On Mechanisms vs. Foundations.
Before I begin, I want to take a moment to congratulate the entire School community for an unprecedented achievement: The School of Public Health now ranks among the top 10 public health schools in the country, according to the latest U.S. News & World Report graduate school rankings released last Tuesday. This new ranking represents the School’s third consecutive rise up the U.S. News list, which assesses the quality of schools accredited by the Council on Education for Public Health. I firmly believe that this achievement reflects both our commitment to be a global leader in public health scholarship and our deep commitment to train the next generation of the public health workforce with a real-world approach to public health. I am truly humbled to have joined this institution at such an ascendant time. This new recognition, of course, also encourages and challenges us to do better, to ever more clearly engage our responsibility as a leading school of public health, and to further innovate in our scholarship, education, and translation as we engage the critical public health issues of today, and of tomorrow.
On Mechanisms vs. Foundations
Today I wanted to comment on one of the challenges in public health scholarship that I have struggled with during my career. At core, the challenge is as follows: Should we, in academic public health, focus on the study of the foundational drivers of population health—on the factors that we know influence the conditions that make people healthy—or should we focus on the mechanisms that explain how these foundational drivers shape the health of populations? And, if the answer were to be “somewhere in the middle,” what is the relative weight we should be giving our scholarship on each of these two areas?
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But is the observation that action on mechanistic factors is easier than work on fundamental factors sufficient justification for a focus on mechanisms? In some respects, the easy answer is that surely they both matter—that we should understand both core drivers and mechanisms. Certainly there is a large literature proposing conceptual frameworks that tie the “upstream” to the “downstream,” satisfyingly demonstrating how foundational factors and downstream factors all matter to the production of health. I find this particular illustration useful and simplifying as a comprehensive framework that brings various factors together.
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I hope everyone has a terrific week. Until next week.
Warm regards,
Sandro
Sandro Galea, MD, DrPH
Dean and Professor, Boston University School of Public Health
@sandrogalea