Why public health is everyone’s business

______________

OPINION

Dr Henry Kyobe Bosa

As Uganda closes another year and looks towards 2026, it is important to reflect on where public health really happens. Many still associate it primarily with hospitals, laboratories, or Ministry of Health offices, or food stalls, or latrines, or handwashing. While these institutions and settings remain essential, public health is far broader: it touches every aspect of daily life.

The reality is simple: public health happens everywhere.

In Uganda, it is shaped daily in markets and trading centres, taxi parks and boda boda stages, markets and large shoping archades, saloons, gyms, rotary club meetings, schools or schools sports gala, workplaces, places of worship, and homes. These everyday settings increasingly determine whether our population becomes healthier or sicker.

Uganda has much to be proud of. Strong immunisation programmes have significantly reduced vaccine-preventable diseases to near zero. The country’s responses to Ebola and COVID-19 demonstrated discipline, science-led leadership, and community trust, saving lives while contributing knowledge globally.

Malaria morbidity and mortality have declined over time, and Uganda’s early leadership in HIV prevention shaped approaches that saved millions of lives globally. Gradual progress towards universal health coverage, particularly through primary care and community delivery models, further demonstrates the value of coordinated, prevention-focused action.

Yet public health challenges continue to evolve and changing face. Non-communicable diseases such as hypertension, diabetes, heart disease, and cancers are rising steadily, placing long-term strain on households, the health system and the nation’s long-term vision. Nutrition sits at the centre of this shift.

Uganda faces a double burden of malnutrition: undernutrition persists among children, adolescents, and pregnant women, limiting growth, learning, and immunity; at the same time, overweight and obesity are increasing, especially in urban and peri-urban areas, driven by changes in diet and physical activity. Both forms of malnutrition increase the risk of chronic disease and reduce economic productivity.

Emerging social and behavioural challenges also influence health outcomes. Drug and substance use among adolescents and adults contributes to mental health concerns, injuries, and reduced productivity. Teenage pregnancy continues to affect education and maternal-child health. Sexual and reproductive health needs, including access to accurate information and preventive care, remain critical for young people and other vulnerable populations. Addressing these challenges is not about moral judgement; it is about reducing disease, preventing harm, and protecting wellbeing across society.

Maintaining a healthy body weight, preventing substance misuse, and promoting reproductive health are no longer simply individual concerns. They are shaped by the foods available in markets, meals provided in schools and workplaces, urban design, transport systems, social norms, and access to services. These are policy choices, not isolated personal decisions.

Public health cannot be delivered by the health sector alone. A market vendor who handles food safely prevents disease. A school that promotes life skills, nutrition, and physical activity invests in lifelong wellbeing. An employer who supports mental wellbeing and routine screening protects workers and productivity. Community and religious leaders who encourage healthy behaviours influence outcomes at scale. When all sectors work together, public health becomes effective and sustainable.

Early screening for non-communicable diseases is particularly important. Many Ugandans live with high blood pressure or elevated blood sugar without knowing it. Routine checks for weight, blood pressure, and blood sugar in communities, workplaces, and primary care settings can prevent disability and premature death. Prevention and early detection remain more affordable and effective than treating advanced disease.

Uganda already has strong community-based platforms to support these efforts. Village Health Teams, local councils, civil society organisations, security institutions, and the private sector can all contribute to nutrition education, healthy weight promotion, substance abuse prevention, sexual and reproductive health education, and routine screening. What is needed is a consistent policy emphasis that prevention is essential, not optional.

This requires deliberate action across government. Health considerations should be embedded in agriculture, education, urban planning, transport, trade, gender, and youth policies. Public health impact must be a routine part of major policy decisions.

Uganda has an opportunity to protect its hard-won gains while preparing for emerging challenges. By recognising that public health happens everywhere, the country can build a healthier, more resilient, and productive population. As we enter a new year, the message is clear: public health is everyone’s business.

The writer is a Senior Military Officer, Fellow of the Royal Society of Public Health (UK), global health specialist, and National Technical Lead on COVID-19, Ebola, and Mpox.