Public Health – a bit like the wizard behind the curtain – waves its fingers at us, and tells us to pay close attention to our physical, emotional, social, mental, and environmental health. We simultaneously asked to care for our community’s health and take steps to protect the health of others – human and other than human alike. On top of that are the determinants of our health such as education, housing, nourishment, access to opportunities that we are also made responsible for. Our wellness and thriving are divided up into unrecognizable, ungrounded categories that ignore our entangled nature. Dividing ourselves up into different parts with different health is as unnatural as it feels.
It is no surprise, then, that the discipline responsible for divvying up individual, communal, and environmental health finds itself siloed and unable to connect with the community knowledge that is necessary for creating a functioning, trusted web of public health. The root of widespread distrust in public health is not a workflow or communications problem (though, we have our work cut out for us in both of those arenas). Rather, we are living in the inevitable outcome of a discipline that was deliberately severed from community wisdom about a hundred years ago.
While trust in major public health institutions declined from 2020 onward, it fell from an already low baseline. The COVID-19 pandemic shined a fluorescent spotlight on the importance and shortcomings of national and global public health systems and infrastructure at a time when cynicism toward those same institutions also took a stronger hold. The mistrust we are now reckoning with is the inheritance of decisions the field made over the last century.
In the 19th-century, public health organizations worked on housing, education, sanitation, labor conditions, food access, and beyond. The core of public health in the United States was what we now call the “Social Determinants of Health.” Settlement houses, Black Women’s Club movements, Indigenous healing collectives, mutual aid societies, and immigrant community clinics were foundational to the holistic, political practice of community-driven public health. The systems that served communities did so in response to those same communities’ expressed needs.
Then, in 1910, the Flexner Report, funded by the Carnegie Foundation for the Advancement of Teaching led to the closure of roughly half of U.S. medical schools, including 5 of 7 historically Black medical schools. The closures consolidated medicine as white, male, and credentialed. It severed medicine from the apprentice-based, community-rooted training that had produced generations of healers and robust systems of care.
In tandem, public health official Hibbert Hill wrote The New Public Health in 1916 and explicitly argued the field should pivot away from the environmental and structural foundations of community-driven and community-responsive public health toward individual behavior change. The broad-reaching work of Public Health’s origins were replaced with mandates to produce evidence, communicate compliance, and manage programs. The social mission went with it. By the 1990s and early 2000s the now coined Social Determinants of Health came back on the scene as concepts – not foundational underpinnings of the discipline. Since then, our field has continued to faction off, and further separate itself from the heart of our work. The work our communities and planet most need.
So, here we sit in 2026 with siloed, disconnected Public Health infrastructure severed from its original mandate. At its origins, Public Health was dreamed, schemed, and carried out by organizations that were deeply in touch with the needs of their communities. And, here we are in 2026 with an immense opportunity to return to our roots, listen to our communities, and build PH programming and organizations in response to the expressed needs of the folks we work on behalf of. We can return to the relational nature of our field to heal both the divides within our organizations and those between our organizations and the people we serve. Story-driven strategy offers us a path forward to reconnection and earned trust.
Story-driven strategy is a method for surfacing what communities already know and letting it shape strategy from the foundation up rather than the deliverable down. Storytelling, at its core, is a trust-building exercise. First, we deeply listen to communities. Those stories become the foundation of the strategies we build, and are also shared to educate about the work we do and the impact it has. The strategies built from community input, then, have immense impact because they are responsive to community needs. As we well know, strategies with more impact garner more attention from decision makers and resource distributors. With more resources and decision-making power, we return to communities to listen again and the cycle continues as we rebuild what has been lost in the past 100 years. This work is not just for communications departments. Every role in Public Health has a story-driven dimension.
The work in front of us is not reinvention. We are being asked to return. Community-grounded public health is not a hopeful future we have to argue the field toward. It was our original practice, and it was taken from the discipline by people who decided that community wisdom was a threat to the institutions they wanted to build. We are inheriting both halves of that history and are being asked to listen, deeply, to each other.