Public Health: Research, Advocacy, and Trust

Institutions of public health are in a tough spot right now. COVID has so battered public trust in the CDC that it has put us into the figure-it-out-yourself phase of this pandemic. Likewise, the public health response to obesity has long been one of both moral panic and ineffective policy prescriptions. Decades of exhortations to eat less and move more have yielded ever more obesity and rising levels of implicit weight bias. But not better health for the public. At the heart of this problem is a difficulty with separating scientific rigor in public health research from the impulse for advocacy in health policy.

Sincere beliefs in what seems like the right (or righteous) policies to address a health problem sometimes don’t line up very well with objective scientific observations. When public health glosses over such gaps, credibility and trust will erode for public health.

The Example of Restaurant Menu Labeling

Restaurant calorie menu labeling provides a good case in point. When we wrote about about the mistaken rush for this policy, it was apparently jarring for public health researchers with a big intellectual investment in this concept. The literature is robust, they told us. The effects are small, but not nil!

We get it. This seems like a good policy. We like knowing that a burrito at Chipotle is really a calorie bomb despite all the marketing that tried to hang a health halo on the brand. But it’s not objectively true to say there’s robust evidence saying menu labeling will have any effect on population health or obesity. Because no such evidence exists. There’s only evidence to say that immediately after implementation there’s a small effect on purchasing patterns in some (not all) restaurants. And that effect fades to nothing over time.

A Bright Red  Line Between Objective Research and Advocacy

There’s absolutely nothing wrong with passionate advocacy for policies one believes in. But when that advocacy begins to creep into public health research, everyone suffers. Researchers risk compromising their reputation for objectivity and rigor. Institutions risk their credibility. CDC puts its reputation for trustworthiness at risk. And ultimately, public health suffers because people find themselves having to figure out themselves what to do – often leading to bad decisions.

This is evident in the pandemic. Countries with high trust in public health authorities have done relatively well. Others – like the U.S. – have fared far worse. People have died needlessly. Likewise, we’ve wasted many decades “fighting obesity” with policies that have little evidence for a health benefit. So obesity has grown despite impassioned pleas from advocate-researchers in public health.

These are sad failures that should lead us to maintain a bright red line between objective, rigorous scientific research and public health advocacy. Because trust is an essential foundation for public health.

Click here for further perspective on academia engaging with public policy.

Scheveningen Women and Other People Under Umbrellas, painting by Vincent van Gogh / WikiArt

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July 24, 2022