On finding courage to stay the course

Part 2 of 2. The importance of doing what we do, even in difficult times

Last week I wrote about this moment of challenge. I suggested that in such a moment there are in some ways two competing impulses. The first: Should we rethink what we do, how we do it? Are there things we should do differently, and why? The other side of that is courage. What about all the things that we do, have done very well, that also may be under pressure? How can we have the courage to stand for things that matter to us? How do we find that courage? So, building on last week, this is about the second part of this formulation: courage.

Most of us admire courage. We admire it in others and aspire to it in ourselves. When faced with setback or danger, everybody wants to rise to the occasion. Nobody wants to feel like they have fallen short.

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On changing when we should change

Part 1 of 2. The importance of reimagining public health in an uneasy time

This piece was co-authored by Dr Nason Maani

Public health is at an uneasy juncture. Its central institutions face diminished public trust. The CDC has faced unprecedented cuts and challenges to its remit and organization. Funding for public health research has been under strain. Presidential declarations on diseases and vaccines have, at times, run directly counter to expert consensus. While understandably dominating the headlines, this is by no means a US-only trend. In more subtle ways, public health is being undermined in the UK too. Public Health England was disbanded, presented as a technical re-organization to strengthen pandemic preparedness, but also serving as a way of deflect criticism over COVID-19. This change replaced an arms-length organization that led campaigns and produced authoritative reviews with one embedded within health and social care, without budgetary independence or the ability to act autonomously. Two years later, a long-planned white paper on health disparities was scrapped. At the global level, health funding has been dramatically curtailed since January 2025. The immediate consequences of all this are increasingly visible: declining confidence in science and government institutions, resignations, confusion, policy vacuums, and a heightened vulnerability to mis- and disinformation

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How data can support a values-based argument for health

On the consequential, rigorous, and inquisitive science that should support a vision of a healthier world.

I recently contemplated how we might do a better job of engaging with the complexity of moral argument on issues of consequence for health. Today, I would like to continue this theme by revisiting an essay about the role of data in shaping and communicating our moral vision. While I have written about the importance of a values-based case for health, I balance that with the contention that such a case should rest on the best possible data, informed by science that is rigorous, consequential, and engaged with questions of central concern for health. It is science that helps us to engage in conversations that inform and persuade, to shape a movement for health. At the same time, data have a persuasive power all their own, even when they are not presented as part of a broader moral vision. Sometimes, clearly presenting the facts about a given issue can be enough to change minds. For these reasons, we should be centrally concerned with the integrity of the science that generates our data as a prerequisite to making the moral case for healthier populations.

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The Social Life of Ideas

Ideas about ideas, at a time when ideas feel endangered

This piece is co-written with Dr Nason Maani and cross-posted here.

Let us start with the present.

We are living in an unusual time. After many years of gains for more open liberal societies, populist forces are in ascendance. Several countries that nominally are open, democratic, and have freedoms of expressions are actively working to suppress media, universities, and other outlets that generally have been engaged in developing and disseminating ideas. Other countries, including some of the largest in the world, have long been operating in a sort-of unsteady social compact, where the population benefits from increasing prosperity, as long as it does not raise too many ideas that may threaten a status quo.

Whither then ideas?

We think ideas matter and are the core of liberal societies. We are interested in the enormous progress afforded by liberalism through core values of pluralism, diversity of perspectives, reasoned and rigorous debate, and gradual improvement of the world we live in, not as a partisan project, but as an intellectual foundation to a better world. And that matters to all we do in health as an aspirational foundation to that very world.

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On the complexity of moral argument

Understanding that good people, for good reasons, hold on to ideas we strongly disagree with

Your neighbors voted for the candidate you cannot stand. They are also friendly, congenial neighbors and regularly bring you baked goods.

Your cousin works in marketing at a tobacco company. They are also a wonderful parent, and you enjoy spending every Thanksgiving together.

Your friend since childhood is avowedly against any form of regulation to industry, convinced that those who cannot make it in a completely free market are simply not trying hard enough. You have enjoyed going on vacation with them every year since you were young.

