The invisible lifeguards of public health

Recent reports of a hantavirus outbreak aboard a cruise ship have reminded us that infectious diseases do not respect borders. Investigators are still piecing together when and where the exposure began.

But the story has followed a familiar pattern: a health threat surfaces, and suddenly the public wants to know who is responsible for keeping people safe. Those people have been on the job all along. Most of us never notice them until something goes wrong.

That is the defining paradox of public health. When it works, it is invisible. When it struggles, everyone asks why it is not working better.

Winnipeggers have lived that paradox. During the COVID-19 pandemic, nurses, epidemiologists, environmental health officers, contact tracers and laboratory staff worked around the clock under enormous pressure.

They navigated shifting science, complex trade-offs and, at times, open hostility from people exhausted and frightened by restrictions they did not always understand.

Many of those same professionals had spent years quietly ensuring restaurants on Corydon Avenue were safe to eat in, that childcare facilities met health standards, and that the pools and splash pads Winnipeg families use every summer were safe to swim in.

None of that work made the news. It rarely does.

Behind the broader public health system is a group of professionals whose titles undersell their roles. Ask most Winnipeggers what a public health inspector does, and they will describe someone checking a kitchen.

That answer is not wrong; it is just incomplete. These are the same people who investigate disease outbreaks, assess environmental hazards, monitor water quality and prepare communities for health emergencies. The restaurant grade is what the public sees. The rest happens out of sight.

Inspectors are one part of a larger picture.

Consider what getting it right looks like across the system. A public health inspector notices improper food-handling practices at a long-term care facility and flags them before an outbreak affects a vulnerable population. A disease surveillance analyst spots an unusual cluster of illness in a Winnipeg neighbourhood and begins investigating before the local hospital sees a pattern. A drinking officer identifies a problem in a distribution system and acts before families face a boil-water advisory.

None of these become a news story. There is no outbreak to report, no victims to interview, no press conference. The success is the silence.

The pandemic was a reminder of how complex public health work truly is. It brought into focus the breadth of skills, systems and co-ordination that effective public health requires: workforce capacity, surveillance tools, laboratory networks, risk communication and community trust. Manitoba’s public health professionals rose to meet that challenge, often under difficult and evolving circumstances.

Many are still doing so. The work has not slowed, even as public attention has moved on.

Public health is not a perfect system, and reasonable people can debate how its authority should be exercised, how trade-offs between individual freedom and collective safety should be weighed and how the government communicates risk. Those are legitimate conversations.

But they are separate from the question of whether we should sustain our investment in the capacity to detect, prevent and respond to health threats. On that, the evidence is clear. Prevention is more cost-effective than response. A strong public health workforce protects lives and reduces pressure on the broader health-care system.

As someone who cares deeply about this city, I believe Winnipeg benefits when public health has the sustained attention it deserves. Not only during outbreaks, but also when reporters ask questions and officials hold briefings.

But in quieter moments, too — when long-term plans are developed, when workforce needs are assessed, when systems are modernized and when the value of prevention is weighed alongside other community priorities.

The people protecting this city every day are largely invisible by design. Public health success leaves no trace. There is no monument to the outbreak that never happened, no memorial to the contaminated food that never reached a school cafeteria, no tribute to the exposure that was caught and contained before it spread. The professionals completed the work and left without anyone noticing.

These professionals deserve more than our attention during crises. They deserve sustained public understanding and support, because the absence of a crisis is often the clearest sign that they are doing their jobs.

Daniel Ajiroba is a Winnipeg-based public health and policy professional and former public health inspector, with experience in environmental public health and health systems policy. He previously taught public health and epidemiology at the post-secondary level.