10 seconds | The Healthiest Goldfish

On creating space for reflection about the right response to tragedies.

We are all aware of the deeply challenging time we are in for the world at large, and in particular for our friends, loved ones, and colleagues from the Middle East. I recently wrote about my thoughts on the Hamas attack on Israel. My thoughts in this prior writing, and since, have been shaped by conversations with colleagues, staff, students, faculty, alumni, in person and online. I have found all conversations thoughtful, condemning the brutal killing of civilians in Israel, while also with honesty recognizing the horrors faced by Palestinians for so long. For these conversations, I am immensely grateful.

As the Hamas-Israel war progresses, and I have continued to engage in these conversations, I have realized that much of what these discussions have addressed intersects with themes I have discussed in The Healthiest Goldfish. Centrally, these include the importance of elevating conversations that are compassionate, respectful, open to all perspectives, and reasoned in their pursuit of truth in a complex, at times chaotic and uncertain, historical moment. With this in mind, I wanted to reflect a bit here on continuing to shape a conversation that reflects these qualities, an effort that is particularly necessary in emotionally charged moments of crisis. In grappling with a moment when there is much heat, and much less light, how can we engage in a way that lives up to our responsibilities in public health? Let me here offer four thoughts that emerge from this moment but that perhaps also have valence for all matters we deal with that require a thoughtful engagement in difficult times.

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The moral, aesthetic, and intellectual case for health | The Healthiest Goldfish

On creating the strongest possible philosophical foundation for our efforts.

A couple of weeks ago, I wrote a rather pragmatic essay about our engagement with colleagues in states that differ in their values. Today, I hope the reader forgives me for a bit more of an abstract essay, one that I have been mulling in my head for some time.

These Healthiest Goldfish essays are fundamentally about making a case for health. These essays, and the books they have helped shape, are, in a sense, efforts to bring together thoughts that have been germinating for a long time about how to create a healthier world. This process has been sharpened by the experience of COVID-19, arguably the most serious threat to public health in a century, which exposed how far we still have to go before we get to a world that is truly optimized for health. Underlying these efforts at sharpening my thoughts about health is the assumption that health matters—that it is a necessary factor for accessing everything we value in life, from the capacity to pursue productive, meaningful work to being able to spend time with family and friends. We all, I think, share the sense that health matters. Yet it is often just this—a sense, rather than a fully-formed idea or philosophical framework. The goal of this newsletter and its associated publications has been to shape a conversation—in partnership with you, the reader—that helps develop this sense into a new practical philosophy of health, one that can help ground our efforts towards a healthier world in the years to come.

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Radical incrementalism, the case for | The Healthiest Goldfish

On successfully achieving the goals of an aspirational public health.

It is not difficult to feel, these days, that we are living in a revolutionary moment that demands a re-ordering of the status quo and a re-thinking of how we structure our world. 2020 brought with it a novel coronavirus pandemic that claimed nearly seven million lives worldwide. The consequences of COVID-19 and the subsequent economic upheavals were not evenly felt, with their burden falling disproportionately on persons of color and persons with fewer socioeconomic resources, occasioning civil unrest that rivaled any the US has seen in the past 50 years. Three years on from the acute phase of the pandemic, we face again a presidential election with the potential to upend the status quo, with the perennially disruptive figure of Donald Trump possibly on the verge of a return to the White House. Living through this moment suggests indeed that much is awry with the world, that transformative change is needed to move us to a better place, and that the turbulence of the moment may provide a once-in-a-generation opportunity to bring about such a change.

Health, and the sharply felt divides that characterize it, has been at the heart of the storm we have lived through in the early years of the 2020s. The pandemic served as a powerful reminder of two long-ignored, yet fundamental, realities: Health is shaped by inequity, and poor health anywhere is—to borrow from Martin Luther King Jr.—a threat to health everywhere. It seems appropriate, therefore, to think of the pursuit of health as a catalyst for necessary transformations, for the creation of a world that is resilient to future pandemics, and one that apportions assets in such a way that the disproportionate burden of poor health does not accrue to a few groups, and that all have the opportunity to aspire to, and fairly achieve, a richly realized life, free of unnecessary and preventable illness.

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Why we should work with people in places we disagree with | The Healthiest Goldfish

The case against disengagement with Red America.

