A cautionary tale: university institutes of public health must “walk the talk”

Public health is, and has long been, defined as the art and science of promoting health and preventing illness through organized efforts of society. This definition and scope convey certain elements and values, which distinguish public health from other fields of scholarship and practice (CPHA, 2017). These include population-level thinking, a commitment to health equity and its foundations in social justice, and an upstream focus on root causes of inequities, which are embedded within political and economic systems. Important work in recent years has highlighted the weakening of these core elements of public health, in Canada and elsewhere (Yong, 2021). Hancock et al. (2020) and McLaren and Hennessy (2020), for example, highlight how the COVID-19 pandemic, despite bringing public health to the forefront, has reinforced a narrow, medicalized version that largely neglects decades of scholarship on intersecting social and ecological determinants of health that shape population well-being in highly inequitable ways. In the light of these trends, one might expect—or hope— that public health institutes within public universities would serve as a bastion. As institutions whose role is to build and empower informed and critically engaged citizens, a public health institute within a public university should provide a space and platform to actively push back against harmful trends that are eroding the foundations that support the core values and actions within our field. Unfortunately, that is not always the case, as we illustrate with reference to our own experience with a university institute for public health. Through individual and joint reflection, we identified two interrelated issues that offer a cautionary tale with respect to the role and responsibility of universities in our field, and which constitute a call to action for all of our institutions to “walk the talk” of public health. The first issue is a passive failure to protect what public health is and is not. The core elements of public health— thinking about health at the population level and how it is shaped by the conditions in which we are born, grow, live, work, and age—require going against the grain of dominant mainstream discourses about health, and corresponding methods, which typically privilege biomedical and behavioural explanations devoid of context and theory. In our setting, the ability to protect and strengthen these ideals was halted nearly from the start by a “big tent” mentality, where everyone was welcome and—by extension—everyone was an expert in public health, regardless of their actual expertise or work. On the surface, it is hard to argue with the ostensibly inclusive “big tent” mentality. But it is highly problematic, and in fact highly exclusive, when it is accompanied by a lack of reflexivity and humility around what kind of work, by whom, rises to the top and why. The “big tent” welcomes, and in fact privileges, downstream and depoliticized work that is usually focused within the welldefined contours of our medical care systems. Such work naturally accrues more quickly and is more easily funded. In an unquestioned neoliberal context that rewards achievements of volume by individuals, these dynamics only serve to weaken and dilute what is strong and unique about our field. When academic institutes fail to explicitly prioritize and challenge Rebecca Haines-Saah and Lindsay McLaren contributed equally.