Public health's reckoning started with COVID. It was too late.

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Yet the field's illiberalism did not suddenly emerge during the COVID pandemic. A reckoning was long overdue: The pandemic merely revealed weaknesses in public health's approach to human beings living with disease. I experienced this firsthand.
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What it's like to get tuberculosis
Most of us won't interact directly with our public health department during our lifetime. Unless, that is, we contract what is considered a 'reportable disease,' which happens to a small fraction of the population each year (COVID was only reportable for a short time).
In 2020, I was one of those people — but I didn't have the novel coronavirus. I had somehow contracted the oldest-known and still deadliest infectious disease: tuberculosis.
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I went to the doctor after a couple of months of coughing, which progressed to intermittent fevers, night sweats, and extreme fatigue. The nurse practitioner first thought the coughing was my childhood asthma rearing its head. Then she thought maybe it was a mild case of pneumonia. A week of antibiotics cleared up the fever and night sweats, for a while at least. But the cough never went away.
Finally, as the pandemic lockdown descended around us in late March, I went to get an X-ray. In some ways, I'm in the pandemic's debt — I would have never bothered to get a cough checked out if COVID's respiratory nature hadn't put my husband on high alert. 'What if it's COVID?' he said, worried.
I got the call two days into what would become our months-long stay-at-home adventure. My X-ray showed granulomas in my lungs — little nests of calcified tissue protecting the billions of teeming
Mycobacterium tuberculosis
that had begun to eat away at my lungs.
Here's what happens when the health care system suspects a reportable disease: First, your medical provider hands your case over to the local public health department. The health department becomes responsible for coordinating all aspects of your diagnosis and treatment, as well as carrying out contact tracing — tracking down and notifying anyone you might have infected.
In my case, which happened in New York State, they also put me under state-ordered quarantine. I was not allowed to leave my house. This and contact tracing are tools that are now familiar to most Americans, as many public health departments
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The State of New York became responsible for my care from that point on. The day after the X-ray news, I got a call from the tuberculosis control nurse at my local health department — I'll call her Joan. She would become my caseworker through the duration of my treatment, although I eventually came to think of her as my warden.
Under New York state law, a person diagnosed with tuberculosis is mandated to complete a full course of antibiotics — often under the daily supervision of a trained health care professional. That means a state public health official has to watch you take your pills every day. In my case, that was six months of antibiotics: eight pills daily for the first two months and then three pills every day for the rest of the time. If a patient refuses to comply, the health department can order them to remain under quarantine for an indefinite period or in extreme cases have them committed to a state-run facility.
I was initially grateful for Joan. For the first few days the pills made me debilitatingly nauseous. After my first night of vomiting, Joan got me a prescription for an antiemetic and dropped it off at my house.
In order to contain the public health threat tuberculosis poses, the government takes care of coordinating all aspects of treatment — down to billing insurance. If you don't have insurance, the state often pays for testing and treatment directly. I had unwittingly walked into an American's vision of a Scandinavian health care utopia.
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I didn't have to call the doctor, make an appointment, go in for an exam, get the prescription, fight with the pharmacy over whether my insurance was up-to-date — instead, the medication just showed up at my door. And it was all free.
As the days passed, I slowly felt better. My state-ordered quarantine was lifted (not that it mattered, since we were on COVID lockdown) as I became noninfectious, and I started to go outside for long walks in the woods behind my house. My visits with Joan had turned into video calls as lockdown continued. (In nonpandemic times, the state would have required Joan to meet with me in person to supervise my daily dose of antibiotics.)
As I got the hang of my treatment, the daily video calls with Joan started to feel unnecessary. I asked her if I could move to checking in weekly or monthly — I was already required to meet monthly with an infectious disease doctor and have monthly blood work to make sure the antibiotics weren't frying my liver (a fairly serious potential side effect of long-term high-dose antibiotic use).
But Joan's answer was an unequivocal no.
Some form of daily observed therapy is the recommended standard of care for tuberculosis in every state, and Joan sent me a PowerPoint presentation explaining why having daily supervision from a nurse was necessary to make sure patients don't slack on their treatment.
I pushed harder. I would take the drugs, as prescribed, no skipping doses. I had already seen what tuberculosis can do to people. I worked in a network of health clinics in Delhi, India, right after college, and the images of people unable to get out of bed, their emaciated bodies racked with fevers and coughs, have stayed with me. I was well aware of the risks and complications that came with not finishing treatment or skipping doses: drug-resistant tuberculosis — a scary diagnosis with no guaranteed cure.
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And I had the state's
Joan was unpersuaded. 'The TB control office told us to take you to court if you don't comply,' she told me during a video call.
Well, that seemed a little heavy-handed.
