Member blog: Dr Sakthi Karunanithi

People often ask what drew me into public health, and the answer starts well before I held any senior title. I began my career as a medical officer in a tea plantation in India, where daily life made it impossible to ignore how health is shaped by housing, income, work and the environment. That early experience turned my attention from treating illness to understanding the causes and the conditions that create them.

I later trained in Community Health Administration at the National Institute of Health and Family Welfare, under India’s Ministry of Health and Family Welfare, and I was proud to support polio eradication in India. Those experiences taught me that progress comes through persistence, partnership and public trust, often built over time and sustained through difficult decisions.

I moved to the UK in 2005, and I often describe myself as, “proud to be born in India and made in Lancashire” because Lancashire has shaped me both personally and professionally. I became Director of Public Health for Lancashire in 2013, with a clear mission to help make the county a safer, fairer and healthier place for all. This sense of purpose has stayed with me and become stronger over the years.

What I enjoy most about public health is staying curious about the interplay between prevailing philosophy, politics and economics, and how these forces shape health in its broadest sense – and health inequalities – over time. Public health practice never operates in a vacuum. It reflects what a society values, what it chooses to prioritise, and what it is willing (or not) to invest in. That context matters, because it influences not only what we do, but what becomes possible.

I have always been interested in turning evidence into practical change. Being selected as a NICE Scholar as I was completing my public health training programme strengthened my commitment to translating clinical evidence into standards that improve outcomes and reduce unwarranted variation. I have also enjoyed the sheer variety of the role, from assessing impacts of fracking to opportunities like digital innovation. Being involved in managing crises like the COVID-19 pandemic, cyber security incidents and other emergencies has continually trained and stretched my thinking in how to make our communities continually safer.

Public health leadership, in my experience, often means balancing multiple responsibilities at once: upholding professional standards, leading a statutory office with clear duties and accountabilities, and leading with purpose. It often involves working within a dynamic and sometimes volatile geo‑political environment and is challenging, but deeply meaningful, work.

Being a member of the Association of Directors of Public Health (ADPH) matters greatly to me. ADPH provides a collective voice, peer support and moral courage for Directors working in complex environments.

What I would say to aspiring Directors of Public Health is to stay curious and grounded. Public health is not just technical; it sits at the intersection of evidence, values, politics and economics. Seek breadth as well as depth, listen carefully to communities, and learn from colleagues across disciplines. Be clear about your values, because the role will test them. And remember, this is both a short and a long game. You may not even get recognised but the privilege of improving lives and reducing inequalities makes it one of the most rewarding leadership roles there is.