Contributor: Public Health Has Forgotten the Public

Pandemics are not simply biological events. They are human crises.

This is the lesson we should have learned from HIV, COVID-19, and, more recently, from Mpox and the resurgence of once contained diseases like measles. We have also learned these lessons from the persistent non–pathogen-based epidemics of addiction, obesity, and violence that continue to claim lives no less devastatingly. And yet, time and again, public health has responded as if pathogens alone drive outcomes, as if data alone change behavior, and as if people are rational actors who simply need better information.

We know that they are not.

For too long, we have built a system that privileges disease over people, metrics over meaning, and authority over trust. We have trained generations of practitioners to track viruses, but not to understand fear or to model how behavior (whether illogical and self-pleasing or essential to their very existence) fuels transmission. We have been less effective in engaging with people on how to navigate misinformation and mitigate mistrust. In short, we have not been effective in meeting people where they are.

The result is a profound and widening disconnect between public health institutions and the populations and the communities they serve.

At the heart of this failure lies one major flawed assumption: that individuals make rational health decisions. Human behavior is shaped far more by emotion, experience, culture, and context than by logic alone. Fear of adverse effects, distrust of institutions, stigma, political identity, and economic strains are among the major forces that drive decision-making in ways that no dataset can fully capture. Public health, however, continues to operate as if information is enough. It is not.

Data informs, but relationships transform.

This is why some of our most sophisticated interventions fail. It is not because the science is wrong, but because the approach is incomplete. We have underestimated the power of human experience and overestimated the persuasive force of facts. If we are to move forward, we must embrace a different framework that places people with all of their flaws and foibles, not pathogens, at the center of public health.

This means recognizing that health is not merely biological. It is biopsychosocial. It is shaped by the interplay of bodies, minds, and environment. It is directed by social structures, political systems, and cultural norms. Pandemics do not unfold in laboratories; they unfold in individual lives, in communities, in populations.

To respond effectively, public health must be grounded in empathy, cultural competence, psychological insight, and political awareness. These are not “soft skills.” They are essential tools for saving lives. Empathy allows us to understand why a parent might hesitate to vaccinate a child. Cultural competence helps us recognize how historical injustices shape present-day mistrust. Psychological insight reveals how fear and stigma influence behavior. Political awareness reminds us that health decisions are often entangled with identity, ideology, and power.

Public health is not only about preventing disease. It is about affirming our humanity and our responsibility to one another.

Without these, even the most elegant interventions will fail.

We saw this clearly during COVID-19. Vaccines were developed in record time, but the rollout exposed a deeper weakness. Messaging was often top-down, transactional, and detached from lived realities. Communities that had long been marginalized were told what to do, rather than engaged in dialogue. Fear was met with facts when it needed to be met with understanding. This was made all the worse by the media, both social and traditional, that provided ample opportunity for people to have their false beliefs upheld and their reckless health decisions heralded, all of which was founded in the deterioration of trust with the public health system, which began to seem bureaucratic and perhaps authoritarian to some. The scientific and the medical communities referred to this as vaccine hesitancy, but in fact, it was a collapse of trust that had been brewing for decades and was catalyzed by COVID-19.

To be clear, such breaks in trust are not new and were evident in earlier pandemic including the flu pandemic of 1918 to 1920 when individuals ignored mitigation strategies or during the early days of the Revolutionary War when George Washington himself rejected variolation (a prequel to vaccination) as means of controlling disease in the army. But as a wise leader who witnessed the devastation of smallpox, he came to understand the science and its value to individuals and to the country. If only such wisdom was evident in leadership today.

This erosion of trust has been further fueled by a broader cultural and political climate increasingly hostile to science and public health. But we must be honest and own our mistakes: this mistrust and rejection of science did not emerge in a vacuum. It has been exacerbated by our own failure to humanize our approach to health. We failed to listen, to engage, and to acknowledge the limits of our expertise and to recognize the lived realities of people in their everyday lives who, too, make decisions, not based on reason, but on whim, on emotions, on selfishness, on what feels good.

We must undo this damage to trust; however, public health cannot demand trust. It must earn it. And earning trust requires a fundamental shift in how we think, teach, and practice.