To some extent, I understood Joan's perspective. Her job was to make sure I didn't infect anyone else with tuberculosis. Full stop. If I skipped doses, I put not only myself but potentially others at risk.
But a question weighed on me, fueling the anger I felt at being treated like a child: How big a risk was that really? Did that risk justify keeping me under Joan's thumb and even taking me to court if I resisted? Wasn't there a better use of Joan's time than chasing after me?
Paternalism and public health
There are deep contradictions between public health and an individual's rights to consent, privacy, and dignity. Most Americans didn't have to grapple with these trade-offs until COVID forced the issue. But COVID was far from the first time the public health system has been tested — and has failed — to weigh the trade-offs it asks of people who contract infectious diseases.
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Often, the trade-offs are framed as insignificant — small steps we are told we should be happy to take to protect our neighbors. Wearing a mask is easy — those who refuse are selfish. Staying at home isn't such a big ask — how important is it really to go out to a restaurant or a friend's party? In my case: It shouldn't be a big deal to have someone watch me take pills every day. What's the harm?
There is logic to this. But it ignores much bigger realities. Why should we be compelled to take steps that haven't been shown to work? Daily observed therapy can be more or less coercive than what I experienced and has come under fire as being unnecessarily restrictive, resource-intensive, and ineffective. A 2015 Cochrane
So why was I, a fully capable adult, under state supervision and threatened with legal action when I had done nothing wrong? Getting sick is not a crime. Yet public health officials sometimes treat illness as though it is.
This is not a new phenomenon. Some of the earliest American public health pioneers were deeply moralistic about the nature of illness. In the mid-19th century, health-minded urban reformers were taking aim at the lack of sanitation in European and American cities as a contributor to poor health. Here in Massachusetts, a statistician named Lemuel Shattuck produced a Report of the Massachusetts Sanitary Commission in which
As cities — including Boston — grew, Shattuck and his peers became concerned that the poor could infect the wealthy, necessitating the state to intervene. He recommended the state establish health boards to enforce sanitary regulations and to study specific diseases that disproportionately afflicted the poor, like alcoholism and tuberculosis (which killed 300 per 100,000 Massachusetts residents in 1850 — today, tuberculosis kills 0.2 per 100,000 nationwide). But the key point is that he did not trust the masses. He wanted state regulations in place not only to protect the common good but to police the least virtuous and keep them from infecting the rest.
This sort of attitude has been pervasive throughout public health history. Gay men were stigmatized and imprisoned all over the world during the early years of the AIDS crisis: Cuba quarantined people living with HIV, many of whom were gay, in medical facilities from 1986 until 1994. In the United States, public health campaigners targeted gay men and told them to simply stop having sex. Alcoholism and substance use disorders are still treated as crimes in most parts of the world. Compulsory drug treatment
Public health's excesses are the downside of something positive: There is little doubt that public health workers are motivated by a desire to protect people's health and lives. But too often, public health has failed to trust those people or respect their rights to question, debate, or even refuse.
Some of that is due to an excessively narrow measure of success, as political scientists Frances Lee and Stephen Macedo write in the
In July 2023, the former National Institutes of Health director Francis Collins
As the long-time global health reporter Donald J. McNeil writes in his recent book 'Wisdom of Plagues
,
'
'I think it's imperative to save lives. To the exclusion of every other goal.'
In some ways, a field that closely resembles public health is the military — where we expect collateral damage in order to achieve victory. But that mind-set is a problem. It has eroded trust between public health and the people it purports to serve. Very few people outside the field are willing to suffer collateral damage to their lives and livelihoods for tenuous reasons.
Taking public health back
As the COVID pandemic unfolded, I saw my small example, my dynamic with Joan and New York state's health department, playing out on a larger scale all around me. Americans across the country tried to make sense of what public health officials were telling them, often with increasing confusion and resentment.
Much of the populist backlash against public health can be attributed to disinformation campaigns and conspiracy theories — but not all of it. Some in the public health field have acknowledged, and are bravely grappling with, the fact that public anger over the pandemic response is justified. No one wants or deserves to be treated as though they are the unwashed masses, to hark back to Shattuck's attitude.
So why has it taken me five years to write this essay? Because I have always been uninterested in piling on an already beleaguered sector — especially now, as the federal government
But I write this now because we will experience another pandemic, and we are in danger of failing worse than we did last time. It is critical we understand all contributing factors to that failure and attempt to root out the paternalism that proved to be a part of public health's fall from grace.
Now the challenge is not to simply regain public trust. It is to retake the field from the forces like Robert F. Kennedy Jr. and his allies who threaten to destroy it from within. To do so, public health leaders will have to demonstrate their fidelity not only to saving lives but to the dignity and messy complexity of those lives.
Christine Mehta can be reached at

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Medicaid handouts only create dependency. Able-bodied adults should work.

