A case for good faith argument | The Healthiest Goldfish

A healthy world is a world founded on good ideas, and good ideas are founded on a process of open, rigorous, even heated, debate. Yet such a debate is not always what we see in our public discourse. Polarization has informed a public conversation which does not always support a healthier world. Conducting a better public debate, it seems to me, is trading the cynicism that often informs bad faith arguments for the healthy skepticism which informs the generative conflict of ideas that truly advances progress. Some thoughts on how we can support such a conversation, towards the goal of a healthier world.

The last several years have been a contentious time. Polarization, informed by political divides, has come to characterize much of the public debate. The below graph reflects this, showing how opinion has migrated away from the center and towards extremes on the left and right.

Source: Pew Research Center. October 5, 2017. The Partisan Divide on Political Values Grows Even Wider. From: https://www.pewresearch.org/politics/2017/10/05/the-partisan-divide-on-political-values-grows-even-wider/. Accessed May 18, 2021.

The time of COVID was no exception—it was, if anything, an intensification of the division we have seen. It did not take long after the emergence of a novel coronavirus for the existential stakes of the political debate to migrate to conversations about masking, lockdowns, social distancing, the origins of the virus itself, the means of treating the disease, and, eventually, vaccines.

These divides have done much to undermine our response to the pandemic, just as they have done much to add dysfunction to our political process and fray our social fabric. Having said this, I would also add that I do not regard emotional, deeply felt, debate to be a uniformly negative influence. I have long argued for the importance of a diversity of perspectives and for creating space for these perspectives to be aired and debated, even when such debates are uncomfortable and contentious. This discourse, when it is conducted civilly and respectfully, is necessary for advancing the ideas that support a healthier world, and, ultimately, a culture and politics capable of meeting the needs of the moment.       

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Part 1: Grief and Loss | The Turning Point

Covid-19 has brought 18 months of grief. More than half a million have died from the virus in the United States, day after day, relentlessly; although we can almost see to the end, this dark moment has not seemed temporary. So much has been precarious for so long. But the grief we’ve felt has come from more than death. Grief has swept through us. All around, there is tremendous suffering.

Grief is always individual. Multiplied across a country, these individual griefs leave a great sadness. Grief is loss—what have we sadly lost, collectively? Years of life, years of health; our actuarial tables have shifted. Prolonged grief has had the expected effects: depression, anxiety, cardiovascular decline. Also countable and fallen: jobs and income.

But we’ve also lost confidence. We couldn’t quite control or command Covid-19. We looked for solace in uncertain science. We clung to changes in graphs and curves. With our data and models, we believed we could control and predict Covid-19. But viruses do not obey. We continue to reset and retime our goals. We have lived in uncertainty. Suffering causes humility.

We lost, for a time, our habits. We withdrew. We stayed still, indoors. We have, many of us, been emotionally paralyzed, fearful. We’ve been busy trying to survive. We’ve been consumed by this effort, while pretending to do the work we have, and caring for our children. We have said goodbye on video cameras. We have watched funerals rather than attend them. Our rituals have been interrupted.

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Why health? | The Healthiest Goldfish

Earlier this month, the CDC announced that fully vaccinated people need no longer wear a mask or physically distance to prevent the spread of COVID-19 (with the exception of places where such measures remain required by law). There are undoubtedly a large number of factors—from the political to the scientific—that informed and influenced this decision. But, leaving aside etiology for the moment, the unexpected announcement does present an opportunity to interrogate why we have done what we have done during the pandemic, and what we want, or perhaps should want, to guide our decision-making during these times.

