Public Health Déjà Vu: Why This Moment Feels Familiar and Can We Finally Break the Cycle?

Patterns in Public Health

Public health often feels like déjà vu. Time and again, we face familiar challenges in a new disguise. Take cholera in 19th-century London: Dr. John Snow mapped cholera cases and traced an outbreak to a contaminated water pump, prompting lifesaving changes in sanitation. Fast-forward to a century later, and public health surveillance is contact tracing new cases of COVID-19 to #StoptheSpread using some of the same protective practices.

Different issues, in different eras; yet, both were major threats to public health, sharing a common rhythm: problems arise, knowledge guides action, and society adapts. It's as if history is remixing public health — a bad remake of a classic song.

It's as if history is remixing public health — a bad remake of a classic song.

Same Fight, New Era: Reliving the Same Crises

The repeating nature of public health challenges is almost fractal. In STEM, fractals are patterns that look similar at every scale — zoom in or out, and the shapes repeat each other in a dynamic formation. The emergence of public health issues and society's response can feel the same way.

A local outbreak can mirror a global pandemic in how it spreads and how we must respond. We even see parallels between a single community tackling disproportionate diabetes prevalence and the broader national fight against chronic disease over decades.

The patterns of a public health crisis and its response recur in small towns, a whole country, and the entire globe, alike. This similarity across geographic contexts reminds us that fundamental causes — like racism, poverty, lack of access to care, or a rampant stream of misinformation — will keep generating health crises until they’re addressed adequately.

Recognizing these fractal-like patterns can turn hindsight into foresight: lessons from past case studies can give us a head start when new public health problems emerge.

Budget Cuts in Motion Stay in Motion

Why do these patterns persist even when we see them coming? Here’s a lesson from physics. (Insert Newton’s first law.) An object in motion stays in motion, and one at rest, stays at rest, unless acted on by an external force. In public health terms, deep-rooted systems, policies, and practices that are resistant to equitable change continue moving in the same direction—until some disruptive force changes them.

Hate it or love it, inertia explains why without a strong intervention, long-standing health inequities and disparities persist and policies can be slow to adapt until another force changes them.

The recent budget cuts, policy rollbacks, and sudden disinvestment in public health at the federal level can likely be the disruptive force that causes a shift in public health.

As with energy, these forceful actions create ripple effects in the public health sector that demand urgent responses and accelerate shifts that might not have happened otherwise (at least not as swiftly or sporadically). Think about how long it took for seat belts to become standard practice in cars — for years, high traffic fatality rates were "in motion" until laws, public campaigns, and cultural shifts applied enough force to change policies and norms.

Newton’s law doesn't just tell us about shifting energy, it law also carries a hopeful message: with force, we can change the trajectory of the future. Just as gravity eventually pulled Newton’s apple from the tree, collective actions, or forces, can knock public health problems off their current path and provide the force needed to redirect public health toward a stronger, more sustainable future. The challenge isn’t just reacting to crisis—it’s using these moments to push for sustainable systemic change.

The challenge isn’t just reacting to crisis—it’s using these moments to push for sustainable systemic change.

The Paradox of Public Health Progress

Public health has made incredible strides—increased life expectancies, lessened the spread of infectious viruses, and developed vaccines that wiped out deadly diseases—yet, somehow, we keep finding ourselves in familiar crises, with disproportionate impacts on vulnerable communities. Why? Because progress in public health is rarely linear. It happens in bursts, often in response to emergencies, only to be met with periods of stagnation—or worse, regression. Sound familiar?

We’ve seen it before: major investments in public health follow crises, but as soon as the urgency fades, so does the funding. Take the Freedmen’s Bureau Acts of 1865 and 1866. In the wake of emancipation, the U.S. government created the Freedmen’s Bureau to provide essential services—healthcare, food, and housing—to formerly enslaved Black Americans. The Bureau built hospitals, established medical programs, and attempted to address the public health crisis facing newly freed people. But within a few years, funding was gutted, hospitals were closed, and federal support disappeared, leaving communities to fend for themselves.

This cycle has repeated throughout history. After the 1918 flu pandemic, underfunded health departments struggled to maintain preparedness. In the 1980s, the federal administration cut budgets for the CDC and other health agencies, slowing public health advancements just as the HIV/AIDS crisis demanded more action. In the 1990s, the rollback of federally funded social programs left communities vulnerable to worsening health disparities.

This is the paradox of public health progress: we know more than ever before, yet we keep repeating past mistakes.

This is the paradox of public health progress: we know more than ever before, yet we keep repeating past mistakes. We’ve built the evidence base, refined our strategies, and proven what works—so why does history keep looping back?

Because systems, like objects in motion, follow Newton’s First Law: they resist change unless acted upon by a strong enough force. Public health, when properly funded and prioritized, transforms lives. But when funding dries up, when policies shift, and when political will fades, public health professionals are left scrambling to respond with urgency that could have been avoided.

The question is: how do we break this cycle?

How We Push Forward (Again)

Progress is not a given; it depends on people making it happen. So what can we — public health professionals, community leaders, and allies — do to be the force that changes the pattern? Here are a few approaches:

• Leverage Lessons from History: Use past outbreaks and health campaigns as playbooks. What worked to curve polio or reduce tobacco use? Adapt those proven strategies to today's challenges.

• Innovate and Adapt: Be ready to try new tactics to enhance old tricks. Embrace technology and creative communication to reach people. When misinformation spreads faster than facts, credible information has to become quicker and easier to access.

• Build Coalitions: Public health is a team sport, so collaborate across sectors — community-based organizations, healthcare, education, business, and government (yes, even government). Just ask any gamer, they will tell you a collective team effort has more force than any single player.

• Advocate and Act: Speak up for equitable, evidence-based policies and invest in prevention. Whether it's securing funding for a vaccination drive or pushing for healthier school lunches, persistent advocacy can overcome policy inertia.

• Educate and Shift Power: Keep communities informed about the "why" behind public health approaches. An informed community is a powerful one, and it increases the likelihood of support and sustainabilty of changes that uplift everyone's health outcomes.

Yes, the challenges in public health are complex and sometimes feel never-ending.

Yes, the challenges in public health are complex and sometimes feel never-ending. Our field faces constant pushback — from budget cuts and political pushback to public fatigue and our own burnout. But remember, we've overcome seemingly unstoppable problems before. The patterns of the past don't have to predict the future; they can inform it. By recognizing recurring issues (our fractals) and pushing hard to change their course, we can create new patterns — ones of progress, resilience, and equitable health.

Public health is a story of hope in action. Each vaccination given, each policy changed, each community program launched is a small victory that adds up to a major transformation. Collectively, those victories can form a legacy of healthier, longer lives.

Let's ensure that even if history's next verse rhymes with the previous one, it brings the fire to continous uplift the health everyone.