Twelve Forgotten Principles of Public Health

This discussion is from a Twitter thread by Martin Kulldorff on 20 December 2020. He is a Professor at Harvard Medical School specialising in disease surveillance methods, infectious disease outbreaks and vaccine safety. His Twitter handle is @MartinKulldorff

#1 Public health is about all health outcomes, not just a single disease like #COVID19. It is important to also consider harms from public health measures. #totalharms @collateralglbl

#2 Public health is about the long term rather than the short term. Spring #COVID19#lockdowns simply delayed and postponed the pandemic to the fall.…@JohanGiesecke

#4 Pubic health is global. Public health scientists need to consider the global impact of their recommendations.…@lhinnant@sammednick

#5 Risks and harms cannot be completely eliminated, but they can be reduced. Elimination and zero-COVID strategies backfire, making things worse.…@JuliaLMarcus

#3 Public health is about everyone. It should not be used to shift the burden of disease from the affluent to the less affluent, as the #COVID19#lockdowns have done.

#6 Public health should focus on high-risk populations. For #COVID19, many standard public health measures were never used to protect high-risk older people, leading to unnecessary deaths.

#7 While contact tracing and isolation is critically important for some infectious diseases, it is futile and counterproductive for common infections such as influenza and #COVID19.

#8 A case is only a case if a person is sick. Mass testing asymptomatic individuals is harmful to public health.

#9 Public health is about trust. To gain the trust of the public, public health officials and the media must be honest and trust the public. Shaming and fear should never be used in a pandemic.…@camakridis

#10 Public health scientists and officials must be honest with what is not known. For example, epidemic models should be run with the whole range of plausible input parameters.

#11 In public health, open civilized debate is profoundly critical. Censoring, silencing and smearing leads to fear of speaking, herd thinking and distrust.…@JeanneLenzer1

#12 It is important for public health scientists and officials to listen to the public, who are living the public health consequences. This pandemic has proved that many non-epidemiologists understand public health better than some epidemiologists.

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