There seems little question that implicit in the CDC announcement is a greater tolerance of some risk; a move away from saying that we are doing everything possible to reduce all risk, to accepting that some risk is acceptable—maybe desirable—as we move to more freely engage with those we have missed this past year. At the same time, I am also aware that the trauma of the pandemic has made it difficult for some to immediately embrace a future without the protective measures we have all become used to, with some amount of risk, even as these measures become less necessary. This is understandable, and those who are processing these feelings deserve compassion and time to adjust. It is clear that returning to something like “normal” will be a journey rather than a single step. So, as we embark, collectively, on this path, I wanted to reflect today on a first principle that informs much about what we have done this past year and will do going forward: why health? Why does it matter that we spend so much time working to generate health? Come to think of it, what is health anyways, at its core? What is it for? Perhaps in better understanding these questions we can better think how to factor in the risks we are, or are not, willing to take, to better address the steps necessary for getting to health; and to think better about the tradeoffs inherent in any decision about the health of populations—now and in the post-COVID future.

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The Irreplaceable Public Sector | The Turning Point

Much has justifiably been made of the embrace by the Biden administration of the levers at its disposal to bring about a latter day version of FDR’s New Deal. President Biden in his first 100 days launched unprecedented, large-scale efforts to rebuild national infrastructure and to implement programs to support those most affected by the Covid-19 pandemic. This comes as a dramatic contrast with his predecessor whose efforts were much more in line with Republican administrations dating back to President Reagan, aiming to reduce the size of government and to limit the scope of the public sector as much as possible.

In the wake of a global pandemic that froze the world in its tracks for more than a year and resulted in nearly 600,000 American lives lost, the return to an engaged, muscular public sector is a welcome shift indeed. From the point of view of the decision-making that is needed to create health, we think that greater engagement of the public sector is not only welcome but essential, both to mitigate the current pandemic and to help us prevent a future one.

In March 2021, President Biden introduced his “Build Back Better” proposal, a $2.3 trillion once-in-a-generation investment, the largest government intervention since the 1960’s. To be spread over eight years, this proposal overtly tackles “infrastructure”—roads, bridges, utilities—and was not framed as an effort to address the nation’s health. But to our minds, this bill addresses many of the drivers of health that shape the world where Covid-19 emerged. By attending to child care ($25 billion), affordable housing ($213 billion), home care for seniors ($400 billion), public transportation, and even the removal of all lead water pipes in the country, the legislation takes on the conditions and structures that create poor health. All these efforts can improve the situations of millions and address the vulnerabilities that Covid-19 exposed.

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The false choice between diversity, inclusion, and the pursuit of excellence | The Healthiest Goldfish

In April, United Airlines pledged to train 5,000 new pilots by 2030 with the intention of no less than half of these new students being women or people of color. With this announcement came pushback, informed by a common objection to diversity and inclusion efforts, one which extends all the way back to the start of debate around initiatives like affirmative action. The objection is that, in seeking to make greater room for historically underrepresented groups, we risk elevating concerns about identity over a commitment to excellence, to bringing in the best people regardless of skin color, sex/gender identity, or other characteristic which has led to past marginalization. These concerns were particularly potent with regard to the airline industry, where anything less than excellence in the cockpit could put lives at risk.    

United’s pledge aligned with ongoing, and welcome, efforts to promote greater diversity and inclusion within organizations. This has been a long time coming, and is something that I have cared about throughout my career. When I first started my time at BU School of Public Health, working with Dean Yvette Cozier we articulated an 11-point agenda for diversity and inclusion at the school. The idea that we should be centering some of these concepts was unusual enough at the time that it was often parodied in right-leaning media. Today, the ideas in the original 11-point plan, since updated regularly are uncontroversial and in fact entirely of a piece with many such plans in institutions throughout the country.

Yet, as the elevation of diversity and inclusion have become a part of the fabric of more and more institutions, we are hearing more frequently the objection that diversity and inclusion are in conflict with excellence, undermining the meritocracy which sustains effective organizations. This has implications for health. Building a healthier world depends on the pursuit of excellence within a range of organizations, from academia, to government, to the public health infrastructure.  As this necessity intersects with the growing embrace of diversity and inclusion within these bodies, it is important not to shy away from engaging with objections to this focus. For our institutions to be strong enough to support health, those working within them must be able to respond to this contention.  With that in mind, I share a few thoughts about the supposed conflict between excellence and our pursuit of diversity, and this pursuit’s broader implications for health.

