Public health under threat: how our leadership must evolve in complex and uncertain times

Public health under threat: how our leadership must evolve in complex and uncertain timesPublic health professionals across the UK and around the world are currently grappling with a landscape of unprecedented complexity.Long-standing systemic challenges across the UK have led to stagnating-even declining-life expectancy and widening health inequalities, whilst on a global scale the very foundations of evidence-based public health programs and principles are under threat. 1,2ur leadership as public health professionals must evolve in response to these mounting challenges.We need a new paradigm in public health, one that embraces the interconnected nature of modern threats to health, and one that is disruptive, agile, collaborative, and firmly rooted in principles of equity and justice.The world is changing rapidly, and public health leadership must adapt to meet the challenges of a more interconnected and dynamic environment.Many of the population-level health challenges facing the UK stem from the deep-rooted social and economic inequalities faced by communities across England, Scotland, Wales, and Northern Ireland.That life expectancy has recently declined in some of the UK's most deprived areas speaks to a long-term failure to properly support our most vulnerable populations, including marginalized minority ethnic communities.Chronic health conditions such as diabetes, cardiovascular diseases, and mental health disorders are increasing at an alarming rate, and the ongoing cost-of-living crisis is further exacerbating these challenges. 3More and more people are being pushed from precarious circumstances into deep poverty, with inadequate access to nutritious food, secure housing, or essential healthcare. 4This not only affects individual health outcomes but also threatens the sustainability of our primary and secondary care systems as well as our productivity as a nation.Looking at public health through a global lens, we see that our profession faces an existential threat from a political zeitgeist that prioritizes individualism at the expense of equity and social justice.The rapid spread of disinformation through social media platforms has led to declining trust in health interventions, as was particularly evident during the COVID-19 pandemic. 5The recent rolling-back of fact-checking