Public Health Rising to the Challenge: The Bloomberg American Health Initiative

The articles in this supplemental issue of Public Health Reports provide insight into what it will take for the field of public health to tackle 5 of the most complex and difficult health problems of our time: (1) large numbers of adolescents disconnected from work and school; (2) violence (including gun violence), intimate partner and sexual violence, and suicide; (3) opioid addiction and overdose; (4) a dysfunctional food system associated with obesity; and (5) threats to the environment.

These 5 problems are the central focus of the new Bloomberg American Health Initiative, which MacKenzie et al¹ describe in their Commentary. “All 5 areas of focus are serious problems facing the nation, with deep connections to economic and social factors,” they write. “None have quick fixes.”¹ Yet there is reason to believe that public health can lead the way toward meaningful progress.

From December 2017 to April 2018, the initiative held 5 national symposia to document the state of understanding and to inform a public health perspective on each challenge. This supplement includes these perspectives, as well as commentaries in the cross-cutting areas of evidence, policy, and equity. Together, these articles provide a road map for efforts to bring public health training to frontline organizations, pursue insights through innovative research, and advance effective programs, policies, and strategies for change.

To help adolescents stay connected, and thereby avoid downstream harms including violence, addiction, and mental illness, Mendelson et al² envision a comprehensive public health effort in schools and communities. Decker and colleagues³ illuminate public health approaches that simultaneously address interpersonal violence, suicide, and intimate partner violence. Turning a public health lens on the opioid crisis, Saloner et al⁴ emphasize the importance of using evidence and engaging communities to overcome barriers to progress, such as the profound stigma associated with both addiction and its effective treatment with medications.

Barnhill and colleagues⁵ tackle the complexity of obesity and diet, offering a model of food system change that unites multiple public health strategies to moderate the coming wave of chronic illness associated with unhealthy eating. In their article on the environment, Koehler et al⁶ write that public health insights and activities can accelerate improvements in our built environment, promoting both healthy communities and a healthy planet.

Three articles highlight several potent public health tools available to address the complex health challenges of the 21st century. To bridge the gap between the “answers policy makers and practitioners need for decision making and the answers that the most rigorous and reliable studies can provide,” Callahan and Stuart⁷ explain how innovative methods can be more widely used to evaluate real-world policies and programs. Pollack Porter and colleagues⁸ highlight the many ways that policy interventions at the local, state, and federal levels can save lives, often with little or no adverse impact on budget. Cooper et al⁹ describe how public health can direct attention, advocacy, and collective impact efforts to the underlying causes of health inequities.

Together, these articles do not pull punches about the enormity of the US health crisis. But as MacKenzie and colleagues¹ remind us, “Although it can be dispiriting to contemplate the health challenges facing the United States today, it is the nature of public health to tackle seemingly impossible tasks.” The articles in this supplement illustrate that the field of public health is, once again, up to the challenge.