Our responsibility in a time of war | The Healthiest Goldfish

On Thursday February 24, 2022, Russia invaded Ukraine. Although there had been a steady drumbeat of warnings that this invasion was imminent, the war that followed was still a jarring reminder of the evils of war, of an event that felt out of place and time, a twentieth-century war unfold in a twenty-first century context. For a time, it was possible to think such a conflict could not emerge in our highly interconnected and interdependent world. It was particularly striking to see such a war in Europe, where our present interconnectedness emerged, in part, from the ashes of two world wars—conflicts which taught us, we thought, to never again fight in such a way.

Seeing our failure to learn the lessons of history has been, I must admit, a cause for some despair, as I have asked myself: what can we do, as individuals, at moments like this? How much power does the American or Russian citizen have to stop a war when the forces of illiberalism seem bent on waging one? It is incredible to think that all this destruction has been wrought by the choices of such a small number of people—really, by the choices of one man, motivated by abstract notions of imperial glory and resentment for how the world changed over 30 years ago.

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Public health within reason | The Healthiest Goldfish

A bit of an opening announcement: This is going to be the last regular weekly Healthiest Goldfish.

When I started The Healthiest Goldfish, my aim was to write a series of reflections about the forces that shape health. These reflections were to be informed by our experience of COVID-19, although hopefully not unduly constrained or defined by the urgencies of the moment, pressing as they were. Indeed, one of the joys of writing is seeing thoughts and ideas evolve and not always knowing the ways in which they will do so. Much of my writing in this space did indeed concern the lessons of COVID-19 and how they point us towards engaging with the foundational drivers of health. From the role of money and resources in shaping health to the dangers of moralism in public health, to the ineluctable importance of complexity, the themes of this newsletter intersected with much that I have written on throughout my career and which have risen to the fore during the crisis of the last two years. It is also true that interwoven with these themes have been a number of detours, touching on subjects as diverse as social media, UFOs, and the importance of good faith argument.

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Now What? | The Turning Point

Nearly two years into the Covid-19 pandemic, we conclude this series of The Turning Point essays in Public Health Post, by asking: what comes next? 

Nearly 800,000 Americans, more than 5 million people worldwide, have died of Covid-19.  More than 250 million people have been infected across the globe. The health effects of long- Covid remain unclear but will likely affect millions worldwide. It is clear that the health consequences of the economic and social upheaval due to Covid-19—mental illness, drug overdose, higher death rates from heart disease—will stay with us for years to come. 

And, of course, none of this is quite over yet.   As we write, the pandemic remains with us, with cases among the unvaccinated on the rise throughout much of the U.S., and the pandemic in various stages of ebb and flow in countries around the world.  An unprecedented global effort to vaccinate as many people as possible has had successes, notably an historic rapid development of safe and effective vaccines delivered to billions of people in record time, and many failures, notably the patchy delivery of vaccines to low-income countries, and the uneven distribution of vaccines within high-income countries.

Now what? 

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The next generation: The kids are (probably) alright | The Healthiest Goldfish

“The children now love luxury; they have bad manners, contempt for authority; they show disrespect for elders and love chatter in place of exercise. Children are now tyrants, not the servants of their households. They no longer rise when elders enter the room. They contradict their parents, chatter before company, gobble up dainties at the table, cross their legs, and tyrannize their teachers.”

So (allegedly) said Socrates. If the attribution is correct, it would appear that even the ancients participated in the time-honored tradition of older generations complaining about the young. What is perhaps most striking about Socrates’ complaint is how modern it sounds. His accusations—that the young lack manners, disrespect their elders, talk foolishly, and love luxury (as opposed to honest hard work, presumably)—could well have been said by any older person today, perhaps while shooing the young off their proverbial lawn.

Consider, for example, common criticisms of Millennials and Generation Z—the age cohorts born in the 1980s, 1990s, and early 2000s. They have been accused of entitlement, oversensitivity, and lacking a robust work ethic. These accusations are variations on old themes. It is perhaps as inevitable as the changing seasons that generations eventually grow up, look to the young, and ask “Are the kids alright?”

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Will We Stop Being Afraid? | The Turning Point

The Covid-19 pandemic was terrifying, justifiably so. A disease that was previously unheard of in 2019 became the third leading cause of death in 2020. As of today, more than 780,000 Americans died—more than 780,000 mothers, fathers, aunts, grandfathers, lovers, sisters, and friends. The disease, transmitted through a respiratory virus, has evoked horror movie tropes—we never knew whether we were close to someone who was infected, or even whether we ourselves might be infected, spreading the disease to others. 

