We Engineered Public Health. Now, Let’s Engineer Public Health Solutions.
Ronni Moore (Class VII Fellow) is an educator from Indianapolis, empowering students to dream big through impactful, community-embedded learning experiences.
What if we treated healthcare the way we treat clean water? We regulate it, fund it, and maintain it, without question, because we know it’s essential for public health. Or at least, that’s how it’s supposed to work. But we know that in too many communities, especially communities of color, access to clean water has been anything but automatic. The Flint water crisis exposed how neglect and cost-cutting decisions can put entire populations at risk. Residents trusted that their water was safe, only to find out after irreversible harm was done that it wasn’t. I am struck by the parallels to healthcare here. Some of us assume the system will be there when we need it, but as others have found, too often, that access to quality care depends on where you live, how much you earn, and the decisions of people who will never feel the consequences themselves.
We know what’s good for us, yet we falter when unhealthy choices are the easiest, cheapest, and most convenient. One of my cohort members put it bluntly, asking if anyone truly cares. We chuckled and blushed a bit as he pointed out the sodas around the table, a stark reminder that while we lament the state of healthcare, evidence of our complicity abounds. At the same time, if it were the case that we truly didn’t care, we wouldn’t spend billions on fitness trackers and wellness trends. The issue isn’t reckless indifference, it’s that over time, our environment has been engineered (ok, by us) to work against us. This brings me to a behavioral psychology framework I first learned about in the book Switch, by Chip and Dan Heath: The Elephant, The Rider, and The Path. The Rider (our rational mind) knows what to do, but the Elephant (our emotions and instincts) often overpowers logic. That’s why the Path, our environment, matters most. I’ve seen this play out in my own home. If I buy oranges, my children eat oranges. If I buy cookies, they devour cookies. It’s not about willpower—it’s about what’s available. If we want real public health change, we can’t rely on our willpower alone. We need to reshape the Path, re-engineer our environment so that more often, the healthier choice is also the easiest one.
We’ve done this before, sometimes imperfectly, but we have had real impact. We made seat belts mandatory, banned indoor smoking, and added fluoride to water to fight tooth decay. Our issues persist, but policy can influence behavior--what if we applied the same thinking to food? Right now, processed junk food is often cheaper and easier to find than fresh, whole foods. But what if we thought seriously about shifting financial incentives? Some countries have had success introducing small taxes on ultra-processed foods and sugary drinks and using that revenue to make healthier options more affordable. Could this be one piece of the puzzle? Not as a punishment, but as a way to redesign our environment, so the easy choice is also the right one.
Flint’s water crisis revealed what happens when we make decisions without proper consideration for public health. We saw it in crumbling pipes, poisoned children, and a long and ongoing fight for justice. But the same neglect is happening in healthcare, where a reactive, sick-care model means we are investing heavily in treating disease rather than preventing it in the first place. Just as we’ve made clean water and handwashing universal public health initiatives, we could do the same for other preventive efforts, whether that’s re-engineering our environment by shifting food incentives, expanding free screenings, or finding every possible way to embed wellness into our daily lives. True liberty in healthcare isn’t just about access to treatment—it’s about building a world where public health isn’t a privilege, but a norm.