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I couldn't have made it as a mom ‒ or cancer survivor ‒ without Medicaid As a Stage 3 breast cancer survivor, mother to a son with profound disabilities and a full-time working member of society, I've had to navigate the unimaginable. Without Medicaid, I could not have managed any of it. The program covers our son's in-home care, and it gave me the ability to focus on both my treatment and career. For families like mine, Medicaid is not a luxury ‒ it is the foundation that holds everything together. Proposed cuts threaten the care millions rely on. We must protect Medicaid so parents are not forced to choose among their health, their job and their children's needs. — Caroline Johnson, Louisville, Kentucky Able-bodied people should be working. Entitlements weren't meant to last forever. As I understand it, the only people who would be cut from Medicaid are able-bodied adults who would need to work a minimum number of hours a week to keep receiving it. 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I think this administration is so shortsighted about Medicaid and food assistance cuts for working families and individuals. If low-income people and working families have inadequate food and no medical coverage, it hinders their ability to work and function in society. All people deserve medical coverage and nutritious foods! I don't think I will ever support Republicans again. This is supposed to be a government for the people, by the people and of the people. These MAGA supporters are all lacking in human decency. Yes, I believe they will cut more and more because they are focused on self-indulgence. Increase taxes for the wealthy who have too much and know that "trickle-down economics" is just a buzz phrase. It doesn't work. Big cuts were made to the federal work force with no strategy and no concern for talented and dedicated employees, along with lots of publicity for fake fraud claims that didn't exist. 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Yahoo

an hour ago

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Americans say they care about getting enough protein and avoiding food dyes. Their eating habits say otherwise.

