For over two decades, I have worked in the arena of public health—a field that is complex and challenging to describe. Unlike linear sick care or treatment, public health involves a variety of educational and communication platforms that, while rooted in evidence-based science, require creativity and the ability to pivot as needed to secure a healthy community.

Twenty-one years ago, the idea of working to prevent cancer was not mainstream; it was rarely heard of and often criticized. We were the first and only organization of our kind at the time. Today, we have seen the impact of addressing issues such as water quality, harmful chemicals, reducing rates of juvenile smoking, and combating infectious agents like human papillomavirus (HPV). Cancer prevention is a very large and all- encompassing umbrella. It also includes developing and educating communities to better develop for effective strategies for access and addressing social determinants of health to effectively detect cancer precursors and early-stage cancers—when treatment may be most effective—remains a critical goal. Treating and curing one cancer can prevent a whole host of other cancers in the same patient.

Today, we have ample evidence that cancer prevention saves lives and often mitigates consequences for other chronic health issues.

Most people think of public health as being exclusively local, focusing on hands-on arenas like food banks, free clinics, and shelters—all of which are absolutely critical.

However, there are problems with focusing exclusively on local footprints and local resources. It frequently places constraints on an effort that should be free flowing which frequently penalizes good work that otherwise may have missed opportunities to both expand and become stronger.

Exclusively working within a specific footprint of a single community in public health can lead to several key challenges, including limited access to diverse resources. Focusing solely on local resources restricts access to specialized expertise, funding, and technological advancements.

In the case of Less Cancer, both founded and operated in a Virginia community from the beginning, we were met with both misunderstanding and at times cynicism. In fairness the community, nobody was doing this type of work anywhere we were really the first of our kind.

Many of our resources came from outside our community despite providing programs and advocacy serving our rural area. Unlike me, a C Student liberal arts major we were enlisting experts anywhere from the National Cancer Institute to leading universities, cancer centers, and research institutes.

Initially, our work included creating education, policies and best practices around precautions around preventable and unnecessary pesticide exposures in schools and other health-affected communities. Foods were another issue, as was indoor smoking. Most of our support and expertise came from outside the rural community in which we operated. I like so many people simply wanted less cancer, less incidences of cancer, less suffering.

But I did not have the credentials or the experience at the time to do much beyond be a squeaky wheel, which is why it was critical I enlist the best and brightest to guide this journey under the umbrella of evidence -based  science. Published peer reviewed evidence is an absolute necessity in building trust. Intelligence must always override intention. My intention to want to prevent cancer carries little weight without the science or the evidence.

Collaborations for Less Cancer came from both government and non-government organizations to include universities, medical schools and leaders that had been thoroughly vetted and especially vetted for special interest or conflicting interests.

Eventually, with the help of the World Wide Web, our work started gaining traction and support from unique and sometimes far-away communities, in turn helping my community at home.

Broader collaboration brings diverse skills and resources, often necessary to tackle complex health issues that may be beyond the scope of local capabilities. Especially when it comes to experts and evidence-based science—both important resources that frequently are not found in smaller communities.

Impeding innovation and best practices are another concern that can be especially limiting for local organizations that remain within the constraints of a localized footprint.

Public health potentially can provide benefits from adopting proven strategies and innovations from other areas. Staying within one’s community limits exposure to new ideas and evidence-based practices that could improve health outcomes. Learning from the successes and failures of other regions encourages more informed and innovative approaches.

Local biases can have a potential negative impact outside of work, no matter how strong. In my case, as with anyone from a small town, people can have a wide breadth of opinions about you and your work, which was an early lesson as to why evidence-based science was and remains so critical in guiding the work. Localized approaches can be clouded by an unhealthy loyalty, or personal prejudices sometimes reflecting the specific priorities, beliefs, or biases of a community, which may impede the most concrete evidence-based practices.

There are challenges in managing widespread or emerging health threats such as cancer. Many public health issues can and do impact increase cancer risks to include infectious diseases or environmental concerns, that are not necessarily specific, to one locality. A highly localized approach may potentially be ineffective in addressing issues purely by limiting resources. Not to mention limiting a rapidly increasing and smaller world.

Public health initiatives greatly benefit from all the stuff above my paygrade to include data and experts to both understand and be able to effectively communicate and advocate across different populations and settings. By staying within a narrow footprint, it’s harder to evaluate the overall impact, scalability, or sustainability of health interventions with limited resources.

In summary, while a local focus in public health is valuable for community engagement and understanding specific needs, limiting efforts to a single area can hinder access to innovation, adaptability, and broader collaboration. These elements are essential for addressing the complex, interconnected challenges of public health effectively.

Collaboration, both locally and beyond, has the potential not just to strengthen work but to streamline any duplication or redundancy.

Together is almost always better—not easy and often inconvenient—but collaborative resources can bring much in the way of time, talent and treasure to smaller communities and their organizations if not directly frequently by example and or modeling especially when it comes to the work in educating communities in public health.