On being useful

In a rancorous public moment, what could I possibly do?

More or less every day, I find myself engaging in conversations around some variant of this question: “in a world where so much seems awry, what could I possibly do?” My answer generally is that we should be leaning into what we do, doing it as well as we can, and that this, in and of itself, is useful for the world.

And yet, the notion of just being “useful,” in a rancorous public moment, feels somehow…small. I argue, though, that far from being small, it is exactly what we should aspire to - individually and collectively - and that if more of us did so, the world would be a better place indeed.

How might we define usefulness? Broadly, we can think of usefulness as a good, one which helps to make other goods possible. In this sense, it is what philosophers define as an instrumental good—a good that is valuable as a means to an end (as opposed intrinsic goods, which are goods that are valuable for their own sake, such as love or happiness.) It is a kind of tool, which allows us to access higher goods until we reach eudaimonia, or human flourishing, which Aristotle saw as the highest possible good and which readers of The Healthiest Goldfish might recognize as what I have long thought health is fundamentally for: to enable human flourishing, the living of a rich, full life. This aligns well with the fundamental goal of public health, an aspiration to create a world where all can live, all can thrive. It also aligns with the notion of radical incrementalism, where we pursue a vision of a healthier world by taking daily steps, sometimes small ones, even when this contribution is “modest.” The Healthiest Goldfish is itself, at core, an exercise in trying to be useful, to help inform a conversation that does right by the world and by the public health community, towards a pragmatic pursuit of healthier populations.

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On finding the discipline to engage

A case for doing the uncomfortable, essential work of listening to ideas we dislike.

There seems to be a growing tendency, in public health, universities, and elsewhere, not to engage with anyone who holds views with which we may disagree. We can see this in a hesitance to invite speakers to events whose views fall outside the mainstream of accepted opinion (or our own opinion), in an unwillingness to appear in certain spaces where ideas we do not like have been aired, and in a general sense that the social distancing of the pandemic era seems to have extended into the realm of ideas, keeping us and our institutions from the perceived intellectual and moral dangers posed by contact with divergent points of view.

It seems particularly troublesome that this language of exclusion appears to becoming common in the very professional and intellectual contexts that are committed, at least nominally, to a free exchange of ideas. There was a time when phrases like “I won’t share a stage with…” and “We shouldn’t platform…” were reserved for the most extreme forms of speech, the most obviously objectionable voices. And even then, efforts were often made to give such voices a hearing, with the understanding that when the objectionable are nevertheless allowed to speak, it sends a signal that free speech remains of utmost importance, a value worth even the discomfort that can come when the right to speak is exercised by those whose ideas we dislike.

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A Healthier Profit

Introducing our new public-facing book on commerce, health, and why the two are more entangled than most of us realize.

This piece was co-authored by Nason Maani, and his version is cross-posted here

There is a story David Foster Wallace told in a commencement address in 2005, that in part inspired the name of The Healthiest Goldfish substack. Two young fish are swimming along when an older fish passes them going the other way and says: “Morning, boys. How’s the water?” The two young fish swim on for a while, and eventually one of them looks at the other and says: “What is water?” Some of the most profound forces shaping us are also invisible due to their near ubiquitous nature. This is certainly true of health at the population level.

One of the most consequential, yet often invisible forces shaping our health, one that we swim through every single day without noticing, is commercial activity, the activities of the private sector. That set of forces, and their implications, is what A Healthier Profit, published by Oxford University Press early next year, is about.

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A conversation on the future of public health practice

Learning from leaders in the field in a time of challenge

Consider a fairly ordinary day. Someone picks up dinner from a restaurant on the way home from work. A mother fills a glass of water from the kitchen tap and hands it to her child. A man collects a prescription from the pharmacy down the street. A toddler receives a routine vaccination at the local clinic. Over the weekend, a parent hears from a neighbor that a stomach bug went around the school but seemed to burn itself out before it spread.

None of these moments register as noteworthy. That is precisely the point.

Behind the meal that was picked up was a sanitarian who had inspected that kitchen, checked its refrigeration temperatures, reviewed its food handling practices, and certified it safe to serve the public. Behind the glass of water was a monitoring system that tests for contaminants, enforces safety standards, and ensures that what comes out of the tap will not make anyone sick. Behind the prescription was a regulatory apparatus that had reviewed that drug for safety and efficacy before it ever reached the pharmacy shelf. Behind the toddler’s vaccination was an immunization program run by a local health department, staffed by nurses who track coverage rates and follow up with families. And behind the stomach bug that did not become an outbreak was an epidemiologist — probably in a small office somewhere, probably underpaid — who noticed the cluster, investigated it, and made sure it stayed contained.

