Public health ended 2025 in one of its weakest positions in living memory – not because of a surge in disease, but because of a collapse in political, financial, and cultural support. 

Vaccination policies long considered settled science are being reversed, and industry-backed “junk science” is shaping legislation to derail proven nutrition policies. 

Even as storied public health entities are being dismantled, the tobacco industry – still responsible for eight million deaths each year – faces little resistance in its cynical PR effort to reposition itself as a champion for health. These are not isolated policy defeats. They are symptoms of a deeper problem: public health has lost its relevance in the public narrative.

For decades, harmful industries have poured billions into persuasion, addicting people to sugar, alcohol, and tobacco. Public health, meanwhile, has organized around the assumption that evidence alone can carry policy goals. 

That may have worked in an era dominated by elite opinion makers driving consensus through limited broadcast media channels and operating with institutional trust. But today’s media landscape—driven by algorithms, influencers, and coordinated narrative warfare – requires something different. 

The field isn’t losing because the science is weak; it is losing because it has treated communications as a garnish rather than as an engine for impact. While our opponents invest in persuasion as a primary tool, public health has largely disinvested in communication as a core infrastructure.

This wasn’t inevitable. Public health’s greatest victories once depended on grassroots education and mass mobilization that shaped the cultural conversation. 

In 1956, Elvis Presley’s televised polio vaccination helped skyrocket teen uptake from nearly zero to 80%. In the 1980s and ’90s, “Silence=Death” graphics and the art of Keith Haring transformed the HIV/AIDS crisis into a global movement for human rights. 

These moments proved that narrative power is as essential to public health as any laboratory breakthrough. And they can be again; the field of public health is poised for realignment. Here’s how it can happen:

The power of culture and influence

Evidence does not “speak” on its own; it requires a deliberate strategy to compete for attention. Industries that profit from harmful products use real-time social listening, test narrative frames the way pharmaceutical companies test molecules, and deploy influencers who reach audiences no government agency can reach. 

They communicate emotionally and strategically, aided by an unregulated attention economy in which algorithms reward outrage and accelerate falsehoods.

Public health must recognize that population health and policy follow culture, not evidence. Today, the main battleground is the “content creator economy.” 

Remarkable voices, from doctors debunking junk science to creators sharing lived experiences, are proving that health can gain traction there. These talented communicators are the modern heirs to the activist-artists of the past; with support, they could help truth compete at the scale of weaponized disinformation of both industry and grifter economy.

Communication as essential infrastructure

The path forward requires a fundamental shift in how we define public health “work.” Leaders must decide to fund communication as essential infrastructure, positioned alongside epidemiology, policy development and providing equitable access to high-quality care. This is not about one-off marketing budgets, but about building a core capability that is permanent and professionalized.

Financing is often cited as a barrier, but it is political will that is the most important resource. Many countries, cities, and states have already found practical ways to sustain this work, and these could be scaled and more explicitly tied to health. 

From health foundations and taxes on alcohol and tobacco, to reclaiming public airwaves or redirecting settlement agreements from industry litigation, mechanisms for significant funding exist.

The challenge is ensuring these resources are used to strengthen health infrastructure – including public engagement systems needed to address the harms caused by these industries. Ironically, more public visibility and engagement are win/win competencies in the battle to secure resources to better engage the public. 

What would it look like to treat communication as core infrastructure—on par with labs, data systems, or clinical delivery? Three priorities would define the work ahead:

1. Building professional communication and community engagement capacity within health departments.

Modern public health requires full-time professional teams with the budget and authority to run campaigns at scale – comparable to the capacity currently reserved for disease surveillance. Health departments hold a unique strategic advantage: access to the authentic, local stories that humanize policy. Experience in jurisdictions like Los Angeles County shows that when health departments move beyond data dissemination and integrate narrative storytelling, they can successfully reclaim the local conversation from digital noise.

2. Integrating public health with the creator economy.

Since many of the most trusted messengers now exist outside of government, public health must develop the infrastructure to collaborate with digital creators while maintaining scientific integrity. Success in this area depends on meeting audiences where they already are. For instance, we see young people leveraging lifestyle themes, using fashion TikToks or travel videos on Instagram to effectively communicate the risks of nicotine to younger audiences who are otherwise unreachable through traditional channels.

3. Shifting from dissemination to community co-creation.

Trust is not built through top-down messaging, but through genuine dialogue. The next generation of public health initiatives must move from “targeting” communities to “shaping” work with them. This shift ensures that campaigns are not only culturally grounded but also community-owned, turning a passive audience into active participants in their own health outcomes.

Reclaiming the ‘public’ in public health

The fundamental truth of 2025 is that for too long public health has retreated into technical, cautious communication – messages optimized for scientific accuracy rather than for the anxieties and daily realities that shape people’s lives. 

As institutions grew quieter and more inscrutable, a communication vacuum emerged – one that the public naturally filled by turning to more responsive voices, often belonging to industries and ideologues and supercharged by platforms that reward attention and disregard truth.

Public health is facing existential challenges, and it may seem far-fetched to include prioritizing communications and public engagement among them. With a desperate shortage of resources, many argue that public health needs to trim back to what is “essential,” rather than think about doing things differently. 

There are worthy arguments about what public health must focus on delivering – global health security, universal health coverage, stronger lab systems – but none of these efforts can succeed without public approval, attention, and trust. 

Public health’s next iteration must respond to the new reality that health, social, and policy change are fundamentally rooted in public attention in a way that they never have been before.

Reversing this trajectory requires reorientation. Public health must reclaim its identity not just as a scientific enterprise, but as a mobilizing one. It must participate in shaping culture and policy – not as a byproduct of producing evidence, but as a deliberate act. 

That responsibility falls not just to governments, but to institutions, funders, and organizations committed to protecting health in the 21st century. If we want a healthier future, we must begin with a simple truth: We need to put the public back in public health.

Steve Hamill is Vice President of Policy Advocacy and Communication at Vital Strategies

Image Credits: Department of Health Collection, New York City, The Haring Foundation, LA County, You Can Save Lives.