On November 30, 1900, in Room 16 of the Hôtel d’Alsace in Saint-Germain-des-Prés, Paris, Oscar Wilde died at age 46. His death was not sudden. The poet, novelist, and playwright had been in declining health for some time. While there is still debate over the exact nature of his final illness, it appears to have been some form of ear disease. Despite his diminished state, Wilde’s famous wit never left him. As he slipped away in his dingy room, he is said to have joked, “My wallpaper and I are fighting a duel to the death. One or the other of us must go.”
Wilde had been among the most celebrated figures of the 19th century. Works like The Importance of Being Earnest and The Picture of Dorian Gray sealed his reputation as a popular entertainer. His humor and charisma made him, for a time, the toast of high society. Yet in just a few short years, he fell from his position of influence into the poor health that would kill him.
While his illness was unclear, the true causes of his death were not. Wilde was killed by homophobia, incarceration, and poverty. He was a gay man living in a country that did not decriminalize homosexual acts between men until 1967. In 1895, he was put on trial for his relationships. On the stand, he eloquently defended the dignity of same-sex love. But he could not overcome the prejudices of his time. He was convicted and sentenced to the maximum penalty allowed by law: two years of hard labor. This meant spending up to six hours a day on a prison treadmill—a device designed for no other purpose than to inflict physical punishment on inmates. It nearly killed him, and he left prison in very poor health. Upon his release, he had little money and fewer friends. Poverty and stigma kept his existence difficult in his final years, and likely hastened his death.
The life of Wilde shows how deeply the conditions in which we live are linked to health. They were able, with terrifying speed, to turn a healthy, successful person into a dying exile. We like to think our society is more enlightened than Wilde’s. In some ways, perhaps it is. Yet the same conditions that ruined his health are harming countless people today. For example, the fact that it was illegal for men to be gay in England until as recently as 1967 may strike us as shocking, a relic of an older time. Yet it has been just four years since US law reflected the basic truth that we should all be able to marry the person we love, regardless of that person’s gender. And homophobia still threatens health. For example, laws allowing businesses to discriminate against sexual minority customers have been linked to a 46 percent increase in mental distress among this population. And LGBT individuals are at a higher risk of a range of health challenges, including depression, suicide, and HIV. These risks emerge from the same marginalization that traces its roots back to Wilde’s day and earlier.
Then there is incarceration. It is true that we no longer use treadmills to abuse prisoners. Yet we still use prisons to break the incarcerated rather than repair the broken system that leads people to commit crimes. We can see this in the number of inmates receiving long sentences for nonviolent drug offenses. And just as Wilde’s prison experience harmed his health, incarceration is making us sick. It undermines the health of individuals by placing them in dangerous, often unsanitary conditions. And it harms the health of communities by disrupting interpersonal networks and placing emotional and financial strain on families.
Finally, there is the challenge of economic inequality and the health gaps it creates. The link between money and health is beyond well-established. Money buys access to the resources that allow us to be healthy—the good food, safe neighborhoods, quality education, and peace of mind that are essential for our wellbeing. Lacking these resources can undermine health and shorten our lives the same way Wilde’s was shortened. In the US, those at the top of the economic ladder now live a full 10 to 15 years longer than those at the bottom.
Homophobia, racism, mass incarceration, economic injustice. Such conditions are at the heart of why we get sick or stay well. This was true in the 19th century and it is true today. At the School of Public Health we seek to improve health by improving these conditions. We do this guided by our core purpose: ”Think. Teach. Do. For the health of all.” We “think” by producing knowledge through our scholarship, we “teach” by transmitting that knowledge to the next generation, we “do” by putting that knowledge into practice in the wider world, through activism, advocacy, political engagement, and participating in the broader health conversation. By “we,” I mean both the community on our campus, and the global SPH community—the nearly 10 thousand alumni living in 117 countries who are engaged in promoting health across continents and across sectors.
This weekend, the class of 2019 joined that wider community. Their task is nothing less than the creation of a healthier world. My wish for them is that, as they pursue this goal, they will keep compassion at the core of their efforts. Compassion is the cornerstone of a world that generates health. Experience, knowledge, good intentions—these are necessary but not sufficient conditions for building such a world. To accomplish the mission of public health, we need compassion. Through compassion, we see the underlying structures that create poor health, and are motivated to improve them. Martin Luther King Jr. said, “True compassion is more than flinging a coin to a beggar; it comes to see that an edifice which produces beggars needs restructuring.” Compassion helps us connect the suffering of individuals to the larger forces that shape the health of all. It also helps us to link our own experiences to the broader narrative of health. This was the case with Wilde. After his release, he wrote The Ballad of Reading Gaol, an unsparing account of life behind bars and an implicit plea for a more just society. That he was able to connect his intensely personal story to the universality reflected by great art speaks to the power of compassion to help us imagine, and create, a better future. May our graduates always be inspired by that same spirit. On behalf of the SPH community, I wish all our graduates the very best, as you start your next chapter.
Sandro Galea, MD, DrPH
Dean and Robert A. Knox Professor
Boston University School of Public Health
Acknowledgement: I am grateful to Eric DelGizzo for his contributions to this Dean’s Note.