All Public Health Is Local
Harnessing the power of the private sector would help create healthcare responses that are more tailored to localized populations
From the USDA’s MyPlate to Michelle Obama’s “Let’s Move!” campaign, Americans are used to thinking of public health on a national level. That way of thinking was solidified during the COVID-19 pandemic when national public health policy dominated the news cycle. Suddenly, Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, was in every living room in America as he briefed the nation daily on the latest pandemic policies.
But although Americans are familiar with national public health institutions, they don’t tend to think well of them—in large part due to botched responses during the pandemic. One recent survey found that only 37% of Americans view the Centers for Disease Control and Prevention as a trusted source of general health information, and just 33% say the same of the National Institutes of Health. Furthermore, trust in the nation's public health institutions decreased over the course of the pandemic.
It's no wonder why Americans across the country are less than impressed by these large, national institutions: Public health is now envisioned as a monolithic entity battling invisible foes. However, public health thrives not in grand pronouncements or sweeping national policies, but in the intimate, granular realities of individual lives and communities. It’s in the clean and modern playgrounds where children play with their friends, free from fear of disease, and in the quiet corner of a pharmacy where a trusted pharmacist dispenses advice alongside medication. It’s the culmination of countless seemingly small and local efforts, each a thread woven into the tapestry of a healthier society.
The challenge is that the biggest public health problems today—from rising communicable diseases and antibiotic-resistant infections to loneliness and decreased mental well-being—are anything but small and localized. They are the ripple effects of a shift in what it means to be a person living in modern society. Technological advancement, globalization and changing social norms are disrupting the way we see local institutions and communities. This begs the question: How can we reconcile the inherently local nature of public health with the increasingly global scope of the challenges it faces?
The answer lies in unlocking the potential of a seemingly unlikely source: the private sector. While often viewed with suspicion or relegated to a purely financial role in healthcare, businesses possess reach, resources and the ability to innovate—all of which are needed to propel public health forward in a sustainable and scalable manner.
The Power of Proximity
Public health struggles are deeply rooted in local realities and on-the-ground conditions. A community grappling with obesity faces vastly different challenges from one battling viral epidemics. A rural village’s access to clean water or medical resources differs drastically from that of a bustling modern metropolis. This is where the private sector’s localized capabilities offer an invaluable advantage.
Businesses, unlike large centralized governments, are embedded within communities and play a key role in the everyday lives of many people. They understand and respond to the nuances of local contexts, cultural sensitivities and specific needs of the population they serve. This proximity allows for greater success when addressing public health concerns, namely through targeted interventions, tailored solutions and quicker responses to emerging threats.
Take Dollar General as an unlikely example. Dollar General stores are staples in most rural American communities, providing citizens with everything from food to household goods to medicine. The average Dollar General customer has a high school education, earns less than $40,000 a year and lives in a rural area. Unfortunately, around 80% of rural American counties are designated “medically underserved,” meaning many Dollar General customers are likely facing a severe healthcare provider shortage.
Recognizing the gap in care that its customers face, Dollar General recently ventured into the healthcare space, partnering with mobile health provider DocGo to set up clinics in its store parking lots. The program is still in its pilot phase, but it could be revolutionary for ensuring that rural patients can more easily access healthcare. The venture demonstrates how a business’s understanding of its customers’ needs can be used to promote public health.
Creative dynamism in response to market demand is the key to achieving better options in healthcare. The private sector—which tends to value creativity and innovation more than the government’s top-down, often-stagnant approaches—can therefore inject much-needed fresh air into public health initiatives. From AI-powered health diagnostics such as DrumBeat, which uses artificial intelligence to diagnose ear diseases in remote Australian communities, to wearables like WHOOP, which tracks chronic disease progression, the possibilities are endless.
Scaling Solutions Beyond Borders
Furthermore, once a successful intervention is born in one community, the private sector can then leverage its global networks to scale it across borders and cultures. This replication potential ensures that local solutions with proven impact don’t remain isolated pockets of success but become catalysts for global change that improve the lives of individuals regardless of their location or socioeconomic status.
Take Zipline, a drone company that provides a low-cost, on-demand delivery service for vaccines, diagnostics and therapeutics. Born in Half Moon Bay, California, this company is now thriving in rural parts of Japan, Kenya and Ghana, among other countries, increasing access to life-changing health interventions.
Zipline’s innovative drone delivery system is positioned to expand around the globe, scaling its ability to improve healthcare for more people. It holds the potential to disrupt the way all health products are delivered and provide access to cutting-edge treatments for millions, especially those in traditionally underserved populations occupying rural and remote areas.
Federal Aviation Administration regulations currently limit drone deliveries in the United States, but last fall the FAA began authorizing some drone operators to fly their aircraft “beyond the line of vision,” opening the door for Zipline and others to expand their operations.
Reimagining the Landscape
By harnessing the local knowledge, innovative spirit and scalable reach of the private sector, we can reimagine the landscape of public health toward one that is much more efficient, effective and accessible. The current approach, promulgated by public health academics and policy leaders, is dominated by the belief that public health is best handled by the government and the government only. Moreover, many public health thought leaders scoff at private sector involvement and assert that the incentives that guide the private sector are at odds with public health goals. This simply is not the case. Where there is a market for public health solutions, public and private sector goals will naturally align.
We can build a public health system that moves beyond the “either/or” mentality that prevents private sector innovations from playing a larger role in public health and embrace a collaborative approach where businesses are active partners in building a healthier future for all. One small town in North Carolina is demonstrating just that. Cary, North Carolina, was plagued by a burgeoning drug use epidemic that saw opioid overdoses increase by 70% over just one year. Town leaders realized they needed a better—and faster—solution to the crisis and decided to partner with Biobot Analytics, a startup that uses robots to analyze wastewater samples for various drugs and diseases. Biobot worked with local leaders to monitor wastewater in 10 different neighborhoods, providing the local government with detailed, timely and unbiased data.
Cary leaders used that data to launch a tailored public health campaign, organizing community events and prescription drug take back days, and building awareness within the community. This community campaign, backed by just six months of BioBot data, drove down opioid overdoses in the town by 40%. By leveraging the innovative and responsive strengths of the private sector and complementing it with the capabilities of local government, Cary’s experience provides a new highly scalable, highly customizable model for what a difference a partnership between the public and private sectors can make in a community—and it’s a model that is more up to the monumental tasks facing public health today than the status quo.
The road ahead may be paved with challenges, but the potential to transform the lives of millions of people is well worth the effort. By joining together, public health and the private sector can weave a tapestry of a new public health system, stitched together with threads of local action, innovative solutions and a shared commitment to a healthier world.