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Pandemics and Prisons | The Turning Point

The incarceration rate in the U.S. is higher than any other country in the world, and about five times higher than the median worldwide. The health consequences of incarceration are legion. Disability Adjusted Life Year (DALY) rates linked to incarceration are more than double that attributed to other conditions commonly experienced in the general population. Death rates are high and are the result of overcrowding, inadequate mental health care, lousy sanitation, freezing temperatures and delayed medical treatments. Half of prison suicides result from solitary confinement.

Further compounding the horrors of the American incarceration system, its burdens are deeply and unevenly felt. African Americans are incarcerated at five times the rate of whites. Nearly half of all Black women have a family member in prison. One in three Black males born today will end up in the correctional system at some point. The bias against people of color is operationalized at many levels: through police arresting minorities at higher rates than whites, prosecutors charging them more often and more severely, leading to longer sentences. The “justice system” is notably unjust.

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Who Decides? | The Turning Point

The Covid-19 moment has been fraught in countless ways, but perhaps most so when concerned with arguments about the trade-offs between strict measures to control viral contagion, and the economic consequences of those trade-offs. At the heart of these arguments has been one—often unspoken—question: who gets to decide what is right for societies? Who decides how to evaluate the trade-offs?

Perhaps this question is illuminated by analogy.

Increases in speed limits across the country have been associated with 37,000 deaths during the past 25 years. In 1993, 41 states had a maximum speed limit of 65 mph; the other nine states had a speed limit of 55 mph. Today, by contrast, 41 states have maximum speed limits of 70 mph or higher; six have 80 mph speed limits. The change has happened slowly as advocacy groups have argued for higher speed limits to reflect reality—many drivers exceed the speed limit anyway.

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Mercy and our present moment | The Healthiest Goldfish

In his play, The Merchant of Venice, William Shakespeare created a character who is entirely justified in seeking revenge. Shylock, a Jewish moneylender, has lived his life as the subject of constant anti-Semitic attacks, with one of his main antagonists being Antonio, the merchant of the play’s title. Antonio has called Shylock terrible names, assaulted, and spit on him. So, when Antonio defaults on a loan from Shylock, one for which the merchant offered a pound of his own flesh as security, Shylock is eager to collect, and the audience—having witnessed the many injustices suffered by Shylock throughout the play—can find it hard to blame him. Yet something unexpected happens in the famous scene when Shylock demands what he is owed. It is there one of the characters, Portia, begs Shylock to consider mercy:

“The quality of mercy is not strain'd,
It droppeth as the gentle rain from heaven
Upon the place beneath: it is twice blest;
It blesseth him that gives and him that takes:
'Tis mightiest in the mightiest: it becomes
The throned monarch better than his crown;
His sceptre shows the force of temporal power,
The attribute to awe and majesty,
Wherein doth sit the dread and fear of kings;
But mercy is above this sceptred sway;
It is enthroned in the hearts of kings,
It is an attribute to God himself;
And earthly power doth then show likest God's
When mercy seasons justice.”

It is worth hearing the entire speech, well-performed here by Laura Carmichael. These words in defense of mercy complicate the scene of perhaps would-be vengeance. As anyone familiar with The Merchant of Venice knows, Shylock is justified in his anger. The play is rife with examples of anti-Semitism, including Shylock’s eventual fate (he is ultimately thwarted in his pursuit of revenge and forced to convert to Christianity). This anti-Semitism should be deeply troubling to all readers and playgoers today, especially given the events of the last century, and recent resurfacing of anti-Semitic animus in the US and globally. Yet—and perhaps because of—the context of Shylock’s justified anger, mercy’s appeal still resonates. It is an appeal worth thinking about, in our present-day context, and particularly in the context of health.

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