Looking back at 2023 through the lens of The Healthiest Goldfish

Reflecting on the thoughts that emerged over the past year.

This is the last Healthiest Goldfish essay of the calendar year 2023. As I was considering topics for this piece, I thought that, rather than introduce a new subject, I would look back a bit on all I wrote over the past year and on the conversations these reflections helped inform. The Healthiest Goldfish has, from the start, been organized around key themes and a certain spirit of inquiry. These themes include looking back on the COVID moment, to understand what we did right and what we did wrong, trying to better balance our values and data in pursuit of our mission, avoiding the pitfalls of communication in an age of social media and the attendant moral grandstanding that can undermine the humility and genuine moral courage that are central to scientific work, engaging thoughtfully with the foundational drivers of health, and shaping a philosophy that can support an effective, pragmatic public health mission to generate transformative change in this post-war moment. I have tried to engage with these topics in a spirit of self-critical reflection. Such reflection can be difficult, uncomfortable. But I do so out of a belief that it is necessary to become better in our pursuit of health.

Read more here

Passion play | The Healthiest Goldfish

How a passionate few capture conversations, with implications for how we do what we do.

During the recent Thanksgiving season, my historical reflections drifted towards a consideration of the French Revolution. This drift was inspired, perhaps, by the recent cinematic treatment of the life of Napoleon, whose career in many ways marked the apex and the end of that revolutionary era. In studying the French Revolution, one is struck by how many currents of thought were swirling around France in that period. The constant political swings—from radical to reactionary, from reformist to an embrace of violence and terror—reflect an era when anything seemed possible for society. In this sense, the period is representative of a characteristic common to many politically unsettled times, the present moment included. That characteristic is the presence of many voices speaking for movements and speaking within movements, all with the potential—with each sudden shift of circumstance—to become the guiding philosophy of masses of people or even of governments, with results both good and bad.  

Read more here

Why I wrote Within Reason | The Healthiest Goldfish

Holding a mirror to ourselves, to the end of being better at what we do.

This week saw the release of my book, Within Reason: A liberal public health for an illiberal time. For the past few weeks, we have been running brief readings from the book together with The Healthiest Goldfish, so readers of these essays will, by now, have an idea of what the book is about. As the book is released, I thought I would summarize here the core argument of Within Reason, the motivation behind it, and the ideas that I hope the book will encourage discussion about, even if I realize that some (many?) may not agree with these ideas.

Read more here

The integrity of the mission to promote health

On being clear on values that guide both thought and action

In “Letter from Birmingham Jail,” Martin Luther King Jr. wrote “In any nonviolent campaign there are four basic steps: collection of the facts to determine whether injustices exist; negotiation; self purification; and direct action.” This is an interesting statement for several reasons, each deserving of its own essay. But what has long struck me most about it is its call for anyone looking to create a better world to first engage in “self purification.” I take this to indicate the importance of carefully examining our values and motivations, to ensure that they support actions that can build a better world. Such work is difficult, and it is on us to make sure that before we do anything we think deeply about the first principles of our work—the values that underlie all we do. Are we truly acting on behalf of better health for all, or are we looking to posture and grandstand?  If we find ourselves alone in taking a position, have we thought deeply enough about what we believe to be able to hold to our convictions when the winds of controversy blow? Such examination is a central goal of these essays. Values help guide our efforts, providing a lens through which to view the world, helping us determine the best application of our scientific data, towards shaping approaches that create better health for all. This is particularly true in this post-war, post-COVID moment.

Read more here

An imperfect health | The Healthiest Goldfish

On creating a world that allows all of us to live healthy lives, no matter how we may define doing so.

In writing these essays, and in much of my past writing, I often invoke health. In addition to essays and articles, I have written several books, all of which are centrally concerned with creating a healthier world. Two of my more recent books, Healthier: Fifty Thoughts on the Foundations of Population Health and Well: What We Need to Talk About When We Talk About Health, are efforts to help shape a vision of health that can get us closer to a radically healthier world. The pursuit of such a vision is informed by the assumption that we have, collectively, a shared understanding of what health is: I know what it is to be healthy and so do you. Our goal is to help each other get there by creating a world that is better, healthier.

Read more here

Having the conversations we should have when we can have them | The Healthiest Goldfish

On creating frameworks that ensure our conversations are truly generative of a better world.

In a recent piece for the London Review of Books, Judith Butler wrote:

“The matters most in need of public discussion, the ones that most urgently need to be discussed, are those that are difficult to discuss within the frameworks now available to us.”

In the context of the moment we are living in, this makes me think, and quite a bit, about what it means to have conversations, and whether and when certain conversations are even possible. I have long believed in the power of conversation. A healthier world is downstream of the ideas that shape such a world, and ideas emerge from conversation and debate. It is through an ongoing process of disicussion that we decide which ideas are good and which are not, where we stress-test our beliefs and opinions through engagement, and sometimes generative conflict, with the beliefs and opinions of others. As I have written before, the goal of this newsletter is to seed such conversations, helping to create a substrate from which productive conversations can emerge to help shape a healthier world. It is in service of such conversations that I have specifically pushed back against ad hominem statements and the use of shorthand via social media to distill complex ideas into grandstanding soundbites, urging us instead to have conversations, the kind that advance understanding and truly make progress.

Read more here

Again and Again. Mass Shootings Continue Unabated in the United States | The Healthiest Goldfish

The mass shooting in Lewiston, Maine is the latest example of a uniquely American phenomenon. But there is hope, progress we are making, in the face of tragedy.

On Wednesday, a gunman killed at least 18 people and injured at least 13 in a series of shootings in Lewiston, Maine. As of this writing, the gunman is still at large and the community in and around Lewiston has been urged to shelter in place, with many businesses and schools closed. The shooting is the latest in a country where such tragedies have become sadly routine. There have been over 560 mass shootings in the US so far this year. Over 35,200 people have been killed by guns, and over 30,600 have been injured by them in 2023. Mass shootings this year include a shooting in Goshen, CA, which killed six people, a shooting in Monterey Park, CA, which killed 11 people, and a shooting in Half Moon Bay, CA, which killed seven people.

Mass shootings touch the lives of those who had previously, like most of us, looked at the gun violence epidemic from the outside. And yet these mass shootings all are part of a long-term, familiar dynamic, a broken status quo we have not yet been able to fix. Over the past decade we have heard an increasing drumbeat of “thoughts and prayers” from politicians, a growing outcry on social media, and yet we continue to have more gun violence deaths and injuries than ever before, punctuated by periodic mass shootings that penetrate the public consciousness. And so, again and again, we search for words that can find meaning, that can shift our thinking. But perhaps there is little new to say, because the arguments have been made, and what is left is for us to act. I went back and looked at what I have said over the past eight years about the topic, since becoming dean of the Boston University School of Public Health. And in many ways what I have said over time still holds today, all of it. The headlines, the stories, are the same. We have been living these stories over and over.

Read more here

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.

Read more here