All of this happened in the background. None of it happened by accident.

Every one of these quiet interventions is the work of public health practice. The challenge in the moment that many recent cuts to public health threaten these fundamental core actions of public health.

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Green shoots in public health

During a moment of challenge, signs of hope.

It has by now been amply discussed that public health faces a daunting and challenging landscape. The all-too-recent pandemic and other disruptions have strained institutions and eroded the public’s trust in what we do—a hard lesson that trust should be tended like a garden lest it wither, driving the public toward unreliable voices. Political upheavals and misinformation have further tested the foundations of public health.

And yet, this unsettled environment, there are signs of hope.

Green shoots are sprouting all around us. If we look carefully enough, we can see promising developments that hint at a renewal in public health. In my role as Dean of the Washington University School of Public Health, I am privileged to be able to see these signs of hope every day, in the good work of colleagues who are creating a brighter present and future for public health. I would like to take a moment today to highlight some of this work, to give a sense of the progress being made on health globally, nationally, and locally, even in this moment of disruption.

Global green shoots

There is much to worry about in global health. But there are also enormous positives happening all around us.

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A Purple Public Health: Remembering the values that sustain us

Resisting the postliberal temptation

This piece was co-written by Dr Salma Abdalla and is also cross-posted here.

In January, we launched the Purple Public Health Project with the aspiration of shoring up the field’s foundations, rebuilding the public’s trust in what we do, and reorienting the field around core values that can help guide public health in this moment and beyond. Today, we would like to discuss these values, and how they align the larger forces that can support social and political progress in this moment.

We suggest that the values of public health are, and should continue to be, the values of small-l liberalism. What do we mean by small-l liberalism?

While there are several definitions of the term liberalism, in this article we refer to a system where political tensions are resolved through persuasion rather than the exercise of raw power, where ideas win out in the long term because they are better, not because they are imposed from above (or from below).

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The economics of attention

Why the ideas we see are not all there is

This piece was co-authored by Nason Maani, and his version is cross-posted here

“You are what you eat” is clearly an oversimplification, but there is a truth to it. We are heavily influenced by what we consume in a physical sense. The same is true of our consumption of information, of ideas, particularly when our attention is in short supply, and competed over in what has been termed the “attention economy”.

It feels there is more information around us than there ever has been, and as a result, one might think, we consume a varied information diet. Perhaps in the morning we scroll through one or two news websites, then perhaps our notifications on a social media platform like Linkedin, X, Facebook, or BlueSky. Maybe we receive a couple of newsletters from Substack, and some “forwarded many times” messages from groups on WhatsApp. Then there are some alerts on our phone from Google or Apple News. After 30-45 minutes, over our morning coffee, it can feel as if we have sampled quite a range of news, work updates, life updates, sports, science, views and ideas from people in the wider world. But what is shaping that information? What biases what we see and read?

The definition of bias in research terms is a systematic error that distorts measurement away from truth. Just like there are innumerable forces that bias accurate measurement, there are also innumerable forces that bias what we think. We do not think it is possible to remove all sources of bias that shape the information we consume. But if we could understand what is biasing the information we consume, we can come to conclusions about the world around us that are clearer and close to truth.

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The human consequences of war

Addressing the physical and mental health effects of conflict.

War has long been a tragic constant of human history. The past is a record of much progress, but it is also, in large part, a litany of violent struggles waged throughout the centuries. In the present moment, conflicts around the world rightly command our attention. With all wars, there are a range of complexities—historical, political, strategic—that inform the emergence of conflicts. It is important to resist easy narratives and the tendency to dehumanize that is so much a part of war and always has been. It is easy, when we speak of war in the language of strategy and geopolitics, to lose sight of what war actually is: the shattering of individual lives. Behind every statistic is a person—a parent searching for a child, a doctor working without supplies, a family fleeing with nothing but what they can carry. War is not an abstraction. It is real people, real bodies, real grief, and the pain does not confine itself to the boundaries we draw on maps or the timelines we impose on conflicts. It is in times of war, then, that it is more necessary than ever to engage with nuance, to seek the facts, to read and think widely about the forces shaping the global ruptures that lead to conflict.

It is also essential, when conflicts emerge, for us to talk about them, to not look away, because there are members of all communities, including our own, who are affected by them. So, while we have a responsibility to the world to address conflicts when they happen—like the wars in Ukraine and Gaza and the conflict in and around Iran—we also have a responsibility to our own communities to engage with what we are seeing, with the shock and uncertainty of the moment.

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