These Five Elements Make Public Health Success Possible

Getting public health implementation right is literally a matter of life-and-death

Dr. Tom Frieden
3 min readMar 3, 2023
A patient in Thailand brings her blood pressure record to the clinic. Photo: Resolve to Save Lives

This article originally appeared in Think Global Health.

In the last couple of weeks, the World Health Organization has confirmed a new outbreak of the deadly Marburg virus in Equatorial Guinea, at least eighteen countries continue to struggle deadly cholera cases, and bird flu swept through Peru and Chile, killing wild birds and sea mammals.

The United States’ COVID public health emergency may be coming to an end, but infectious diseases still abound. How disruptive and deadly these diseases are depends on how well the government prevents, detects, and responds.

Getting public health implementation right is a matter of life-and-death: without vaccines and public health action, the COVID pandemic would have been at least twice as deadly. Many and perhaps most of the twenty million people killed by the pandemic worldwide would be alive today if public health actions had been more effective.

Successful public health implementation requires five elements: good data, rigorous analysis, sensible guidance, broad buy-in, and effective action.

  1. Get good data. Delayed recognition that COVID was spreading led to tens of thousands of avoidable deaths in many countries. COVID shows that experts should adapt their strategies based on data, and to do that well, they need to collect better data. Improving data quality will take time and require strengthening public health at the local, national, and global level.
  2. Analyze the data rigorously. Truth does not usually emerge from data without careful analysis. Many surface-level analyses miss underlying complexity. Like a good surgeon, a good data analyst should be a technical expert with sound intuition from extensive experience. For example, the cursory observation that most COVID hospitalizations now occur among vaccinated people doesn’t mean vaccines aren’t working. More accurate analysis shows that people who are vaccinated, and especially those who are up-to-date on their vaccination, are far less likely to be hospitalized and to die.
  3. Develop practical guidance based on the data. Public health guidance should be practical, easy to understand, and readily implemented. Crafting it well is both a science and an art, and requires understanding what measures will be accepted and when. This requires understanding the realities — based on data — of what the costs and benefits of recommended actions are, how to increase adherence, and when to adjust guidance. Right now messaging needs to reach older adults and immunocompromised people with boosters, including the helpful guidance from the CDC. Most people dying from COVID today would have survived if they were up-to-date on their vaccination or if they had gotten the antiviral medication Paxlovid when they became ill.
  4. Build buy-in with transparency. Different communities have different values. When balancing health benefits against other societal harms, communities operating in accordance to the same data may choose different policies. That’s okay. What’s important is to be transparent about what decisions are being made and on what basis. It’s crucial to bring people along by explaining what experts know, what they don’t know, and what they’re doing to learn more. There should be open discussion of the pros and cons of policies and ways forward.
  5. Implement, learn, and improve. If government agencies implement programs right, people learn as they go by getting more and better data in real time, and the five-step process loops back to enable continuous improvement.

A persistent challenge is to maintain trust when new data necessitates a shift in guidance and action. Shifts occurred throughout the pandemic due to variants of the virus, introduction of vaccines and treatments, and new research findings. This shouldn’t come as a surprise, and health leaders need to better communicate this.

Public health has saved billions of lives over the past fifty years. It has also improved wellbeing for billions of others through safer water, vaccines, road safety, reduced exposure to lead, fewer workplace injuries, and more. Reducing today’s leading causes of death will come from public health interventions.

There will be future epidemics. Experts don’t know when or what form they will take. Many lives depend on if we remain humble, continue to learn, and take these five steps to a safer, healthier future.



Dr. Tom Frieden

President and CEO, Resolve to Save Lives | Former CDC Director and NYC Health Commissioner | Focused on saving lives.