John Snow created this map showcasing all the cholera cases near the Broad Street water pump.
By Becca Bakal, MPH
This National Public Health Week, I’m thinking about what
working in public health means to me. At its most basic level, public health is
about looking at health from the level of a population, instead of focusing on
I like to think of it as working upstream, where clinical
healthcare is downstream. Public health is about preventing problems, more than
fixing them (although that’s part of it too).
Most people would trace the field of public health to 1854,
when John Snow identified and shut off a contaminated water supply that had
caused a cholera outbreak in London.
Snow mapped all the cases of cholera in the outbreak and
found out that they all had something in common: they were near one water pump.
He had the handle taken off the pump, and the cholera outbreak ended.
Snow took a birds-eye view of a health issue that was
impacting a group of people -- in this case a neighborhood. Because he zoomed
out and literally focused upstream, he was able to identify the cause of the
issue and intervene to prevent more people from falling ill.
This is similar to our work at the Norton & Elaine
Sarnoff Center for Jewish Genetics. We strive to help families who are at risk
of certain genetic health conditions by reaching them early, when they can address
that risk and prevent illness. In our work, focusing upstream means:
- First and foremost, educating individuals of
Jewish ancestry and professionals who care for those individuals – such as
rabbis and doctors – about how ancestry is linked to genetic risks.
- Facilitating access to carrier screening for
folks who are starting their families, to help one generation learn about the
risk it can pass on to the next. Screening is a classic example of a public
health initiative: it helps to identify potential health problems early, in
this case by looking at one generation to determine the risk to the next
- Encouraging families to look at past health
history for clues about future health risks.
- Linking families to a genetic counselor and additional
resources if they want to learn more about, or pursue, other types of genetic
testing and screening—for example, testing for BRCA gene mutations that increase risk for certain types of cancer.
Although in many ways public health principles and
techniques have evolved since the time of John Snow, in other ways they have
stayed the same. We still prevent illness by working upstream.
I feel lucky to be part of a tradition of folks improving
the health of the public, and part of a community of innovators building new
and improved techniques to meet the demands of the future. Happy National
Public Health Week!