The world cheered as Sierra Leone was declared free of Ebola earlier this month. An army of courageous physicians, nurses, technicians, and lay care providers provided the medical care that limited the outbreak’s devastation. However, credit for containing the disease also goes to a legion of researchers, epidemiologists, community health workers, educators and others who led the public health response in West Africa and beyond.
We owe the existence of these professionals, and the knowledge they wield, to the field of public health. A century ago, that field barely existed. The concept that health could be promoted at the population level through better choices by communities, organizations, families, and individuals was still new.
A field is a community of organizations and individuals working together to solve a common set of problems, develop a common body of theory and knowledge, or advance and apply common practices.
As The Rockefeller Foundation targets new challenges—such as resilience and planetary health—the question of what makes a healthy field, and what philanthropy can do to help build a field, comes up frequently. Our Strategic Insights team recently studied elements of successful field-building. We looked at a number of examples from philanthropy, such as the Robert Wood Johnson Foundation’s work on building the fields of tobacco cessation and end-of-life care.
One of the most useful examples of field-building we found takes us back more than a century, to lessons learned during the early work of The Rockefeller Foundation and its predecessor, the Rockefeller Sanitary Commission (RSC) in accelerating the growth of the field of public health in the U.S., beginning in 1909.
Focusing a field on a problem can give a field early momentum and build credibility.
To grow, a field must convince existing stakeholders that it can offer powerful new solutions to the problems they care about. The RSC and the Foundation focused on hookworm—a disease that had serious economic impacts on the workforce of the Southern states, but that could be effectively combatted by applying insights from public health. Foundation officers of the day noted that it was “a positive wedge” that was likely to be a “most successful means of convincing communities that health is a purchasable thing.”
Although hookworm was indeed successfully eradicated in the U.S., that disease was only the starting point for public health. As the field gained credibility through victories against hookworm, it left behind tested public health institutions and personnel that could be used to address other problems.
Identity is critical to unifying a field.
A vibrant field must embrace diversity, but it also must engender commitment and community based on a common identity. The first foot soldiers of the hookworm campaign were physicians splitting their time between medical practice and public health. It soon became clear that people who saw themselves first and foremost as full-time public health practitioners would be needed to advocate for the field and drive it forward. In order to train committed public health officers and nurses with a distinct esprit de corps, the Foundation funded the creation of the Johns Hopkins School of Hygiene and Public Health—the first public health school to be independent of a medical school.
Networks are the connective tissue of a field.
A thriving field doesn’t rest on a single institution—rather, it is the connections and collaborations between institutions and individuals that allow new ideas to be generated and new resources to be pulled into the field. In the case of public health in the U.S., this base of this network was created through the formation of boards of health at the local, then state, level. These institutions were modelled on, and learned from, each other. However, they also collaborated intensively with national-level institutions, such as the new schools of public health and the U.S. Public Health Service, to obtain trained staff, access to laboratory services, and a growing body of research insights.
The tactics involved in field-building vary: Not every field will require founding new local institutions or graduate schools to grow. However, networks, identity, and focused application to important problems were common elements in the cases of successful field-building we looked at, and in other studies of field-building. They provide a useful framework for building fields that can confront today’s problems—and perhaps next century’s as well.
Thank you to Jim Smith and Laura Miller from the Rockefeller Archive Center for their guidance and knowledge about the history of field-building at the Rockefeller Foundation.