Over the past year—and particularly over the past month or so—the Spokane area has heard more about the Spokane Regional Health District than it has heard in the past decade. The COVID-19 pandemic and the fallout over the firing of longtime health officer Dr. Bob Lutz have created a groundswell of feelings about the agency.

In the midst of these events, it’s easy to forget that the work of public health goes far beyond controlling a deadly virus. A deeply interdisciplinary field, public health focuses on preventing health problems and improving quality of life. Additionally, social factors like education, housing, employment, and education play a key role in determining health, so public health overlaps with fields like urban planning. It extends to almost everything we do to make our city a better, healthier, and more resilient place to live. 

For example, sidewalks, bike lanes, and walkable (or rollable) neighborhoods are a public health concern. Not only are automobile accidents one of the leading causes of death, particularly among young people, but walkable neighborhoods are associated with lower rates of obesity, diabetes, and other chronic health problems. Innovative local health districts across the country are working to promote active transportation (like walking, biking, and rolling). And in 2015, the U.S. Surgeon General issued a call to action encouraging cities to promote walking and rolling as a way to prevent disease.

Homelessness is a public health concern. Many people experiencing homelessness have chronic mental or physical health issues which are rarely well-treated without stable housing and supportive services. Across the country, local health districts are playing a vital role in the adoption of a “Housing First” model applied successfully in Spokane which provides housing before addressing these concerns. Some health departments are going even further—directly advocating for improved homeless services as a way to promote the public health.

And yes, racism is a major public health concern. Whether in housing, employment, education, income, or wealth, racism is a key factor of the social determinants of health. Even more directly, however, police violence (both physical and psychological) disproportionately affects marginalized populations and people of color. In 2018, the American Public Health Association issued a policy statement calling for structural reforms to policing and more proactive investment in community-based alternatives. Not because they have any specific agenda, but because they recognize the public health impacts of such violence. 

If some of these concerns sound political to you, you’re not wrong. 

Public health has always been a deeply political field. Politicians determine how much we allocate to active transportation, how hard we fight homelessness, and whether we address racism in policing. Public health professionals are only one piece of the puzzle. They simply provide the data on which politicians can choose to act.

As we continue to fight the pandemic, and as we continue to watch the Health Board’s actions, let’s remember that public health is always political—whether fighting COVID-19 or fighting racism, poverty, or unwalkable neighborhoods.