At the American Public Health Association (APHA) annual meeting in November, speakers repeatedly described public health as the “invisible shield” protecting US communities. In side conversations outside the formal sessions, I heard a more personal resonance: many practitioners felt the phrase applied to them as well. They, too, feel invisible.
It is easy to understand why. Lists of verboten words circulate. Layoffs mount, and vital roles are labeled “nonessential.” Massive multidisciplinary projects and data sets vanish. Career scientists within government are silenced.
Yet, at the opening plenary of the 2025 APHA Annual Meeting and Expo, the organization’s executive director, Georges Benjamin, noted that this moment coincides with “communication at the speed of electrons.” Taken together, these conditions suggest a growing disconnect between who does the work and who receives the credit.
Well, I for one have received enough credit and adulation to last a lifetime. In October, I was selected for one of the 22 MacArthur Fellowships—often referred to as “genius grants”—for my work in overdose prevention. This prestigious award, spanning all aspects of society, comes with five years of unrestricted funding. Because the selection process is confidential, nobody applies, and nobody knows they are being considered. The committees spend more than a year reviewing candidates and gathering independent evaluations. To receive that improbable telephone call is a dream so sublime it defies expectation.
Only a handful of public health practitioners have received this award in its 45-year history (far fewer than biomedical scientists). In a highly collaborative field such as public health, the singular nature of the honor obscures the underlying nature of who does the hands-on work and caregiving. I have not packed the thousands of boxes of naloxone and drug-checking kits we distribute, nor am I the one who analyzes drug samples in the lab, nor do I conduct street outreach. The current decline in overdose deaths reflects the labor of extraordinarily dedicated team members and the hundreds of frontline workers who make public health happen every day.
When news of the award broke, I was immensely relieved to hear many in the harm reduction and public health communities describe it as a win for themselves and for the field as a whole, which it undoubtedly was. Never has appropriation felt so appropriate.
Sharing credit is one of the qualities that makes public health a distinctive profession. Another is that the work we do has immense social ramifications. We continue to show up for our jobs—yes for the paycheck but also because most of us find the work meaningful. In our microcommunities, we can see the effects of what we do: we have a sense of who did not get sick, who recovered, who is better off because of our efforts. We know the outbreaks we helped contain, the meals delivered, the contamination cleaned up.
Amid the daily tumult of logistics and reports and caregiving, we can lose sight of the incredible privilege of working in a profession devoted to social impact. Few in the profession are motivated by public recognition, yet positive reinforcement can be a salve for burnout: it helps counteract relegation and invisibility. Collectively, we call this way of working “science in service.”
In this moment of disenfranchisement, it strikes me that, to keep doing the work, we must become better at showing our work. We must also speak up for those whose efforts are minimized or overlooked. Those of us operating with megaphones and independence—including patient advocates, people with lived experience representing their communities, extraordinary outreach workers, clinical staff, and federal officials under gag orders—can do more to amplify the voices of the marginalized.
We as public health practitioners should avail ourselves of more opportunities to articulate the work we do and why it matters for the greater good. This applies both to our individual contributions and to our collective efforts. Academic conferences are not enough. The humble double-sided pamphlet, professional social media, photo and video essays, community presentations, and news media engagement are attainable. And if you prefer not to be in front of the camera yourself, elevate a partner organization instead.
The objective is not ego-laden puffery. It is a responsibility to offer an authentic alternative narrative that showcases our impact: show our work to show our worth. Put another way, instead of reacting to the daily political opprobrium, we stand to benefit from crafting a creative and affirmative vision for health in the United States.
After the pandemic’s overreaches and a decade of deepening bureaucratization, public health policy has come to be viewed in popular culture as shorthand for the worst excesses of big government. Yet most public health practice happens quietly, in the unglamorous, everyday work of community caregiving. As Eliza Wheeler of the nonprofit Remedy Alliance For The People exhorts us: “Celebrate a populist public health!”
Ancient wisdom teaches that it costs nothing to elevate others. This principle has driven my own work for the past two decades. In each group I have choosen to join, I have sought out this motivating mindset. Our time is finite, and we can choose to align ourselves with people who uphold our values; this is, I would argue, just as important as any enticing scientific credential, if not more so.
As our vocation demands, we must also look to the root causes of the credit mismatch. I have had the honor of speaking at state summits for those engaged in local overdose prevention efforts funded through opioid settlements. Looking out across the thousands of faces, I am struck by how many of the attendees are women. That credit does not flow for this painstaking work is not surprising, given the social tendency to devalue labor based on who performs it, including people with lived experience. Their strength is their persistence. The hard-won gains in reversing the decades-long increase in overdose deaths have largely been through steadfast science-driven care. Across the country, I see neighbors taking care of neighbors, far removed from the macho national rhetoric about stopping drug shipments with walls, drones, or warships. In rural communities and urban clusters alike, nobody wise is waiting for airstrikes on boats in the Caribbean. Instead, we take care of our own.
Hear this: what you are doing is working. Keep going, and embrace the opportunity to elevate your successes. The stories that matter most unfold at the local level. We can draw on the meaning that keeps us moving through our daily duties, reclaim the narrative, and place credit where it belongs: with the people doing the caregiving.
Biography
