By Alexandra Piatkowski

Public health shouldn’t have to fight for its place—but here we are. Around the world, our field is facing political pressure, public skepticism, and an erasure from “professional” definitions and decision-making tables. COVID-19 didn’t create this tension, but it exposed cracks that many communities were already feeling.

Should it have to be this way? Of course not. But this is the landscape we’re working in—and we still have agency. We can choose how to communicate, how to show up, and how to rebuild the trust that has been shaken (and in some places, deliberately targeted) recently.

It’s frustrating, it’s unfair, and it’s exhausting. And still—we have work to do.

We can’t control the political climate. We can’t control algorithm-driven misinformation. We can’t control who chooses to undermine the field.

But we can control how we show up, how we practice, and how we build trust—one conversation, one project, one community partnership at a time.

Here’s what defending public health really looks like in 2025 (and beyond).

1. Be honest about what we know—and what we’re still learning

Communities don’t expect perfection. They expect truthfulness.

Saying “here’s what we know right now, and here’s what might change” builds far more credibility than acting like the science will never evolve. People can handle complexity; they can’t handle feeling dismissed.

2. Start with lived experience, then bring in the data

Data hits differently when it’s grounded in real life.

During one community consultation, an LGBTQ+ resident shared that they rarely left their house—not because they didn’t want to engage in programs, but because they didn’t feel safe walking down their own street. “I’m not avoiding services,” they said. “I’m avoiding the comments and the stares.”

That one sentence reframed everything.

We could have started with statistics on mental health disparities or violence against LGBTQ+ communities—but their story made the issue real in a way numbers never could. Then we brought in the data showing the clear links between safety, belonging, and health outcomes.

Stories aren’t emotional extras. They illuminate barriers the data alone can’t capture.

3. Work through trust, not titles

The most trusted messenger isn’t always the one with the longest CV. It might be a youth worker, peer supporter, cultural leader, faith leader, or the community ambassador who knows everyone by name.

Strong public health means working with these trusted voices—not trying to speak over them.

4. Show your process

When people understand how decisions were made—who was consulted, what evidence was used, how equity was considered—they’re far more likely to trust the outcome.

Transparency isn’t just a communications tactic. It’s a public health competency.

5. Get curious when people push back

Most skepticism comes from history and lived experiences, not hostility.

Asking “what’s worrying you the most?” can transform a tense interaction into a productive conversation—and often reveals structural barriers or past harms the data hasn’t captured.

A cross-border reality

I write this from Canada, and I know how fortunate we are in many ways. Our public health systems—while strained—aren’t being dismantled the way they are in the U.S.

But I worked in the U.S. for several years, and I care deeply about my American colleagues and neighbours. Public health doesn’t stop at borders—our communities, economies, and vulnerabilities are linked. And Canada isn’t exempt from pressure: post-COVID budget cuts, workforce loss, misinformation, and “back to normal” thinking are very real threats here too.

The challenges look different—but the risks echo each other. And we need each other to get this right.

Where we go from here

Defending public health isn’t about being the loudest voice. It’s about practicing differently: with humility, transparency, partnership, and an unwavering commitment to equity.

It’s the small things that can start to build or rebuild trust:

One more curious question
One more community voice invited early
One more plain-language explanation
One more transparent decision
One more barrier removed

We shouldn’t have to fight this hard for public health. But we do. And we’re more than capable of doing it—together.

At Piat Public Health, this is exactly the work we focus on: grounding decisions in evidence, centring lived experience, and helping organizations strengthen trust through equity-driven, community-informed approaches. If you’re navigating these challenges, I’m always here to support the work.

Public health protects everyone. Now it’s our turn to protect public health.

Defending Public Health: What It Really Takes in 2025