In a time of partisan rancor, it is becoming — at least in the public narrative — almost impossible to engage with those whose perspectives might differ markedly from ours. For anyone who is engaged in the business of population health, political choices, and the candidates who espouse them, matter, as does caution to create the right framework for corporate incentives and disincentives, and minimizing the impact of harmful products.

How could rational, good people, feel so strongly, so differently than we do?

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Building health on shared values

Why a focus on enduring principles should underlie all efforts in health

We are in a time when much is being overturned. Policies are being rolled back, funding is being cut, long-standing institutions overhauled. Globally, it seems like the U.S. is retreating from its role as leader of the postwar international order, which for 70 years was the bedrock of a lasting, if imperfect, peace.

In health, this time of change has been acutely, painfully felt. Everyone knows someone who has lost a job or faced sudden uncertainty around the future of their work. We witness institutions that appeared broadly seaworthy — and that we assumed enjoyed public support for doing good, necessary work — enter choppy waters, with close to half the country either indifferent to their fate or actively hoping they will sink.

Beliefs that constituted a kind of collective faith — vaccines are safe and effective, the work of science can be trusted, technological progress is a net positive for society — have, for reasons understandable and less so, lost their hold on our consciousness. They were once the default opinion of many, if not most of us. No more.

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Clarifying misunderstandings about population health

A science refresher to help move us past the health mistakes of the moment

This piece was co-authored by Dr. Greg Cohen

I have written quite a bit now about the challenges of the moment to the health of populations — from systematic efforts to limit the public health workforce, to funding cuts to health research, to threats to health insurance coverage. These are all challenges that one worries will have a substantial effect on the health of the American (and global) population. There is no question that some of these changes are driven by ideological difference, and some by an effort to simply do things differently, to break from past precedent. But it also occurs to me that some of what is happening may arise from a misunderstanding, on the part of political appointees overseeing national public health infrastructure, of the facts about what shapes the health of populations. So, here, partnering with Dr. Greg Cohen and informed by work I have done over the past decade-plus with Dr. Kerry Keyes, I thought I would summarize some core concepts of population health science and why they matter to the current moment, and, de facto, why paying attention to these concepts might suggest a course of action that diverges from the path currently being pursued by some who are responsible for the public’s health at the federal level.

By way of introducing core principles of population health science, let us ground the discussion in a lightning rod topic, if there ever was one: the COVID vaccine. Caught up in the cultural tumult of the past few years, COVID vaccines are currently restricted by CVS and Walgreens pharmacies across multiple states. According to a Kaiser Family Foundation poll administered in early August, only approximately 40% of Americans plan to get a COVID-vaccine booster this fall, and the majority of those who want to receive the booster are concerned they will not be able to access the vaccine or insurance coverage for it. This is a rather odd turn for vaccines that until recently were considered a miracle of modern science and are responsible for saving millions of lives and averting millions of years of life lost worldwide. Leaving aside more cynical political agendas that have used COVID vaccines as a lever to score partisan points, it is important to contend straightforwardly with concerns fueling uncertainty around COVID vaccines, concerns that have led many to doubt the vaccines’ efficacy and utility.

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On keeping the faith

Leaning into hope at the start of a new school year

One of the privileges of working in a university is the opportunity that comes with the seasons. The summer months provide space for thinking, for taking a step back from the moment and engaging with the ideas and philosophical grounding for what we do. On the administrative side, summer is a time for planning the year to come as we look ahead, with excitement, to welcoming our new students. Then our students arrive, bringing new ideas, new energy, and a spirit of hope that infuses the whole school community.

As we welcome students in 2025, I would like to take a moment to lean into hope in this Goldfish space, into believing in the mission of public health.

In doing so, I find myself thinking about an expression that has stuck with me over the years: “Keep the faith.”

It is a phrase many of us have heard — most recently, perhaps, from former President Biden, for whom it is a favorite expression. At its simplest, “keep the faith” is a reminder to not give up, to keep going in the face of adversity, to hold true to our values and aspirations. It can also have a religious resonance, reflecting a belief in the possibility of a transcendent spiritual reality to which the challenges of this world will ultimately give way.

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