Americans are fed a lot of information about what counts as healthy food. We wanted to know if these nutritional values are really as important to Americans as the headlines suggest, so, with the help of YouGov, we polled more than 1,500 U.S. adults in April 2025. The results: Most people agree that protein is important, and food dyes should be banned. And yet, a much smaller share of Americans are checking food labels for these ingredients. So what gives? We spoke to experts about whether Americans really value the nutritional concerns that make headlines, and what you can do to better align your ideals with your dietary habits. We asked Americans about whether they consider nutritional information when they choose what to eat and, if so, what factors they prioritize (meaning: calories, sodium, etc.). Then we zoomed in on two nutritional topics that have gotten a lot of buzz lately: protein and red dyes. Protein has been having a moment, partly because it's what some experts have dubbed 'the last macronutrient standing' amid the bad raps of fats and carbs. Its connection to muscle building and weight loss — especially in conjunction with GLP-1 medications like Ozempic — has been a further boon to protein. Americans seem to have taken note. A large majority (85%) of respondents to the Yahoo News/YouGov poll said that protein is very or somewhat important to them when choosing what to eat. Yet among the two-thirds of respondents who said they check nutritional labels, only 13% said that protein is the factor they pay most attention to when choosing what to eat. And only about a quarter of respondents said they're eating more protein now than they were a year ago. We found the same pattern when it comes to food dyes. More than two-thirds (65%) of respondents to our poll said they approve of U.S. Health and Human Services Secretary Robert F. Kennedy Jr.'s move to ban many artificial colorings. But only 37% of respondents said they actively avoid food dyes, and just 27% said they always or usually check food labels for the ingredients (another 24% said they sometimes check). If we're so aware of what we should be including or avoiding in our food, but don't necessarily act on it, are we just too lazy to make healthy choices? Not exactly. For example, 66% of the respondents to our survey make the effort to check nutritional information. But the most commonly considered factor was calorie content (16%), which isn't necessarily a good indicator of whether a food is healthy, according to recent research. While it might seem fairly easy to check foods for their content of other nutrients, calculating out how much we need of each of these (protein, vitamins, etc.) gets complicated, fast. 'There's a lot of evidence that people don't take actions that are in their best interests based on their knowledge,' says Dr. Dariush Mozaffarian, director of Tufts University's Food Is Medicine Institute. 'People have an aspirational image of what they would like to do, and then [there's] what they do in real life.' This phenomenon is known as the intention-action gap. 'And for nutrition, it's doubly or triply complicated by the beliefs and intentions and knowledge also being a huge source of confusion for people,' says Mozaffarian. Picture yourself at the grocery store or in the drive-through line. What's on your checklist? Protein? Food dyes? Calories? Whole grains? And how much is enough, or too much, and what even qualifies as a whole grain anyway? Does a Whopper meal count as paleo? 'That confusion dramatically increases the gap between aspirations and actions,' says Mozaffarian. It also takes time — a lot of it. 'Our lives are all busy, and just because we would like to do something doesn't mean we will actually get around to doing it,' Teresa Fung, an adjunct professor of nutrition at Simmons University and Harvard University, tells Yahoo Life. And with new diet trends and hyped ingredients and priorities cropping up all the time, it can be hard to stay focused on the things that really matter for your personal diet. Fung is glad that people are aware of issues like food additives, 'but hopefully it's not at the expense of other things,' she says. 'If it's just for a few months that I'm paying attention to [any one food issue] and then a year from now I'm not,' that's not helpful, she adds. However, some public health experts, including Mozzaffarian, believe that certain foods 'just shouldn't be on the shelf,' he says. Specifically, he notes that poor quality diets and ultra-processed foods are linked to health conditions such as heart disease, type 2 diabetes and metabolic syndrome (a collection of related health problems common among overweight and obese people). 'It's not an information problem, it's a product problem,' Mozzaffarian says. Until food is better regulated, nutrition labels are still key to making healthy choices, says Mozaffarian. Grocery shopping and cooking at home go a long way to help you take control of your health, instead of eating packaged, restaurant or fast foods. And, perhaps counterintuitively, 'if you want to eat healthier, buy more products without labels,' Mozaffarian says, meaning whole foods like fruits, vegetables and eggs. When it comes to protein, most people actually don't need to stress too much about whether they're eating enough of it. 'The typical American diet already has enough protein, so if people are already doing it, they don't really need to take the additional action' of checking labels for protein content, she says. Fung also suspects that, like most single-nutrient eating trends, the protein obsession will fade. 'It happens all the time: There are always new discoveries, and people focus on them until they're no longer new, then we wait for the next shiny new thing,' she says. That's another strategy: If the food rules you're trying to follow are super trendy, they probably aren't that sustainable, or essential, Fung adds. However, in some cases, there's a grain of truth to nutritional trends, and some exceptions are worth making. For example, perimenopausal and menopausal women really do need to up their protein intake. And the majority of Americans don't eat enough fiber, so the ongoing fibermaxxing trend actually is dietitian-approved. Fung and Mozaffarian acknowledge that, even if you aren't trying to keep up with the latest food fad, it takes a lot of time and energy to eat the way you aspire. 'It's like another job you have to do after you come home from your job,' says Fung. She says that if you can afford it, buying precut vegetables that are bagged and washed can save time and make it just a little easier to cook at home. She also advises making one or two simple changes at a time if you're trying to improve your diet. 'Pick two things you want to change, and they have to be things that are changeable within your resources and that you can change for the long haul,' says Fung. 'Healthy dietary habits are never extreme.' She adds: 'Health is a long-term project.'

Yahoo

an hour ago

• Yahoo

Americans say they care about getting enough protein and avoiding food dyes. Their eating habits say otherwise.