When Russia invaded Ukraine, I wrote a piece addressing the issue of working with scientists from countries which are engaged in actions that run counter to our values. Russia's invasion is a profound injustice, causing harm to those in the region and amplifying the global risk of nuclear war. This raises the question of whether, by continuing to collaborate with Russian scholars—and by continuing to engage with Russian cultural products more broadly—we are in some way complicit in the country's continued aggression towards its neighbor. This question does not lend itself to easy or comfortable answers. In science, we are centrally concerned with the pursuit of truth, and the truth is that actions that undermine the creation of a just world place at risk the conditions of freedom and equality that sustain human progress and science itself. It is our mission, then, to take seriously the possibility of disengaging with countries and organizations whose actions undermine the shaping of such a world.

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We may disagree | The Healthiest Goldfish

On ideas, criticism, and the generative debates that shape a healthier world.

In recent writing for The Healthiest Goldfish, I have argued that we are in a post-war moment for public health. By this I mean that the disruption of the pandemic created space for a reimagining of public health, a shoring up of its foundations by integrating the lessons of COVID into what we do, to shape a new practical philosophy for our work. This has meant asking questions about what is most fundamental about what we do. Questions like: What is health for? What are the limits of science? How can we better center proportionality in public health thinking? How do we reconcile the role of individual behavior in shaping health outcomes with the structural drivers of health? How should we think about the influence of context, effort, and ability in shaping these outcomes?  

These questions are consistent with writing I have done for many years in an effort to engage with the issues that matter for public health. I write because I have long believed that this is how ideas shift and change—through a process of thinking, writing, and debate. Participating in this process can, over time, help to change the paradigm around health, getting us closer to a healthier world. I encourage others to engage in this process, toward the goal of a more inclusive public conversation with many perspectives represented. Writing is at its best when it is a conversation, a debate. It is in the space between different views, in the generative conflict of ideas, that we sharpen our thinking and elevate the ideas that create a better world. As long as I have had a voice that people have listened to, I have seen it as part of my responsibility to engage in these conversations. This was the case at the beginning of my career, and it remains core to my current role as Dean of a school of public health. As such, I welcome views that are different from my own, I learn from them, and I would consider my time poorly spent if I did not, in the course of my daily reading, encounter one or two pieces of writing which challenge how I see the world.

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The astonishing privilege of living in a high-income country | The Healthiest Goldfish

On the advantages of resources and geography that shape how we think and what we do.

Part of the work of promoting health is engaging with the role of privilege. There are many kinds of privilege, and essentially all forms of privilege influence health. There is the privilege of getting a good education. There is the privilege of being financially well-off. There is the privilege of having regular access to good food. All of this contributes to our health. But, in addition to shaping our health, privilege also shapes our perspectives, the worldviews we bring to the very work of promoting health. That means that if we are concerned with health, we need to be engaged in an ongoing process of acknowledging our privilege, to see clearly the forces that create a better world, to ensure that the resources that support health are not exclusive to a privileged few.

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Welcome, with a Focus on Inclusion | Dean's Note

On the values that shape our community, as we look ahead to the coming year.

Welcome to the 23-24 academic year. To all our returning students, staff, and faculty, I hope everyone has had the opportunity for a restful summer break. To our new students, staff, and faculty, it is wonderful to have you join our community. I think, and hope, you will like it here.

As we enter the academic year, it seems appropriate to take a step back, to revisit the values that animate what we do. Our mission is to improve the health of populations. We do this through our scholarship, teaching, and engagement with the world of practice. And we do it by contributing to a better world, a more inclusive world, one where everyone is part of the conversation about health, and no one is excluded from the conditions that support a healthy life. Creating this world starts here at the school, where we aspire to be a school community that models the kind of world we would like to see. It is a privilege to be part of a community that embraces these core values, values that have remained constant throughout the school’s history.

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Who speaks for health? | The Healthiest Goldfish

On the role of community voices in the work of public health.

Public health is concerned, correctly, with putting the community front and center in all we do. This reflects our intent to listen to community priorities and to center the needs of the communities we serve. We cannot fully address these needs if we do not engage with communities, making sure that we bring into the conversation those who are affected by the work of public health. One would be hard pressed to find much disagreement with this statement in public health today. And yet, the practice of engagement with communities can be substantially more complicated than this statement might suggest. Balancing the values, data, and often-evolving science that informs the work of public health can at times lead to uncomfortable conflict between the various considerations that inform the work of public health. Starting from a place of appreciation for, and elevation of, the community engagement that is central to our work, I wanted today to ask some perhaps difficult questions about what we mean by “community” and the extent to which our engagement with communities is sometimes complicated and requires careful thinking about what we do, and why we do it.

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