Centering human rights and autonomy for all | The Healthiest Goldfish

On centering a concern for the dignity, autonomy, and values of the populations we serve.

One of the most important intellectual strands in public health over the last century has been the development of a health and human rights approach. This approach reflects the understanding that health is inseparable from the social and political rights that support the dignity and autonomy of the individual, and that efforts to improve health must engage with these factors. This echoes the concern for human rights as a global aspiration that emerged in the aftermath of World War II and that is expressed in documents like the Universal Declaration of Human Rights. As our concern for human rights has evolved, so has our understanding of what human rights means in a context of health, our focus broadening beyond healthcare to include the core drivers of health. Such a focus aligns with the spirit of the Declaration, which says:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

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When our values are not shared | The Healthiest Goldfish

On the misalignment of values that can cause the public to reject our efforts.

When we understand that the health of populations is shaped, in large part, by the world around us, it becomes clear that our work is to create a world that generates health. Concretely this means a world with less violence, safe water to drink, clean air to breathe. Creating such a world requires the promotion of a radical vision of the right way to create health and commensurate efforts to discourage approaches that harm health. Reduced to its core element this becomes work that is engaged with a fundamental conflict between right and wrong.

How do we determine what we consider to be right?  In large part that emerges from the empirical foundation of population health science that should be core to all we do. But, data alone cannot tell us everything about which actions to take. Our choices about what is best for the health of populations should be shaped by a balance between our data and our values. This pushes us then to ask: what are the values we embrace in public health and adjacent fields that take as their core goal the creation of a healthier world?  Through this recent set of essays on shaping a new practical philosophy of health I have been hoping to support a process of reflection about this question. But, of interest today, and just as importantly, what should we do when our values are challenged, even forcefully rejected, by the populations we aim to serve?

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The biases we bake into our systems | The Healthiest Goldfish

Our human tendency towards bias can become entangled with the networks and institutions we create.

On November 30, 2022, OpenAI launched ChatGPT, an artificial intelligence chatbot. Since its launch, ChatGPT has already done much to influence how we work, communicate, and think about the role of artificial intelligence in our lives. The speed at which this influence has been felt calls to mind the early days of the internet as we engage with an emerging, potentially world-changing technology. The speed of AI development has raised concerns about AI safety, including the worry that AI could become too powerful too quickly, generating humanlike consciousness with the power to outpace us, in a scenario echoing many a science fiction film. While AI likely has a long way to go before it reaches this stage, if indeed it ever does, in one respect it may already have shown signs of being all-too human. As users familiarized themselves with ChatGPT, concerns have emerged about what appears to be a political bias in its “thinking.” Recent analysis found ChatGPT to have a “pro-environmental, left-libertarian ideology.” In a commentary for Brookings, Jeremy Baum, and John Villasenor wrote of testing ChatGPT by asking it a range of questions about political issues. OpenAI CEO Sam Altman has commented on the issue, saying that ChatGPT has “shortcomings around bias” which the company is “working to improve.” These biases reflect more than just the growing pains of a new technology. They reflect how a tendency towards bias—to which we are all susceptible—can become embedded within the systems we create.

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Affirming Our Values in a Post-Affirmative Action Era | Dean's Note

On continuing to pursue equitable admissions practices.

This week the Supreme Court issued a decision ruling against the consideration of race in higher education admissions. While this decision had been long expected, it is still disappointing, a setback for the work of shaping more equitable admissions processes. The ruling poses a challenge to the promotion of diversity within higher education and runs counter to a vision of work founded on creating pathways for underserved communities. President Brown, in his note to the community, reaffirms Boston University’s values, and sets the stage for the University’s further work in reviewing our admissions practices. 

As this evolves, I wanted to reflect on this moment from the perspective of public health. As a School we remain committed to shaping a diverse, inclusive community that is representative of the populations we serve. As with past Court decisions, while the legality around key issues may change, often with implications for public health, the core principles which underlie our work will continue to be as they have always been. Our commitment to diversity and inclusion remains a central value which serves as an organizing principle for all we do. 

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When our biases get the better of us | The Healthiest Goldfish

Reckoning with the often-invisible biases that shape our work.