Americans are fed a lot of information about what counts as healthy food. We wanted to know if these nutritional values are really as important to Americans as the headlines suggest, so, with the help of YouGov, we polled more than 1,500 U.S. adults in April 2025. The results: Most people agree that protein is important, and food dyes should be banned. And yet, a much smaller share of Americans are checking food labels for these ingredients. So what gives? We spoke to experts about whether Americans really value the nutritional concerns that make headlines, and what you can do to better align your ideals with your dietary habits. We asked Americans about whether they consider nutritional information when they choose what to eat and, if so, what factors they prioritize (meaning: calories, sodium, etc.). Then we zoomed in on two nutritional topics that have gotten a lot of buzz lately: protein and red dyes. Protein has been having a moment, partly because it's what some experts have dubbed 'the last macronutrient standing' amid the bad raps of fats and carbs. Its connection to muscle building and weight loss — especially in conjunction with GLP-1 medications like Ozempic — has been a further boon to protein. Americans seem to have taken note. A large majority (85%) of respondents to the Yahoo News/YouGov poll said that protein is very or somewhat important to them when choosing what to eat. Yet among the two-thirds of respondents who said they check nutritional labels, only 13% said that protein is the factor they pay most attention to when choosing what to eat. And only about a quarter of respondents said they're eating more protein now than they were a year ago. We found the same pattern when it comes to food dyes. More than two-thirds (65%) of respondents to our poll said they approve of U.S. Health and Human Services Secretary Robert F. Kennedy Jr.'s move to ban many artificial colorings. But only 37% of respondents said they actively avoid food dyes, and just 27% said they always or usually check food labels for the ingredients (another 24% said they sometimes check). If we're so aware of what we should be including or avoiding in our food, but don't necessarily act on it, are we just too lazy to make healthy choices? Not exactly. For example, 66% of the respondents to our survey make the effort to check nutritional information. But the most commonly considered factor was calorie content (16%), which isn't necessarily a good indicator of whether a food is healthy, according to recent research. While it might seem fairly easy to check foods for their content of other nutrients, calculating out how much we need of each of these (protein, vitamins, etc.) gets complicated, fast. 'There's a lot of evidence that people don't take actions that are in their best interests based on their knowledge,' says Dr. Dariush Mozaffarian, director of Tufts University's Food Is Medicine Institute. 'People have an aspirational image of what they would like to do, and then [there's] what they do in real life.' This phenomenon is known as the intention-action gap. 'And for nutrition, it's doubly or triply complicated by the beliefs and intentions and knowledge also being a huge source of confusion for people,' says Mozaffarian. Picture yourself at the grocery store or in the drive-through line. What's on your checklist? Protein? Food dyes? Calories? Whole grains? And how much is enough, or too much, and what even qualifies as a whole grain anyway? Does a Whopper meal count as paleo? 'That confusion dramatically increases the gap between aspirations and actions,' says Mozaffarian. It also takes time — a lot of it. 'Our lives are all busy, and just because we would like to do something doesn't mean we will actually get around to doing it,' Teresa Fung, an adjunct professor of nutrition at Simmons University and Harvard University, tells Yahoo Life. And with new diet trends and hyped ingredients and priorities cropping up all the time, it can be hard to stay focused on the things that really matter for your personal diet. Fung is glad that people are aware of issues like food additives, 'but hopefully it's not at the expense of other things,' she says. 'If it's just for a few months that I'm paying attention to [any one food issue] and then a year from now I'm not,' that's not helpful, she adds. However, some public health experts, including Mozzaffarian, believe that certain foods 'just shouldn't be on the shelf,' he says. Specifically, he notes that poor quality diets and ultra-processed foods are linked to health conditions such as heart disease, type 2 diabetes and metabolic syndrome (a collection of related health problems common among overweight and obese people). 'It's not an information problem, it's a product problem,' Mozzaffarian says. Until food is better regulated, nutrition labels are still key to making healthy choices, says Mozaffarian. Grocery shopping and cooking at home go a long way to help you take control of your health, instead of eating packaged, restaurant or fast foods. And, perhaps counterintuitively, 'if you want to eat healthier, buy more products without labels,' Mozaffarian says, meaning whole foods like fruits, vegetables and eggs. When it comes to protein, most people actually don't need to stress too much about whether they're eating enough of it. 'The typical American diet already has enough protein, so if people are already doing it, they don't really need to take the additional action' of checking labels for protein content, she says. Fung also suspects that, like most single-nutrient eating trends, the protein obsession will fade. 'It happens all the time: There are always new discoveries, and people focus on them until they're no longer new, then we wait for the next shiny new thing,' she says. That's another strategy: If the food rules you're trying to follow are super trendy, they probably aren't that sustainable, or essential, Fung adds. However, in some cases, there's a grain of truth to nutritional trends, and some exceptions are worth making. For example, perimenopausal and menopausal women really do need to up their protein intake. And the majority of Americans don't eat enough fiber, so the ongoing fibermaxxing trend actually is dietitian-approved. Fung and Mozaffarian acknowledge that, even if you aren't trying to keep up with the latest food fad, it takes a lot of time and energy to eat the way you aspire. 'It's like another job you have to do after you come home from your job,' says Fung. She says that if you can afford it, buying precut vegetables that are bagged and washed can save time and make it just a little easier to cook at home. She also advises making one or two simple changes at a time if you're trying to improve your diet. 'Pick two things you want to change, and they have to be things that are changeable within your resources and that you can change for the long haul,' says Fung. 'Healthy dietary habits are never extreme.' She adds: 'Health is a long-term project.'