What is reasonable? | The Healthiest Goldfish

On defining what is reasonable in pursuit of health, guided by our values, a sensitivity to context, and a pragmatic assessment of human nature and our own capabilities.

Most of us aspire to be reasonable. We do not set out to be irrational, to be easily swayed by emotion and bias. Rather, we try to ground our actions in reasonableness, with the understanding that such a standard is a good basis for living as individuals and as a society. The neuroscientist and philosopher Sam Harris wrote, “There is no society in human history that ever suffered because its people became too reasonable.” This seems to me, well, reasonable. We understand that, when our actions are informed by reason, we tend to make better choices for ourselves and for our world.

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Revisiting the question of “why health?” | The Healthiest Goldfish

We aspire to be healthy so that we can live full lives.

Let’s talk about health.

How we think about health is often wrong. In fact, we often do not think about health at all when we think we are thinking about health. What we think about is disease. We worry if we have a pain somewhere. We wonder if we are maybe diabetic. We brood about the possible causes of a chronic itch. We ask ourselves, “Did I just pull a muscle?” We may believe this constitutes thinking about health. But it does not. We are, in fact, thinking about the absence of health. We are thinking about disease. This mis-think extends to the public conversation. When health is written about in the media, it is more often than not in writing about disease.

I am sometimes asked to comment in the media on issues of consequence for health. Typically, I am asked to look at the world through the lens of disease—of how to avoid or treat sickness. I am asked about a particular new virus, about diseases of the heart or of other organs. This impulse to seek this perspective is understandable. There are few experiences in life more all-consuming than that of disease. When we are sick, our affliction is often all we can think about, and this is the case at both the individual and societal level. When we are in pain, when our body does not work as it should, it can become the central fact of our lives.

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On Choosing What We as a School Endorse | Dean's Note

Defining when we speak collectively as a community.

We are an activist school of public health, committed to creating healthier communities at the local, national, and global level. This is reflected in our school’s values statement:

We are committed to igniting and sustaining positive change that leads to health and well-being around the world. We strive for a respectful, collaborative, diverse, and inclusive community within our School of Public Health. We aim to promote justice, human rights, and equity within and across our local and global communities.

This means applying our knowledge and practice towards the goal of better health for all. It also means sometimes using our collective voice to support measures that will get us closer to this goal and speaking against policies that may harm health. There is, however, a range of issues, measures, policies that pertain to health and that may call for our collective attention.  At a simple operational level, the question therefore arises: should we as a school endorse a particular position, should we lend our collective name to a particular approach? In last week’s Note, I shared thoughts about how we can best support free and respectful academic speech by individuals within and at SPH. In today’s Note, an extension of last week’s theme, I will share some reflections on speech that we may—or may not—choose to endorse as collectively.

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On Supporting Free and Respectful Academic Speech | Dean's Note

Defining the limits of speech to help make space for debate that is truly open and inclusive.

Over the last few years, I have written several times about speech in an academic context. It is a topic which reemerges fairly regularly in our space, a natural result of working in a community of ideas supported by the values of free inquiry and expression. It is healthy to revisit these first principles, to ensure we are living up to our core ideals and that these ideals do indeed continue to reflect the best we can do as a community. Few principles are as fundamental to our community as our engagement with speech, the expression of our ideas.

The work of public health is, in large part, the work of acting on ideas and data that emerge from a context of free inquiry and open debate. This is reflected in our school’s mission to “Think. Teach. Do.” We are able to do because we can think and teach in a context where our minds can be truly open to the ideas and practices that shape a healthier world. It is important, then, to continually reexamine what we are doing to ensure our community supports such a context. With this in mind, today’s Note will be the first of a two-part reflection on speech and our community. Today will focus on the challenge of defining and engaging with objectionable speech and those who express views with which we do not agree. Next week will address how we speak collectively as an institution on issues of consequence, including issues of speech.

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Centering proportionality in public health thinking | The Healthiest Goldfish

On doing the most possible good while doing the least possible harm.

There is an old saying from the world of competitive fencing, one that is used to teach beginners how to hold the foil—a light, flexible blade used in the sport. The saying is, “Hold it like you would a bird. Too tight and you choke it. Too loose and you let it fly away.” That is proportionality. The pressure applied to the foil must be in proportion to how much is necessary for maintaining control. Too firm a grasp prevents the fencer from wielding the foil nimbly. Too loose a grasp and an opponent can easily knock it to the floor. Success lies in applying the right proportion of strength—no more, no less.

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The right amount of risk | The Healthiest Goldfish

On shaping a better engagement with risk guided by a practical philosophy of health.

I have been thinking a lot lately about risk and its role in our understanding of health. Risk, by definition, is our estimate of the potential for X outcome—that outcome being, in the case of health, sickness or injury. Most of us have an intuitive understanding of the link between health and risk. We regularly make choices about our health that involve our perception of what is risky and what is not. Such choices include choosing not to drive when it is icy, avoiding certain food brands when a recall is announced, and wearing sunscreen to the beach. We also factor in risk when making choices with an eye towards the long-term, such as choosing to live in a safe neighborhood, opting not to skip annual doctor’s appointments, and embracing regular exercise. We make these choices based on a calculation of risk. We think about the risk of taking or not taking certain actions and we decide to do what we think will keep us safe and healthy.

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Leaving behind values disguised as science | The Healthiest Goldfish

On shaping a science that supports a new, post-war vision for public health.

In my book, Healthier, I proposed that the work of public health is best served not just by the generation of data but also by the promotion of values, and that positive change happens at the intersection of science and values. We shape a healthier world by building a base of knowledge while working within the broader culture to advance the values of public health. This means working to build collective engagement with the foundational determinants of health—the social, political, commercial, environmental, and technological forces that shape the health of populations—with special care for how these forces affect the marginalized and vulnerable. These are our values, the first principles of our field. Shaping a healthier world is as much the work of these values as it is of our data.

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The potential, and limits, of science | The Healthiest Goldfish

On shaping a science that supports a new, post-war vision for public health.

Improving the health of populations depends on science, on building a foundation of knowledge that helps guide our actions. I have previously written about how the work of public health rests on the work of population health science. My book, Population Health Science, co-written with Dr Kerry Keyes, and several other commentaries such as this 2017 article in Epidemiology, were efforts to help advance the fundamentals of the field—the science at the heart of all we do. 

At this post-war moment, when we are looking to build new foundations for public health, a focus on science to help us to ground these efforts has never been more important. Therefore, today’s Healthiest Goldish is the first of two essays on the role of science in the work of public health—on its strengths, its limits, and its intersection with the values of those who practice it. 

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