The Social Life of Ideas

Ideas about ideas, at a time when ideas feel endangered

This piece is co-written with Dr Nason Maani and cross-posted here.

Let us start with the present.

We are living in an unusual time. After many years of gains for more open liberal societies, populist forces are in ascendance. Several countries that nominally are open, democratic, and have freedoms of expressions are actively working to suppress media, universities, and other outlets that generally have been engaged in developing and disseminating ideas. Other countries, including some of the largest in the world, have long been operating in a sort-of unsteady social compact, where the population benefits from increasing prosperity, as long as it does not raise too many ideas that may threaten a status quo.

Whither then ideas?

We think ideas matter and are the core of liberal societies. We are interested in the enormous progress afforded by liberalism through core values of pluralism, diversity of perspectives, reasoned and rigorous debate, and gradual improvement of the world we live in, not as a partisan project, but as an intellectual foundation to a better world. And that matters to all we do in health as an aspirational foundation to that very world.

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On the complexity of moral argument

Understanding that good people, for good reasons, hold on to ideas we strongly disagree with

Your neighbors voted for the candidate you cannot stand. They are also friendly, congenial neighbors and regularly bring you baked goods.

Your cousin works in marketing at a tobacco company. They are also a wonderful parent, and you enjoy spending every Thanksgiving together.

Your friend since childhood is avowedly against any form of regulation to industry, convinced that those who cannot make it in a completely free market are simply not trying hard enough. You have enjoyed going on vacation with them every year since you were young.

In a time of partisan rancor, it is becoming — at least in the public narrative — almost impossible to engage with those whose perspectives might differ markedly from ours. For anyone who is engaged in the business of population health, political choices, and the candidates who espouse them, matter, as does caution to create the right framework for corporate incentives and disincentives, and minimizing the impact of harmful products.

How could rational, good people, feel so strongly, so differently than we do?

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Building health on shared values

Why a focus on enduring principles should underlie all efforts in health

We are in a time when much is being overturned. Policies are being rolled back, funding is being cut, long-standing institutions overhauled. Globally, it seems like the U.S. is retreating from its role as leader of the postwar international order, which for 70 years was the bedrock of a lasting, if imperfect, peace.

In health, this time of change has been acutely, painfully felt. Everyone knows someone who has lost a job or faced sudden uncertainty around the future of their work. We witness institutions that appeared broadly seaworthy — and that we assumed enjoyed public support for doing good, necessary work — enter choppy waters, with close to half the country either indifferent to their fate or actively hoping they will sink.

Beliefs that constituted a kind of collective faith — vaccines are safe and effective, the work of science can be trusted, technological progress is a net positive for society — have, for reasons understandable and less so, lost their hold on our consciousness. They were once the default opinion of many, if not most of us. No more.

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Clarifying misunderstandings about population health

A science refresher to help move us past the health mistakes of the moment

This piece was co-authored by Dr. Greg Cohen

I have written quite a bit now about the challenges of the moment to the health of populations — from systematic efforts to limit the public health workforce, to funding cuts to health research, to threats to health insurance coverage. These are all challenges that one worries will have a substantial effect on the health of the American (and global) population. There is no question that some of these changes are driven by ideological difference, and some by an effort to simply do things differently, to break from past precedent. But it also occurs to me that some of what is happening may arise from a misunderstanding, on the part of political appointees overseeing national public health infrastructure, of the facts about what shapes the health of populations. So, here, partnering with Dr. Greg Cohen and informed by work I have done over the past decade-plus with Dr. Kerry Keyes, I thought I would summarize some core concepts of population health science and why they matter to the current moment, and, de facto, why paying attention to these concepts might suggest a course of action that diverges from the path currently being pursued by some who are responsible for the public’s health at the federal level.

By way of introducing core principles of population health science, let us ground the discussion in a lightning rod topic, if there ever was one: the COVID vaccine. Caught up in the cultural tumult of the past few years, COVID vaccines are currently restricted by CVS and Walgreens pharmacies across multiple states. According to a Kaiser Family Foundation poll administered in early August, only approximately 40% of Americans plan to get a COVID-vaccine booster this fall, and the majority of those who want to receive the booster are concerned they will not be able to access the vaccine or insurance coverage for it. This is a rather odd turn for vaccines that until recently were considered a miracle of modern science and are responsible for saving millions of lives and averting millions of years of life lost worldwide. Leaving aside more cynical political agendas that have used COVID vaccines as a lever to score partisan points, it is important to contend straightforwardly with concerns fueling uncertainty around COVID vaccines, concerns that have led many to doubt the vaccines’ efficacy and utility.

