A special essay by Shenbei Fan, BMSc, MPH (c)

When considered in the context of COVID-19, it is easy for many of us to overlook the fact that “public health” had not always occupied such a dominant place in the collective imagination. Indeed, my own inclinations to explore the contours of this field are a fairly recent development that has paralleled, in many ways, the narrative arc from obscurity to prominence that the field has undergone in the past several years.

In hindsight, I have come to realize that my current interest in “public health” began taking root from a young age, even if I had only recently come to acknowledge the potentialities of the field as a unique professional discipline connected to, yet distinct from, the realm of  “conventional” healthcare and medicine. As the offspring of immigrant parents, I had developed a keen sense—even as early as elementary school—of the implications surrounding one’s place on the socio-economic ladder and the dynamics of “climbing up” the ladder in a process which I  eventually came to understand as social mobility. This notion was instilled, in large part, from my very pronounced experiences migrating to ever “bigger and better” residences over time as my parents metamorphosed from struggling “adventurers” in a new land to full-time workers in stable, respected occupations.

In parallel, my young and curious mind became acutely attentive to the differential patterns in which “richer” and “poorer” individuals lived, worked, traveled, and even ate. I noticed, for instance, that high-rise apartment towers were generally synonymous with “worse off”, while detached single-family homes were generally synonymous with “better off”. I also noticed that “affluent” supermarkets such as Loblaws tended to emphasize quality and craftsmanship in food to a far greater extent than “budget” supermarkets such as No Frills which tended to emphasize “the basics, at low prices”. Of course, I eventually dispensed with these simplistic, binary categorizations as I matured and developed the capacity to perceive nuance, but these lived experiences have played a profound role in shaping a worldview, unbeknownst to me in my younger years, centered around the notion of social health determinants.

Somewhere in middle or high school, this intrinsically felt awareness of socio-economics culminated in a heightened propensity to undertake exploration about these issues. One evening, I came across an enlightening report that piqued my fascination: Poverty by Postal Code. It detailed, in vivid numbers and testimony, the plight of low-income Torontonians residing in high-rise apartment buildings, with many forced to contend with poor maintenance, pests, malfunctioning elevators, and a dearth of facilities to engage in recreational and social activities. Reading personal stories of individuals and families who experience these adversities instantly triggered a flashback of surprisingly profound memories of my toddler and kindergarten years in which my family was compelled to make do with aging rental housing in high-rises and basements that offered cramped and, at times, squalid living conditions.

These memories were brought back further as I engaged in several enlightening experiences performing paid and volunteer work in recreational programs for children and youth. The first of these experiences was a semester as a teaching assistant at a music school in Regent Park, one of the most economically deprived neighborhoods in Toronto. The school made a special effort to offer subsidized lessons for students from underprivileged families. A few years later, I served as a program facilitator at a Salvation Army day camp, where the director emphasized the need to offer an enriched experience for all children and families, many of whom were experiencing significant socio-economic adversity. In one of our staff discussions, she uttered a quote I will never forget: “Where else would these children find themselves? Cooped up in apartment buildings while they develop obesity?” These experiences shook me back into the reality that my increasingly prosperous upbringing was hardly a universal reality for all citizens in Canada or indeed, the world. Many remain “behind”, with limited prospects for upward social mobility, and will continue to face substantial hardship into the foreseeable future.

In late high school and early undergrad, still well before COVID-19 had catapulted “public health” into the world’s spotlight, I decided to commit to the challenging, yet highly-rewarding path of “pre-med” at Western University, having taken into consideration my relatively strong aptitude for the sciences. Like most eager freshmen, I appeared destined to embark on the standard journey of high GPAs, outstanding extracurriculars, and plenty of time spent in “research” positions. After all, the (perceived) prestige of physicianship remains rivaled by none but a few professions: law, engineering, and perhaps a few others. In the spirit of “taking baby steps toward a big goal”, I signed up for a multitude of on-campus positions in clubs and organizations populated by many other fellow “pre-meds” who appeared to share an ambition of “making it to MD”. From “Autism Awareness” to the “Diabetes Association” to the “Pre-Med Society”, the opportunities at Western to engage in experiences that would “boost my chances” were seemingly endless. Within a year or two, I was helping out at community outreach events and coordinating guest speaker sessions with members of the local academia eager to share their latest research on various healthcare topics.

Without attempting to speak of this phase of my personal journey disparagingly, I have come to believe it is important to maintain a holistic vision of one’s potential role in the world that rises above the narrow pursuit of some “designated” path that may or may not turn out as planned. It dawned on me that medicine was just one of many options where I could put to use all my accumulated knowledge and skills to make a true difference in the world. This new perspective of life and work was bolstered through a dramatic shift in the focus of coursework during my final year of undergrad studies in which the emphasis was no longer solely on the “science” of biochemistry or genetics but rather on enabling students like myself to develop a multidisciplinary grasp of all that health entails. No longer was I limited to “memorizing” the intricacies of cell structures; there was now exploration of health as a fundamentally societal phenomenon encompassing politics, economics, and demographics.

It was primarily during this time that public health truly began to interest me. The idea that health is not solely a function of an individual’s physiology or genetic disposition, but also the product of multiple intersecting social forces, meshed well with my long-standing interests in the socio-economic well-being of populations that had developed from a very young age. In addition, the emphasis in public health of population-level or systemic forces transcending individual determinants spoke profoundly to my personal ethos of supporting the marginalized and vulnerable that had been fostered profoundly by my earlier work experiences with these populations. Furthermore, I became attracted to the public health vision of promoting health as opposed to solely preventing disease, which—essential as it is—forms only one component of well-being in human societies.

Spurred by this mounting interest in addition to the emergence of COVID-19, I proceeded to pursue an MPH at Waterloo with the added benefit of flexible online learning and an experiential practicum that will hopefully offer me highly valuable hands-on experience in the field. Having successfully completed my first semester of studies with great passion, I look forward to exploring new dimensions of public health and developing a well-rounded understanding about the nature of morbidity and mortality and the prospects of spearheading meaningful change in policy and other realms. Public health is, to me, a discipline indispensable to the continued well-being of society as our species embarks on a period of unprecedented change and transformation.