Studying and practicing public health amid real values divides
This piece was co-written by Dr Salma Abdalla and is also cross-posted here.
How do we advance a practical philosophy of health so that we can lean into the goals and aspirations of public health? At a foundational level, that is the central goal of the Purple Public Health Project. We have written on the values that may animate us, and the importance of trust necessary to engage populations to be able to do the work we need to do. All those are building blocks of the context on which we can build the work of public health. We worry, however, that thinking of shared values and trust as foundational scaffold might suggest that our aspiration is to get to a place where everyone agrees with the work and goals of public health. We suggest, rather, that we are doing the work of public health not when there is such agreement, but when there is disagreement that is clearly visible and discussed. To our mind the aspirations of public health—that all can live healthy, fulfilling lives—are so radical, that we cannot truly expect to make progress towards them without an underlying level of disagreement both about the shades of the aspirations, but also how we may get there. Seen this way, disagreement, about the goals and methods of public health, is a feature, not a bug. Stated more eloquently, Hannah Arendt wrote that plurality, i.e., the fact that each of us brings a distinct perspective on a shared world, is a condition of human action, not an obstacle to it. Unfortunately, public health has sometimes (often?) treated plurality as a problem to be managed on the way to consensus. We would like to suggest in this piece that disagreement is a condition we need to learn to work with and within, and even to welcome.
Our dominant orientation in the field, perhaps more so in recent years, has long been that disagreement is best met with more persuasive evidence, and more compelling argumentation to “bring more people around”. If only people understood the data, surely they will side with the goals of public health? However, most of the disagreements that actually matter in public health are not arguments over what the evidence shows. They are in fact disputes about what, in light of the evidence, we should do. They are arguments about cases of values. We made the case in Februarythat data and values belong to different domains and should be kept conceptually separate. This argument extends that one by focusing on the values, recognizing that values differ, and that those differences in values between people seldom narrow through closer contact with better data.
Moving beyond abstraction, it is worth talking, plainly, about the dominant value disagreements that genuinely challenge the work of public health. Thinking through these areas of such disagreement highlights that these issues are not isolated points of contention but features of a challenging moral terrain.
Read more here