Where Is the Future in Public Health?
The Milbank quarterly 2010 Jun; 88(2): 149-68
CONTEXT: Today's societies have far-reaching impacts on future conditions for health. Against this backdrop, this article explores how the future is represented in contemporary public health, examining both its conceptual base and influential approaches through which evidence is generated for policy. METHODS: Mission statements and official reviews provide insight into how the future is represented in public health's conceptual and ethical foundations. For its research practices, the article takes examples from epidemiological, intervention, and economic research, selecting risk-factor epidemiology, randomized controlled trials, and economic evaluation as exemplars. FINDINGS: Concepts and ethics suggest that public health research and policy will be concerned with protecting both today's and tomorrow's populations from conditions that threaten their health. But rather than facilitating sustained engagement with future conditions and future health, exemplary approaches to gathering evidence focus on today's population. Thus, risk-factor epidemiology pinpoints risks in temporal proximity to the individual; controlled trials track short-term effects of interventions on the participants' health; and economic evaluations weigh policies according to their value to the current population. While their orientation to the present and near future aligns well with the compressed timescales for policy delivery on which democratic governments tend to work, it makes it difficult for the public health community to direct attention to conditions for future health. CONCLUSIONS: This article points to the need for research perspectives and practices that, consistent with public health's conceptual and ethical foundations, represent the interests of both tomorrow's and today's populations.
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