Public Health Through the Lens of Systems Engineering

A course assignment caused me to go on a bit of an intellectual voyage

One of my first assignments for my PH 6010 course (Public Health & Health Policy) was to write a post for the class Yellowdig (an online forum platform that is used by UVM for its courses) was to define public health. Given that my academic background is primarily that of a systems engineer, I decided to write my post through that perspective, how I would define and describe the public health sphere to another systems engineer interested in doing public health related work. As a result, I ended up going on a bit of a tear for the assignment - which I want to share with all of you (my Substack readers) and I hope this framing is understandable to everyone regardless of background.

Without further ado, the content of that assignment is below.

Part 1) How do you define public health?

Public health, broadly defined as what society does collectively to assure the conditions for health, can be reframed from a systems engineering standpoint as the design, operation, and optimisation of a complex, adaptive human system whose output is population health. Rather than focusing on individuals, public health targets communities and entire populations, with its effectiveness hinging on the integration of multiple interrelated domains - biological, environmental, behavioural, social, and political.

From a systems engineering perspective, public health can be treated as a multi-input, multi-output (MIMO) system. Inputs include interventions, resources, policies, and environmental factors; outputs include epidemiological indicators like morbidity, mortality, and quality of life. This framing allows engineers to apply tools such as feedback loop analysis, optimisation algorithms, and system dynamics models to improve system performance.

Major systems principles integral to this understanding include:

1. Complexity and Interconnectivity: Public health issues are inherently complex, often influenced by non-linear, interdependent factors. A systems engineer must be comfortable mapping and analysing these interactions - using tools like causal loop diagrams or network analysis - to identify leverage points and unintended consequences.

2. Optimisation under Constraints: Public health systems face finite resources and must prioritise interventions for maximal population-level benefit. Here, operations research methods - such as linear programming, resource allocation models, and cost-effectiveness analysis - align directly with systems engineering practices.

3. Feedback and Adaptive Control: Epidemiology provides critical system feedback - surveillance data, outbreak trends, and intervention outcomes - that mirrors control system logic. The “assess-plan-act-evaluate” cycle in public health parallels closed-loop control systems in engineering, requiring continuous monitoring and iterative refinement.

4. Resilience and Robust Design: Public health systems must withstand shocks (such as pandemics) while continuing to function. This maps directly to fault-tolerant design and resilience engineering. Engineers can contribute by modelling risk scenarios, identifying failure modes, and building flexible response systems.

To avoid disciplinary disconnect (given the difference in frameworks between systems engineering and those used in public health), systems engineers should anchor their public health work in the population-level mission of the field, remaining attuned to social context, equity concerns, and the often qualitative nature of community-based interventions. Public health success is not just about efficiency but also justice, accessibility, and sustainability.

Ultimately, a systems engineer entering public health should see themselves as helping to design and optimise an adaptive human service system, governed by complex feedback and embedded within a socio-political environment. The challenge, and opportunity, is to apply the rigour and structure of systems thinking without losing sight of the human, relational, and ethical foundations of public health.

Part 2) How would you describe public attitude toward public health? What do you think are the reasons for this? Identify at least two reasons.

The public attitude toward public health in the United States, and increasingly in many other contexts, can be described as ambivalent, often marked by undervaluation, misunderstanding, and at times politicisation. While many people support the idea of community health in theory, they often fail to recognise the full scope of what public health entails or how its benefits are delivered. Public health tends to be most visible during crises (for example pandemics & natural disasters) but least appreciated when it functions well - a classic case of success breeding invisibility.

1. Public Health Is Preventive and Systems-Oriented - Not Individual Nor Immediate

Most people intuitively understand clinical care: a patient sees a doctor, receives treatment, and (ideally) improves. Public health, however, operates at a population level, often through preventive, regulatory, or environmental interventions that may take years to show effects. For instance, clean water, vaccination programmes, or tobacco taxes save millions of lives—but their benefits are diffuse, statistical, and largely invisible to the public. Because these impacts are not directly experienced by most individuals, they often go unrecognised or underappreciated.

From a systems engineering lens, this is akin to a well-functioning infrastructure system: if the bridge doesn’t collapse, or if the infection never spreads, most users don’t attribute that outcome to upstream design or intervention. The invisibility of successful prevention means public health rarely generates the personal gratitude or perceived value that clinical care does, even though it is often more cost-effective and impactful over time.

2. Politicisation and Mistrust of Government Institutions

Especially in recent decades, public health in the U.S. has become increasingly politicised, particularly around issues like vaccinations, mask mandates, reproductive health, as well as gun violence. These interventions often intersect with values, beliefs, and personal freedoms, which makes them fertile ground for ideological polarisation. In some cases, public health officials are viewed not as protectors of community wellbeing, but as agents of state overreach - especially when mandates or regulations are involved.

The SARS-CoV-2/COVID-19 pandemic starkly revealed this tension: measures like mask-wearing, lockdowns, or vaccine promotion were interpreted by some as prudent public health actions, and by others as coercive infringements. This mistrust is compounded when communication is inconsistent or technocratic, failing to engage diverse communities or acknowledge legitimate concerns. The end result is erosion of trust in public health institutions - even when those institutions are acting on the best available evidence.

In summary, the public’s attitude toward public health is shaped by a lack of visibility into its benefits, combined with cultural and political dynamics that make its interventions appear distant, abstract, or intrusive. From a systems engineering viewpoint, public health suffers from a feedback problem: its positive outputs are delayed or diffuse, and its corrective actions often generate pushback rather than reinforcement. Improving this dynamic requires better communication loops, stakeholder engagement, and systems-level transparency - so that the public can see not only what public health is doing, but why it matters to their lives.

As always, please feel free to comment below if you have thoughts.

Also, I know I promised everyone a write-up of my road trip home, and that’s coming later this weekend, but I needed to get this done first, and I hope that’s understandable for everyone.

On that note, that’s a full lid, everyone!