In 2020, we became afraid quickly, changing how we live in ways that were previously unimaginable over the course of a few short weeks. We kept our distance from others, shifted workplace patterns that had characterized our whole lives, started wearing masks in public spaces, changed or canceled our travel plans, changed our minds about eating in restaurants. Fear of illness and death became a key predictor in our willingness to take measures to slow the spread of Covid-19. Fear was useful—it kept us safe, it saved lives—and gave public health messages their emotional appeal. The opposite of fear was not fearlessness, it was carelessness, which wore the covering of an opposing fear, the loss of personal autonomy, as many complained about quarantines and government mandates.

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Sectarianism and the public’s health | The Healthiest Goldfish

A recent Kaiser Family Foundation analysis found that Americans who have not been vaccinated are now three times likelier to lean Republican than to lean Democrat. The persistence of vaccine hesitancy has kept vaccine uptake from being as widespread as it might be, helping prolong the pandemic. Its intersection with political partisanship suggests the role sectarianism plays in this. Vaccine hesitancy is, in many ways, a phenomenon of mutual incomprehension. The hesitant, for a range of reasons, are not able to see why so many would find the vaccines safe enough to take. And the vaccinated, particularly those in the public health establishment, cannot see why anyone would refuse an effective vaccine in the midst of a deadly pandemic. This divide mirrors other divides in the US; most notably, as the new analysis reflects, the red versus blue divide that has long characterized our politics.

The story of vaccine hesitancy, then, is, in large part, a story of sectarianism. I would argue that a key reason why the issue of vaccine hesitancy remains so intractable is because we have failed to fully reckon with the degree to which hesitancy is shaped by the larger story of division in this country. Certainly, we have acknowledged division, bemoaned it, but in terms of actually addressing it, we have done little. When it comes to vaccine hesitancy, much of our effort has been directed towards simply making the case for greater education about vaccines and for more expansive mandates. In doing so, we sidestep the central issue, one which is core not just to vaccine hesitancy but to how we collectively engage with the forces that shape health.       

Given this challenge, it seems helpful to take a step back and look at the role of sectarianism in our thinking and behavior around issues that matter for health, and at how we can address sectarianism towards shaping a better engagement with these issues.

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Covid-19 Profits and Profiteering | The Turning Point

Since March 2020, forty million Americans filed for unemployment payments. Meanwhile, 40 new billionaires took their places on the world’s richest lists, with many new fortunes created by the pandemic. Culture war grifters have made new fortunes selling alternatives to vaccines. Foreign swindlers have taken advantage of the huge transfer of wealth from federal programs to US households. While the era of the Covid-19 pandemic has been about human lives, it has also turned out to be a real workout for capitalism.

Executives and the biochemists with stakes in the companies that developed vaccines have made incredible profits, as have those running the contract research organizations that directed the clinical trials, and those directing the glass manufacturing businesses that make vials for the vaccines. Riches have come to those who led companies that made gowns and face masks, gloves and hand sanitizers, and those who produced diagnostic tests, digital x-ray analysis systems, and pulmonary products like oximeters. Those who created software for scheduling appointments at mass vaccination sites did as well as antibody treatment manufacturers and home delivery services.

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The challenge of slow-burning threats. | The Healthiest Goldfish

A few weeks ago, the 2021 United Nations Climate Change Conference, known as COP26, was held in Glasgow, Scotland. The meeting reflected a global effort to address climate change. Climate change is a unique challenge, in that it poses an existential threat, yet its effects have accrued so gradually over time that, until recently, it has been difficult to rally support for addressing the problem. In considering climate change, I have found myself thinking about other slow-burning threats, and how we often fall short in addressing them. For example, on May 15, 2017, TIME magazine ran the following cover story:

Source: TIME Magazine Web site. https://time.com/magazine/us/4766607/may-15th-2017-vol-189-no-18-u-s/. Accessed October 8, 2021.

The TIME cover story reflects one of the most perplexing realities of the COVID-19 pandemic: we saw it coming. We did not know specifically that a pandemic would strike in 2019. But we were long aware of the likelihood that such a contagion would emerge, and we knew it would probably happen relatively soon. Yet when COVID-19 did come, it looked very much like it caught the world unawares. Our response was a chaos of good ideas and bad ideas, good implementation and bad implementation. Many of these shortcomings can, of course, be ascribed to poor—or, at best, inconsistent—leadership. US leadership, in particular, was in the midst of immense disruption and transition when the pandemic struck, with the unprecedented figure of Donald Trump in the White House and a presidential election like no other culminating in November of 2020. It was perhaps unavoidable that these circumstances would shape the coherence of our pandemic response. Indeed, there is a temptation to lay all our failings during COVID at the feet of the unique political moment in which it unfolded. This temptation may be particularly acute for those of us in public health, who have an interest, human beings that we are, in not always facing our shortcomings as squarely as we might.

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