Historically, attention to public health has waxed and waned as crises strike and then abate. The result has been a patchwork of inadequate public health infrastructure, the weaknesses of which are evident in the United States’ uneven response to COVID-19. Written just before the current crises, Bechara Choucair’s Precision Community Health: Four Innovations for Well-being offers one potential path forward for public health in an increasingly uncertain future.

Choucair proposes that precision community health must serve three functions to be successful: anticipating crises, preventing them, and effectively combating crises when they do arise. These functions are performed through the four strategic pillars of coalition building, big data, media, and policy.

The weight of epidemiological evidence clearly indicates that the greatest barriers to health equity are systemic: racism, environmental injustice, economic inequality, state violence, and patriarchy. While Choucair acknowledges that social and economic forces are at the root of the geographic disparities in health outcomes, the examples that he uses to illustrate the precision community health approach instead focus on the level of individual choice and behavior as the locus of change.

Consequently, Choucair undermines his argument that precision community health can bring about health equity, which will result only from broad systemic changes in our government, economy, and built environment. It is here that public health interventions must concentrate their efforts, rather than on individual choice or behavior. Choucair is correct that coalition building, crafting powerful media messages and programming, leveraging big data, and implementing more precise policy are major tools of this work. However, to improve the health of the collective, these tools must be directed at the systems that shape us and not at the choices we make.

Read the full article about fixing systems by Andrew Binet at Stanford Social Innovation Review.