Roughly 72 percent of commencement speeches by graduating students begin with, “Here we are, we made it,” so I am wary of beginning there. Okay, I just made that statistic up off the top of my head. But congratulations are in order! Remember to take time to thank all of your people who supported you these last 18 months, because we all relied on someone for guidance, strength, ad hoc pep-squadding, and more. So thank you, Emile and Lucas, for being patient with me whenever I ran off to work on another school assignment, and thank you so much, Susanne, for always encouraging me and for all the extra labor you had to do while I was in this program.
Meanwhile, the public health sector is in the midst of many crises affecting individual, community, and population health. We are entering into these crises as professionals now, and we will be working in this chaotic environment, in a sector which is challenged by competing mental health needs, substance use disorders, infectious diseases, the rampages of climate change, and persistent health disparities. In listening to everyone’s final ILE presentations this week I was struck by how much the literature talks about system transformation but how little of it is actually happening.
I was working in public health before I entered this program, but I had previously felt like an outsider or an interloper. Now that I can put MPH after my name, and trust me, I already ordered new business cards, I’m not sure I feel very different about my location to the field. You may feel similarly, that you are too small to change large-scale outcomes around type II diabetes, maternal health for Black women, opioid overdose rates among unstably housed people, improving cancer diagnosis, increasing hepatitis B vaccination rates for Asian Amerians, or cleaning up neighborhood soils or particulate matter as industry just chugs more waste into the environment.
But there are more than two dozen of us in our cohort. We are not one person, we are many. Some of us will create new interventions and will show that they are more efficient at improving health than the last interventions, or as my older son would say, “take that, previous science!” Some of us will apply our training around prioritizing racial justice to our current professions, and that commitment will create ripple effects in our areas of influence. Others are moving into policy, and may re-orient the state or their region so that many lives at once will have better access to health care. None of us, in other words, are actually in this alone.
At our after-class toast on Thursday night, I asked those in attendance if the reasons you applied to the program were still your motivators at the end of the program. I was surprised to see unanimous agreement, although we talked about how much we’d learned, or we mentioned the new ideas we were incorporating into our vision of public health and how we wanted to interact with those visions. Enrolling in this program was a good thing we all did! I grant you permission, although of course you don’t need my permission, to reflect back from time to time on what called you to this field, whenever you think you need a reset. Depending on what part of the field you’ll work in, you might need to reflect more or less often. (As someone who works in HIV and substance use, I reflect quite OFTEN.) Or as my younger son said in the midst of COVID-19, “I just build LEGOs to reduce stress.”
If the work might be at times stressful, public health is also a brilliant conduit for opening up vital discussions around the consequences of unchecked privilege and their specific effects on population health. I can hardly think of a more relevant example than the extreme greed of the Sackler family. In their successful attempts to become billionaires, they manufactured a nationwide opioid dependence by promising they had created a non-addictive narcotic, Oxycontin, that would cure us all of pain forever, which led us directly annual to the 100,000 overdose deaths we see today. This week research was released showing that fully ten percent of Americans have a close familial relation who has died of an opioid overdose. That is just staggering.
This periscope into the whys of our health challenges is a fundamental strength public health work. Public health practitioners have sounded alarm bells on toxic waste sites like the Love Canal, they’ve called out cancer clusters, they routinely work through individual stories of trauma to identify the patient zero when tracking down infectious disease in a community, they assess unsafe food handling practices in the marketplace, and we all know, post-pandemic, that they quarantine people when needed to keep a community safe. My family and I were quarantined in 2013 when I brought pertussis to Walla Walla County after getting coughed on for two hours on a flight from LA, but that’s another story for another day. But the point is, public health has this history, not completely unproblematic history, of course, of linking A to B and of beginning important conversations around association and causation, in an effort to improve health, lives, and systems. And now we are a part of that history and practice. If we have critiques of those problematic elements, we also have the capacity to do the future work in public health differently, with those limitations in mind.
I’m so excited for the work we all will do. I know our contributions will not be small. They mostly won’t be easy, either, although I am here for the quick wins whenever they show up. Public health has been politicized, and I have been struck by the uneasy realization that there is no public health intervention that takes place outside of the political sphere. So dig in, you know why you want to do this work, and you are ready to tackle these big challenges. The cohorts of students ten, twenty years from now, ought to be looking at a robust history of declining disparities, because people like you and made a real difference. That’s what I wish for us all, brilliant ideas among servant leaders in public health who built relationships and made our lives better. Congratulations, colleagues! I’m proud of every single one of us.
Trans/plant/portation 
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