-to-follow and engaging account of the broader social and historical factors that influenced the contributions that are often taught in a vacuum today. The ultimate purpose of this book is to demonstrate how the past informs the present and to share ideas that may influence current policy development and innovation.

The author outlines a detailed yet accessible history of each highlighted public health figure in basically the same format for each chapter: a brief overview of their primary accomplishments followed by a narrated timeline of important events beginning with essential personal (eg, educational, professional) and historical background. From there, each chapter is organized slightly differently depending on the primary focus of the figure’s contribution. For example, the author highlights John Snow’s methodological contributions to public health, so that chapter details Snow’s approach to understanding cholera; whereas the emphasis in Lillian Wald’s chapter is population health disparities, so it is organized around historical and current understandings of health inequity.

The overall outcome is a book that details what will surely be an interesting history to some but does not go much further to illuminate how the past can improve the present. After all, what greater purpose do learning lessons have than to strive for continuous improvement? Our initial impression is that the author, at times, missed opportunities to explicitly connect these stories to important current issues and to draw a more clearly defined throughline from the past to the present. Many of the chapters focus significant attention on the pioneers’ often abrasive and headstrong personality traits and conflicts, which often led to furthering obstacles for their public health innovations. While the author does an excellent job describing how each featured historical figure overcame obstacles and endeavored to improve the world around them in their own time, we would have liked to have seen more emphasis on how those stories might extend into the present.

For example, the Edwin Chadwick chapter is ripe for discussion on the importance of cross-disciplinary collaboration to advance public health initiatives related to sanitation, Chadwick’s passion, as well as the imperative of upstream intervention for an issue that has yet to be solved in modern times. Likewise, in the Snow chapter, the author connects Snow’s methodological processes to the development of a COVID-19 vaccine; but seemingly, the more salient lesson might be related to navigating the tension between scientific expertise and prevailing opinion, given that the dominant theme of that chapter is how fervently contemporaries dismissed Snow because his ideas challenged the status quo. Perhaps the author could have drawn some parallels between Snow and Anthony Fauci, for example. The promise of learning lessons from the past to improve the present is best realized in the chapter on Lillian Wald, in which he tells the story of shifting, but never resolving, health inequalities. Given the author’s background, this is not surprisingly his most illuminating chapter.

Nevertheless, in the epilogue, the author does attempt to tie together the parallels between past and present by identifying five key themes that are present in each of the stories he just told. According to the author, these themes—(a) community action, (b) systemic data collection, (c) sustained effort, (d) social inequity, and (e) political action—were, and remain, pillars of public health. In the epilogue is where he attempts to draw the clearest throughline from the past to present, providing a few current-day examples.

Overall, this book does provide interesting insight into the personalities and personal and professional challenges these seven public health figures overcame to advance our understanding of health, health inequities, and public health policy. If family medicine faculty or learners are particularly passionate about public health, they may find this book an interesting addition to their library; however, the book offers little that is immediately applicable to the practice or instruction of family medicine.