The work of creating the conditions that generate health is, at its best, about the pursuit of truth. To improve the health of populations we must engage with the truth about the world in which we live—the reality of the systems and structures that generate health. Just as we would not build an aircraft based on distorted design specifications, the work of public health needs to be grounded in foundations that reflect reality. Yet, if we are honest with ourselves, it is hard to escape the conclusion that we sometimes fall short of this ideal. We are human, and, as humans, our relationship with the truth is refracted through how we see the world. And we do not always see the world the way it is. Much of the time we see the world through our own lens, and that lens can be colored by biases. Perhaps my favorite definition of bias is “a preference or an inclination, especially one that inhibits impartial judgment.” That seems about right. It is our own take on things, and that take inhibits us from seeing the world as it should be. This is true in our daily lives, in all we do, and, for today’s reflection, in our science.

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Reflecting on the Lessons of Juneteenth | Dean's Note

We need to acknowledge the worst of our past to shape a better future

On Monday, we will celebrate Juneteenth, a day that commemorates the issuing of General Order No. 3, which freed enslaved persons in Texas, the last place in the US where slavery still continued in the final days of the American Civil War. Union General Gordon Granger issued the order on June 19, 1865, two months after Robert E. Lee surrendered his forces at Appomattox Court House, and over two years after President Abraham Lincoln gave his signature to the Emancipation Proclamation. 

Despite its significance, Juneteenth was only recognized as a federal holiday in 2021. This is typical of the delay which too often accompanies the work of addressing the realities of racism in the US. Slavery existed for centuries before it was abolished, the Emancipation Proclamation was signed years before its effects were fully felt in the South, and the Civil War had been over for two months before enslaved persons in Texas gained their freedom. Delay, deferral, the “bad check” Dr. Martin Luther King, Jr. spoke of America giving its Black population—these have been defining characteristics of America’s engagement with its history of racism and the effects of this history in the present. This has kept the legacy of slavery and racism part of the American landscape long after General Granger issued his order, an influence which pervades much in the current moment. Part of the conversation about race that has emerged over the last few years has been about how it has been possible to overlook this, to fail to notice the many ways the effects of an unjust racial status quo still permeate American life. If we are willing to look closer at what we have called progress, we can see the many ways it is incomplete, reflecting the unfinished work that is America itself. 

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Reconciling context, effort, and ability | The Healthiest Goldfish

Can we expand our thinking to better engage with the full range of forces that shape our lives, and our health?

In recent years, a highly polarized political discussion has emerged about meritocracy in the US. On one side of the debate is what might be called the classic view of American meritocracy, the Horatio Alger-esque story of striving one’s way to success through individual ability and effort. In this framework, all have more or less equal potential to rise, and it is only differences in individuals’ talent and effort that shape differences in life outcomes. This has arguably long been the dominant narrative about meritocracy in the US. More recently, however, a new narrative has emerged, one that in many ways aligns more closely with our public health paradigm. This narrative says that what has passed for merit (for example, doing well on exams, being promoted, or simply being healthy) principally is a product of engrained social systems. Structural forces—such as systems of historical injustice, present-day inequality, or marginalization due to identity status—have created a context which advantages some and disadvantages others. Forces like structural racism or class endowments which one is born with can generate both privilege and marginalization, and these are the key factors that determine how one does in life. While individual ability and action has a place in this framework, it is considered less significant than is the context within which we operate. This then leads us to an understanding of the world where seeming differences in ability and achievement are mostly differences in an individual’s relation to the foundational forces that shape our world. We should, this thinking goes, always take this into account in evaluating and rewarding what might seem to be the fruits of individual effort alone.

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Pride, Progress, and Challenges to LGBTQIA+ Health | Dean's Note

On celebrating Pride Month in a context of gains and setbacks for LGBTQIA+ rights.

I have long felt that public health is more than a series of policies and proscriptions against disease. It is also a celebration of community, of mutual respect and care, of the love and connections that support a rich, full life, of the diversity that makes our world a better, more varied place, and of the progress that advances a healthier status quo. This is what we celebrate each June, as we mark the arrival of Pride Month. Pride Month is a time for celebrating the LGBTQIA+ community, for acknowledging the many contributions of our LGBTQIA+ friends, family, students, and colleagues, for marking progress towards the full acceptance of this community, and for recognizing the challenges it still faces.

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