Reevaluating paternalism | The Healthiest Goldfish

Sometimes we must curtail certain liberties so we can support the freedom to live a healthy life. But how much constraint is too much? How much is not enough?

Part of the aim of these essays is to engage with topics which may be challenging, reflecting the importance of having difficult conversations that advance progress. If we find that nothing we say causes us to feel a bit uncomfortable, it is hard to think we are truly having the kinds of conversations that make us better at holding a mirror up to ourselves towards a more effective pursuit of health. With this in mind, I will today address a topic that is certainly touchy, challenging, while at the same time being essential to the work we do to generate a healthier world. That topic is paternalism.

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The Perils of Scientific Disengagement | Observing Science

FThe world at times feels like it is on fire, with highly visible forms of injustice challenging our collective moral conscience. Scientists live in this world, and it comes up, time and again, whether scientists should put pressure in our particular ways on those who are committing atrocities, who are waging war, or who are oppressive to their people, in order to encourage a change in such (usually national) behavior.

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Everything, everywhere, all at once? Or not? | The Healthiest Goldfish

On conserving our energy and resources for where they can do the most good in the moment, without compromising our long-term vision for a healthier world.

Regular readers of these essays will recognize that a core theme of much of my writing is that the business of health is the business of being concerned about the world around us. The air we breathe, the water we drink, the food we eat, the places where we live, work, and play, politics, the economy, the environment, and the broader geopolitical issues of war and peace—these forces are fundamental to whether we can live healthy lives. They are, to return to the central metaphor of The Healthiest Goldfish, the water in which we swim. Creating a healthy world means attending to these forces, optimizing them for health, to ensure our water is “clean.” This work requires an intellectual and practical commitment to engaging with a “big picture” vision of health. A healthier world is a world where we tackle forces as foundational as climate change, structural racism, and individual behavioral choices, all of which affect health.

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A very narrow view of the world | The Healthiest Goldfish

Revisiting how approaching our work from a Western, high-income perspective can shape how we think and what we do.

II try to be alert to my biases when I think, write, and act. As I have written before, our biases inform the questions we ask about our health, pointing to answers that then inform action. One feature of thinking about one’s biases is the recognition this brings of having even more biases than one originally considered—more, perhaps, than anyone can fully reckon with. Social and occupational status, personal identity, our talents and lack of them, our virtues and shortcomings all constitute the lens through which we see the world. They are the water in which we swim. Just as water is to the swimmer so ubiquitous that they can forget they are in it, our biases are so ubiquitous that they can shape much of what we do and think without our being fully aware of them.

This makes it important to continually revisit our biases, in the interest of keeping them in perspective so that, even if we can never fully step outside of them, we can at least remain aware that they are there, an inextricable part of how we see the world. Addressing our biases is also core to building and maintaining the public’s trust in what we do. If we allow ourselves to become out of touch, unaware of the biases that shape our view, we are less likely to be seen as trustworthy, engaged partners in the work of promoting health, alienating us from the public. This alienation works both ways. When our vision is clouded by bias, it is harder to see the person standing in front of us, harder to understand their perspective, or what is most supportive of their health.

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It’s Time To Talk About Peer Review | Observing Science

Fifty, or even twenty-five years ago, procuring, analyzing, and presenting data in a way that illuminated larger truths was the exclusive province of scientists who did their work in institutions and then published their work in academic journals. That began changing with the democratization of data, more ready access to electronic means of disseminating writing, and with the rise of fields like data journalism, which started doing much of what scientists did—evaluated data and presented it in a way that produced meaning. These evolutions are, in the main, positive. They allow greater access to data for many well outside the confines of mainstream science, encouraging transparency. They allow for the possibility of insights that might otherwise have been missed by scientists and create ample space for publishing these same insights. In addition, these shifts have allowed for the more rapid analysis of data to address pressing contemporary issues, unbound by the processes of science.

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On not looking away from less visible global conflicts | The Healthiest Goldfish

Creating a healthier world must include paying attention to the many underdiscussed wars happening throughout the world.

The world has been appropriately riveted in the past few years by two very visible conflicts: the war in Ukraine, provoked by Russia, and the war in the Middle East, provoked on October 7 by Hamas’ horrific incursion into Israel and then perpetuated by Israel’s ongoing retaliatory attacks on Gaza. I have written extensively about both wars and they have captured the public’s attention, and rightly so, given both the enormous implications they have for global stability, and the tragedies they have wrought on people living in Ukraine, Gaza, and Israel. However, I have also acknowledged that our attention to these conflicts should not, must not, mean that we look away from other conflicts that are equally as devastating for the people in other areas whose lives have been upended by war. It is sometimes difficult, perhaps next to impossible, to recognize that regions that we have grown accustomed to seeing through the lens of war were once areas where, before the war, people lived their daily lives as we do, going to school, to work, playing in parks, falling in love, getting married, becoming sick, dying with dignity. All of these are aspects of living, and they have been disrupted by war and conflict in so many areas, some of which we do not think about or keep in our minds anywhere near as much as we should.

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Funding and the Questions We Ask | Observing Science

Among the many aphorisms attributed to Albert Einstein—some helpful, some less so—this has perhaps stood the test of time: “If I had an hour to solve a problem and my life depended on the solution, I would spend the first 55 minutes determining the proper question to ask, for once I know the proper question, I could solve the problem in less than five minutes.”

It seems unlikely that we could find a thoughtful working scientist who does not agree with this. Asking the right question is a sine qua non of good science. For example, if the problem is that too many Americans die from gun violence, what are the right questions to arrive at a solution to stop this epidemic?

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On regaining trust, avoiding self-satisfaction | The Healthiest Goldfish

Some first thoughts on restoring trust in the work of public health.

One of the reoccurring themes of these essays is the crisis of trust we face in working for health. The decline we have seen in recent years in the public’s trust in us poses a challenge to our capacity to create a healthier world. This suggests that it is on us to think self-critically about why this decline in trust, to reflect on how we conduct ourselves, on how our self-presentation may make the public more or less likely to embrace our efforts. Do we speak and act with humility or do we morally grandstand? Do we listen to others, including those with points of view with which we disagree, or do we just like to hear ourselves talk? Do we project optimism and a healthy self-confidence, or do we tip into the self-satisfaction that can put people off?

Each of these questions should give us cause for reflection, their answers of deep relevance to what we do. Lately I have been asked quite a bit: how do we rebuild trust in public health? I am not sure I have an answer, but I thought I would engage these ideas with a few essays on topics that relate to trust.

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