Galea and Vaughan Comment

The statement “Vision without execution is hallucination” is generally attributed to Thomas Edison and is a modification of an ancient Chinese proverb; it has gained currency in the private sector as a motivational, agenda-setting aphorism. The idea of this statement is that although vision is important and can set our sights, little is achieved without the hard work necessary, the step-by-step progress, toward achieving the vision. Although this may seem inarguable, it has often struck us in our professional experience how often the dots fail to be connected, how often vision is articulated without tactics rather than implemented to concretely move organizations toward that same vision. Indeed, serial expressions of vision and priorities without action create an environment of hopelessness rather than empowerment. This is a nagging preoccupation in some of our writing about a public health of consequence, featured regularly in AJPH since 2016¹ and referred to by McBride et al. in their article “Public Health of Consequence: Shifting the Cultural Narrative From Churning Grants to a Scholarship of Consequence” (p. 1535).

Although the idea of a public health of consequence, that is, generating scholarship and acting on issues of contemporary consequence to improve the health of the public, has gained rhetorical traction, does saying that we aspire to such a public health mean we are actually doing it? And, pushing the question further, is it actually possible to do scholarship that leads to a public health of consequence in a modern academic public health environment where an extramural grant-driven research program may lead to “churn,” leaving little time for thought?

Refreshingly enough, McBride et al. answer this question with a resounding yes. Documenting a department-wide change that was started in 2014, McBride et al. show that by taking three steps—crafting proposals, fostering thought leadership, and mentoring for consequence—the department increased their grant hit rate from 10% to 48% while maintaining faculty satisfaction of more than 70%. Their case study, despite any limitations of the form, makes a compelling case that it is indeed possible to bridge vision and action with thoughtful and purposeful execution. The article shows what it takes to systematically implement an overriding and aspirational idea—generating a public health of consequence—despite, or perhaps because of, situational realities. The work of McBride et al. has, to our minds, three important implications that are worth highlighting.

First is the oft-voiced canard that it is not possible to do meaningful work in an extramurally funded system. We recognize that this notion may arise from a reluctance of population health scholars to engage in seeking extramural funding. However, evidence documented by McBride et al. suggest that the practical realities of our engagement—the need to obtain funding to generate population-level data as well as to fund one’s position—need not limit the extent to which we engage with a population health of consequence.

Second, conducting scholarship of consequence requires careful deliberation. We must ask ourselves What questions are we trying to answer? How do we get to these answers? And we must apply these questions to all stages of our work, starting with the conceptualization of research ideas, continuing with grant design, and in the execution of the grant-funded work.

Third, ideas can give rise to execution, and ideas can be both generated systematically and taught to the next generation. McBride et al. describe their efforts to foster thought leadership through careful deliberation that leads to sharper ideas and better grant writing. They discuss how they have brought together these ideas, grant writing, and mentorship of the next generation. Their success suggests that deliberate steps can bridge the divide between vision and execution. McBride et al. provide a roadmap that points the way for many of us in academic public health to not only imagine but practice a public health of consequence.