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On keeping the faith

Leaning into hope at the start of a new school year

One of the privileges of working in a university is the opportunity that comes with the seasons. The summer months provide space for thinking, for taking a step back from the moment and engaging with the ideas and philosophical grounding for what we do. On the administrative side, summer is a time for planning the year to come as we look ahead, with excitement, to welcoming our new students. Then our students arrive, bringing new ideas, new energy, and a spirit of hope that infuses the whole school community.

As we welcome students in 2025, I would like to take a moment to lean into hope in this Goldfish space, into believing in the mission of public health.

In doing so, I find myself thinking about an expression that has stuck with me over the years: “Keep the faith.”

It is a phrase many of us have heard — most recently, perhaps, from former President Biden, for whom it is a favorite expression. At its simplest, “keep the faith” is a reminder to not give up, to keep going in the face of adversity, to hold true to our values and aspirations. It can also have a religious resonance, reflecting a belief in the possibility of a transcendent spiritual reality to which the challenges of this world will ultimately give way.

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What happens then?

The practical consequences of losing a country’s commitment to science

André Malraux was a French novelist whose most durable contribution was perhaps his decade as France’s minister of cultural affairs in the 1960s. Malraux was convinced of the importance of promoting French culture among the masses and, during his tenure in the ministry, made his hallmark the restoration of older national landmarks such as art galleries, museums, and older French villages that had fallen into disrepair. During a period of time marked by postwar reconstruction and enormous pulls on national resources, Malraux argued — successfully in the main — for the importance of culture at the heart of the very idea of France, a theme built on his writing, particularly “The Psychology of Art.” The result of this work is a country whose cultural heritage lies at the heart of its identity. And, that identity has enormous practical implications for the well-being of the country. France is by far the world’s most visited country, with nearly 100 million annual tourists, contributing about 10% to the country’s GDP. That culture is now unquestionably central to the country’s national ideal is validation of Malraux’s approach to lean into the country’s strength — in this case, its cultural heritage — and to use that very advantage to make the country better.

And this brings us to the current state in the U.S., where a core national idea as core to the country as culture is to France — the United States’ preeminence in research and innovation — is being threatened by challenges to funding by the current federal administration. And it brings us to the question of, what do we really stand to lose if we lose science as the heart of our idea of ourselves?

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It bears conversation

On the value of engaging with difficult ideas from disagreeable sources

The U.S. health-care system, and research that has aimed to study this system, has long been stymied by challenges in sharing personal records over different platforms and systems. Scholars have observed the potential of research using shared data access platforms, including, for example, efforts in Europe to track persons across different health systems. In some ways this has felt like yet another intractable problem that is insoluble and that challenges U.S. health care.

But what if there were a solution? And what if that solution were announced by a sitting president who has, in his first six months in office, done much to undermine the cause of health? Well, that is exactly what President Trump announced recently, i.e., a health-care records system that would allow the sharing of personal health information for providers, including across different systems. Clearly there are many details that would need to be worked out — that is true of any new idea that tackles a long-standing status quo — but surely one would expect that we might have a chorus of enthusiasm from those in health and health care for the effort to address a difficult problem?

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In praise of diligence

On showing up when there is much to be done

I am back to writing The Healthiest Goldfish after a few weeks during which time I finished my upcoming book, “Why Health?” (more on that later), and took some time away, which was restorative. Naturally when one takes some time away, it creates an opportunity for some reflection, a chance to read a bit more broadly than usual, and to think, to look ahead. This was no different, and for that I am grateful.

As I was shuffling through my mental slide deck, I came upon a vivid memory: attending a lecture in October 1991 — I looked it up, it was October 24, to be precise — at the Faculty of Medicine, University of Toronto. It was the Gairdner Foundation International Award Lecture, and the speaker was someone I had never heard of: Kary Mullis. I was then a medical student, and I went because it looked interesting.

Mullis, as I would come to learn, had developed polymerase chain reaction (PCR), a method that would revolutionize molecular biology, diagnostics, and forensic science. He was just a year away from winning the Nobel Prize in Chemistry, in 1993 at the age of 49. But on that autumn day in Toronto, he was just a quite-evidently eccentric American scientist with a surfer swagger.

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