A new era for public health has begun at Washington University in St. Louis, marked by a two-day celebration welcoming Sandro Galea, MD, DrPH, as the inaugural Margaret C. Ryan Dean of the School of Public Health and the Eugene S. and Constance Kahn Distinguished Professor in Public Health.
The events, held Jan. 29 and 30, featured a public lecture as part of WashU’s Assembly Series and a formal installation ceremony honoring the leaders and donors who have laid the foundation for the new School of Public Health. The ceremony signified the launch of WashU’s first new school in a century, an ambitious undertaking aimed at transforming public health research, education and practice.
A bold vision
In his Assembly Series talk, “Why Health? Reimagining What We Think About When We Think About Health,” Galea delivered an unflinching look at the past, present and future of public health.
Amid shifting federal policies and potential cuts to public health funding, Galea addressed the moment head-on: “I realize I am speaking about health at a particularly propitious time for health in the country,” he said. “It is because this is such a challenging, confusing, unclear time that we should be doing this. The promise of universities is that they will be here long after all of us have passed through, and our job is to generate ideas that transcend politics of the moment.”
Speaking to a packed audience in Graham Chapel, he framed health as the foundation of human progress — one that is historically fragile and deeply influenced by social and economic forces. “The point of health is that we all have the opportunity to live full, rich lives and do whatever we want with those lives,” Galea said.
With more than 80 data-rich slides, he traced the evolution of public health, highlighting the dramatic rise in life expectancy since the 19th century, the devastating impact of COVID-19, and the staggering gaps in health equity.
“We inflected life expectancy down by about two or three years during the COVID pandemic, essentially globally,” Galea noted, adding that the U.S. already was falling behind other high-income nations before the pandemic.
The crisis, he argued, is preventable. “The full suite of what makes us healthy or unhealthy is preventable,” he said, citing risk factors such as high blood pressure, air pollution, smoking, and poor diet — all of which could be addressed through policy, education and systemic change rather than medical intervention alone.
The U.S. spends 40% more on health care than any other nation, primarily on hospital care and physician services. Americans claim to value health, he said, but funding tells a different story. Resources overwhelmingly go to treatment rather than prevention, ignoring the social and structural determinants of health.
Health is shaped by much more than medical care. It is influenced by smoking, drinking, sexual activity, living conditions, education, job status, family support and income, among other factors, he said. Addressing health requires an interdisciplinary approach, spanning social work, engineering and the arts and sciences. This vision has led to the creation of a public health school designed to bridge these disciplines, fostering collaboration and innovation.
Galea emphasized that equity must be central to public health. “There should be no conversation about health without equity at the heart of that conversation.”
He pointed to stark gaps in life expectancy, varying by geography, race and income. “Why is it OK that if you’re born in Nigeria, you can expect to live 25 years fewer than if you’re born in Japan? Why do we accept a six- or seven-year gap in life expectancy between U.S. states?” he said.
Public health requires looking beyond personal biases and considering the well-being of entire populations, he said.
He noted that public trust in science is declining, especially in conservative areas where health often has been overlooked. “Our job is to bring health to all. That means understanding where people are. That means communicating with where people are.”
His call to action was clear: “Health is not a red or blue issue — it is purple. We all want to live long, healthy lives. If we fail to communicate that, we fail at our mission.”
Galea used a metaphor to illustrate the essence of public health, comparing it to caring for a goldfish — a concept that inspired the name of his blog, “The Healthiest Goldfish.”
“I love my pet goldfish. I want it to be healthy. So I tell it to swim around this bowl 10 times clockwise, 10 times counterclockwise. I feed it organic food and take it to the best goldfish doctor. And then one day, I find it dead. How could it be? The reason my goldfish died is because I forgot to change its water,” he said.
The “water” in this analogy is the world around us — the policies, structures and environments that shape health outcomes. “Our job is to create a world that generates health,” he said.
Galea believes universities must lead the charge. “This is why universities exist,” he said.