Three challenges for the public health profession

For the PSPHP leadership, as well as veterans like former Department of Health secretary Manuel Dayrit, who gave a talk on livable cities, perhaps the most encouraging sign was how young the attendees were and how motivated they are to be part of the field. As PSPHP president Michael Caampued told me, it is thanks to years of “mentoring, outreach, and collective conviction” that the community has grown; surely, public health will grow even more in the coming years, with PSPHP serving as a “big tent” for people who have decided to follow what was once, and still is, considered an unconventional path for doctors.

As the public health profession grows, however, I would like to issue the following challenges that I think must be met if it is to make even more of an impact in the health-care system and beyond:

The problem with the medical profession is that we rarely criticize each other, reluctant to antagonize our own colleagues and mentors—and fearful that doing so will sow mistrust among the public. Epistemically, too, our authority is hardly questioned; the medical profession’s view is seen as infallible, like a pope, on matters concerning health, even by journalists. As a result, we don’t have accountability mechanisms on everything from pricing to policy; few, if any, admit their mistakes, and unlike other countries; we haven’t conducted an independent review of our COVID-19 response. Even when individuals are willing to speak out, there are issues that require institutional support, like calling out false therapeutic claims or whistleblowing about corrupt practices. I believe that far from causing mistrust, openness to critique and debate will make the medical profession more trusted by the public.

Like the rest of Philippine society, the medical establishment in the country today is generally very conservative, from social issues like abortion and drugs to political matters like supporting (or challenging) the government’s health and social policies. I say “today” because this can change in the future and I say “generally” because the profession also has a living legacy of activism and advocacy that have helped realize major reforms like the reproductive health law and the sin tax law. But in the main, the profession has either supported the government or abstained from controversial issues. To some extent, this is understandable because doctors need to maintain some level of neutrality, especially when fulfilling our primary mandate of providing care. But even the officially neutral International Committee of the Red Cross has spoken out against the atrocities in Gaza (as I believe we all should), and doctors are one of the few groups who can offer a different way of looking at highly moralized and/or politicized issues and be actually listened to by politicians and the public alike.

As the COVID-19 pandemic showed, acting as if the medical profession has the monopoly of knowledge can lead to disastrous policies—like face shields being required and children being protractedly locked down. We need all kinds of expertise—from mass communications and sociology to engineering and environmental science—as well as inputs from other health-care workers, local communities, and patients themselves. By oftentimes privileging eminence over evidence, we have been slow to adopt new knowledge and embrace novel approaches. Top-down policies have not worked, and democratizing expertise, I also mean geographic and cultural inclusiveness; listening to Cebu-based doctors share their experiences during the pandemic, as well as Caraga-based doctors to the barrios talk about universal health care implementation, reminds me that there’s so much we can gain if we are to incorporate the perspectives of those outside Metro Manila. Institutions like PSPHP can cultivate a community of diverse expertise and experiences, bringing us closer to the participatory vision of primary health care.

Thankfully, I see all of the above already in motion—the Cebuano word “lihok” comes to mind—including in the conference which played host to different perspectives and ideas. By maintaining a critical distance from the medical establishment and by asserting its leadership not just in the Philippines but globally, our public health profession can raise accountability, inclusiveness, and innovation in in the health-care system, allowing it to better respond to our people’s needs.