Public health gets a much-needed hug

Remember when people loved public health? Neither does anyone else. The Invisible Shield, a new four-par­t documentary directed by Jason Kliot and Taimi Arvidson, tries to remind us why we should be grateful for the system we have in the United States. The filmmakers create an intimate portrait and include some familiar stories told wonderfully. At the same time, people who know the field well may find themselves speeding up their streams (I watched with an epidemiologist I know who got bored in places).

Episode one, “The Old Playbook,” examines the time when vaccines and public health interventions were yet to come. “Imagine a world where no vaccines existed, where a third of your children died before reaching adulthood. This was the reality of all human life until just about a hundred years ago,” Steven Johnson, author of Extra Life and The Ghost Map, tells viewers. Then came the rise of public health, the “invisible shield” that protects all humans. Johnson sheds light on this metaphor not even three minutes into the start of the series. Joshua Sharfstein, a physician and a professor at the Johns Hopkins Bloomberg School of Public Health, solidifies it: “Public health saved your life today, and you didn’t even know it.”

We are taken back to a time when people did know this, when they got to see smallpox, cholera, and other harrowing diseases tamed or eliminated. But we also see what happened during COVID-19, when the system seemed to fail so many of us. These stories are woven through each episode and serve as a backdrop for a candid discussion of the major issues facing the public health system today. The second episode, “Follow the Data,” highlights (you probably know what’s coming) John Snow’s efforts to stop the spread of cholera in London’s Soho district during the 19th century. This story is like something out of public health Genesis: “And John Snow looked at the data, and he saw that it was good, and he called it ‘epidemiology.’” The documentary gives it a terrific refresh—it illuminates this history with an exceptionally detailed rendering of the black-and-white map Snow used to track cholera-related deaths in the town. (Skip to the 18-minute mark to check out the cool animated bird’s-eye view of his famous map.) The map enlivens what is, at heart, a discussion of the advent of data collection as a core tenet of the field. The last quarter of the episode delves into race and ethnicity reporting issues, making for a nice segue into the third episode, “Inoculation & Inequity.”

In episode three, we are reminded of the history of public health injustices, such as (again, you know what’s coming) the Tuskegee syphilis study and the resulting mistrust between health care workers and people of color, particularly African Americans. The roots of distrust go much further back, as we hear from Lauren Powell, president and CEO of The Equitist: “We have plenty of evidence to show us that there is differential treatment between Black patients and white patients, that physicians often under-prescribe medication for Black patients and falsely think that we have thicker skin than white patients and therefore can tolerate more pain, which is directly connected to slavery.” Beautifully and succinctly said.

As a Black woman, I commend the directors for devoting an entire episode to how systemic racism has birthed numerous health care inequities for Black and brown folks. It’s a gravely significant issue; the filmmakers addressed it both boldly and sensitively.

Of course, we’re all aware of how COVID-19 helped push inequities to the forefront of the world’s collective consciousness. The pandemic also revealed some trials and errors of public health professionals and scientists—mistakes that, for many people, overshadow how quickly the scientists created vaccines and stopped the spread of the coronavirus. The question now is: Can public health do better?

The final episode, “The New Playbook,” seeks to answer that question—but falls a bit flat in its efforts to do so. We are told we should do things like hire chief health strategists, create better data analytics, alleviate stress for public health workers, and invest in more resources for the field. What we don’t hear enough about is how. Do we, for instance, give them mental health days? What would it take to offer those workers free mental health services? How can we get people to put community interest ahead of individual interest? How can we ensure that people don’t just think “the pandemic is over” and forget what a mess things were four years ago? In a series that sometimes seemed to go on too long, this episode left me wanting more.

The series features many of the field’s brightest and most influential minds, which allows viewers to appreciate the breadth and scope of the field. But there are almost two dozen of them spread across a little over three-and-a-half hours of footage. It’s like the Marvel Universe invaded a public health documentary, so you are constantly trying to remember who used what superpower back in issue 74.

Still, Invisible Shield is worth watching, if only because it tells some good stories, a skill desperately lacking in public health. Ideas are for the most part clearly articulated, and there are captivating graphics in each episode.

Top image, TV tile art: The Invisible Shield