People at the centre

Since the 2024 US presidential election disruption of many US institutions, numerous leadership shifts and budget reallocations and reductions, along with legislative and policy changes, have shaken public health global financial architecture, damaging institutional global and domestic roles. Crucially, this fraught time also offers an opportunity to renavigate the positioning of the field of public health and the directions taken more than a century ago. In the 19th century the biomedical model became dominant and public health greatly reduced its focus on adverse living conditions-the previous strategy that underpinned many foundational advances as progressive elements of the sanitary movement allied with social movements to achieve better living conditions. Years later, this positioning left public health largely silent on growing corporate influence, privatisation, and inequality in income and wealth. The enduring US racial hierarchy also adds to the long odds of placing people at the centre-the overarching goal of improving people's health.