We must begin in our schools of public health. Our students must be trained not only as scientists, but as listeners, communicators, and partners. They must be equipped to engage with communities in ways that are respectful, responsive, and relational. They must understand that effective public health is not delivered to people, it is built with them, and they must understand the life experiences that drive decision-making and fuel the mistrust of public health. People are not born mistrusting, they develop mistrust. Understand the how and why is key to shifting the dialogue.

We must also transform our institutions. Public health agencies must move beyond 1-way communication and toward genuine engagement. This means no more overly intellectualized talking heads that spew information on the news but public health scientists who speak from the heart with compassion. It also means scientists who are truly involved in people and communities in the design of interventions, recognizing the legitimacy of lived experience. Not just advance polices because they think they know better. I ask you to consider the rejection of the sugary drink tax in New York City or the ongoing failures of tobacco policies.

It also means confronting an uncomfortable truth: expertise alone does not confer legitimacy. Legitimacy comes from connection.

I was reminded of this in a deeply personal way not in a lecture hall, but at a family celebration. In the summer of 2021, at the engagement party of my second cousin, I was seated with a group of guests, including a cousin of the father of the bride, his wife, and his young child. His wife and child were vaccinated for COVID-19. He was not. The father spoke with the kind of certainty we have all encountered; he was firm in his decision, unmoved by statistics, resistant to the usual arguments about safety and public responsibility. Data would not reach him. Authority would not persuade him to get vaccinated. Another lecture on transmission dynamics or vaccine efficacy would only have deepened his resistance. So, I chose a different approach.

I did not speak to him as a public health expert. I spoke to him as a human being. I asked him about his son—what he hoped for him, what kind of life he wanted for him, what it would mean to watch him grow, to see him succeed, to be present for the milestones that define a life, and then I said simply: getting vaccinated is not only about you. It is about being there for him. It is about giving yourself the best chance to see his future unfold. Something shifted. Not immediately, and not dramatically—but perceptibly. The conversation moved from defensiveness to reflection, from resistance to consideration. A week later, I learned that he had gotten vaccinated. What changed was not the science. What changed was the frame.

I was further reminded of this recently during a series of talks in Greece, where I observed many of the same challenges we face in the US. Despite differences in culture and context, the underlying dynamics were strikingly similar, including a fragile economy, strained public systems, and a growing disconnect between institutions and the public. In both settings, the consequences are profound for health outcomes. This dynamic plays out across the world.

We so often assume that people make decisions based on evidence alone, but more often, they make decisions based on beliefs, personal meanings, identity, feelings, relationships, and cultural values. When we appeal only to reason, we miss the deeper currents that shape behavior. When we appeal to humanity, we open the possibility of change.

This is what it means to humanize public health. It is not about abandoning rigor. It is about expanding it. It is about recognizing that empathy is not ancillary to effectiveness. It is about understanding that to move people, we must first meet them where they are, not where we wish them to be. And it is about reclaiming a vision of public health rooted in the common good.

More than 2 millennia ago, Greek thinkers understood this in ways that still resonate today. Hippocrates reminded us that “diseases do not come from the gods but from the foolishness of men,” underscoring that human behavior lies at the heart of health and illness. Pericles, in his vision of civic life, declared that “we consider him who does not share in the common good not to be idle, but to be worthless,” noting the importance of uplifting our essential responsibility to each other.

These are not merely historical observations. They are moral imperatives. They remind us that pandemics and all public health crises are as much about how we care for one another as they are about how we combat disease. They remind us that to be part of a community is to act with empathy, to recognize our shared responsibility, and to understand that our individual choices shape collective outcomes.

If public health is to regain trust, improve outcomes, and meet the challenges ahead, it must return to this understanding. Because in the end, public health is not only about preventing disease. It is about affirming our humanity and our responsibility to one another.

Perry N. Halkitis, PhD, MS, MPH, is dean, distinguished professor, and Hunterdon Professor of Public Health and Health Equity at the School of Public Health at Rutgers University. He is the author of the new book Humanizing Public Health: How Disease-Centered Approaches Have Failed Us, out May 5 in paperback and ebook formats from Johns Hopkins University Press.