Contributor: Why Public Health Keeps Failing—and How to Fix It

As a Greek American and a public health scholar who has lived through 2 pandemics, I return often to this wisdom from my ancestor. Hippocrates knew, millennia ago, what we still resist admitting today: disease is less a divine punishment than the consequence of human folly.

Yet we keep forgetting. We develop vaccines, we build labs, we celebrate biomedical marvels, but we fail to address the very human conditions—our fears, misinformation, politics, and failures of empathy—that allow pathogens to spread. We also neglect the structural inequities—poverty, lack of affordable care, poor housing, racism, homophobia, misogyny, and other forms of marginalization—that create the conditions in which disease flourishes.

Public health has not faltered because of inadequate science. We have identified pathogens, developed treatments, and designed effective prevention strategies for HIV, COVID-19, mpox, tuberculosis, and more. We know the harms of obesity, tobacco use, and untreated mental illness. What has faltered is the assumption that people are rational actors making decisions based solely on facts. They are not. People neglect vaccinations, smoke, or remain bedridden by depression not because they lack knowledge but because their choices are shaped by emotion, fear, shame, pleasure, and ingrained beliefs. For many, these are not choices at all, but the consequences of poverty, unaffordable health care, or lack of access. These realities are compounded by fear of the medical profession itself and by a system too often ill-equipped to meet the needs of marginalized communities.

The HIV epidemic made this painfully clear. Stigma and mythological beliefs fueled its spread as much as biology. Many avoided testing or treatment out of shame. Even when therapies became available, myths and fear kept people away. Condom use was resisted not for lack of knowledge, but because people felt it diminished intimacy and pleasure.

COVID-19 replayed these tragedies on a global scale. Vaccines were developed in record time, yet emotions and politics hijacked the response. Some refused boosters because they were linked to political leaders they disliked. Others clung to conspiracy theories about microchips or fertility, encouraged by public figures who placed ambition above science. Many resisted masks not for lack of evidence but because they felt they suffocated individuality and rights. These were not failures of science—they were emotion-laden behaviors.

The central flaw of modern public health is its overreliance on the idea that information alone changes behavior. Nearly every theoretical model assumes rational choice—but humans are not machines. Fear, anger, mistrust, and identity often outweigh charts and graphs, and the medical profession, if anything, is even less prepared, if at all, to grapple with this reality.

Emotional reactions to health behaviors do not arise overnight; they are shaped over lifetimes. Every society lives by myths. Some are harmless; others kill. During the COVID-19 pandemic, misinformation hardened into myth. Falsehoods about vaccines became cultural identity markers. By the time fact-checks caught up, behavior had already been shaped. Public health cannot dismiss these beliefs as irrational; it must confront them in ways that address both intellect and emotion.

Pandemics also are never just about science. They unfold in legislatures and newsrooms as much as in hospitals. Politics has always been a determinant of health. In the last decade, leaders on both sides of the political spectrum who should have amplified science instead weaponized it to advance ideology. Policies that should have built trust instead undermined it.

Yet, there was hope. Altruism—the act of caring for others—could have been our salvation. In the early years of AIDS, many gay men changed their behavior to protect their partners; similar shifts occurred during the mpox outbreak. During COVID-19, masking and staying home could have been framed as empathy—protecting the vulnerable. They were instead politicized as assaults on freedom.

This is not just a public health problem. The same dynamics distort society. Some feel the economy is collapsing despite strong evidence of growth. Some feel crime is out of control, despite clear statistics showing decreases in homicide and other crimes. These feelings, more than facts, are undoing us.

Public health exists within this ecosystem of emotion, belief, and politics. To be effective, it must adapt to the society we live in—not the rational one we wish existed.

What would a more human public health look like? It would be one that recognizes that people act not only on what they know, but on what they feel. People must feel heard, not lectured, with interventions grounded in science and lived experience. They must feel cared for by providers who engage in empathetic dialogue rather than simply reciting facts. They must feel connected to others, with altruism elevated as a guiding principle that reminds us that protecting others is also protecting ourselves. They must feel safe in their identities and communities, with public health addressing why false beliefs take root and helping individuals confront them without shame. They must feel that the system is fair, with equity pursued relentlessly to dismantle the structural inequities—poverty, racism, homophobia, misogyny, and lack of access to care—that magnify disease.

We live in an age of pandemics—HIV, COVID-19, mpox, avian flu, even Alaskapox. We also face epidemics of obesity, cardiovascular disease, and addiction. More will come. Science is essential, but science alone will not save us.

Hippocrates was right: disease does not come from the gods but from our own actions. Our folly is believing that facts alone can change behavior.

As someone who came of age during HIV in 1980s New York, who survived COVID-19 firsthand, and who now leads a school of public health, I know the path forward is clear. We must create a public health that listens as well as instructs, that acknowledges feelings as well as facts, that builds trust as well as technology, and that is activist in its pursuit of equity.

In the end, the failure of empathy may be our greatest tragedy. Public health is not about isolated bodies, but about communities whose fates are intertwined.

We must humanize public health.

Perry N. Halkitis is dean, distinguished professor, and Hunterdon Professor of Public Health and Health Equity at the School of Public Health, Rutgers University. His upcoming book, Humanizing Public Health: How Disease-Centered Approaches Have Failed Us, will be published by Johns Hopkins University Press in early 2026.