The responsibility of idea stewards

What we owe the ideas we inherit

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

Ideas, and the institutions that house them, are under pressure of a kind few of us anticipated a generation ago. Universities are being challenged, research funding is being constrained, and the very legitimacy of expert knowledge is being contested in ways that feel (and perhaps are) particularly acute and raw. In such a moment, it is tempting to reach for the language of defense, of protecting ideas, of shielding institutions. But that approach may not always be right for the moment. And it is particularly not right when we think carefully about our role in the world of ideas. Those of us who work in these settings could call ourselves producers of ideas, or thinkers, or scholars, or, as we suggested earlier in this series of essays, workers in idea factories. But perhaps more than anything else, we are stewards of ideas, both holding ideas in trust and improving them for the next generation. That shift in framing is central to the point of this essay, part of our Ideas about Ideas series. When we think of those who generate ideas as stewards, it pushes us to ask what such stewardship demands of those of us fortunate enough to find ourselves in the business of ideas, particularly now when the task may be as much to reinvent our ideas as it is to preserve them.

What then might be the responsibilities of stewards of ideas? We organize our thinking here along three lines. First, we talk about foundational moral, intellectual, and aesthetic responsibilities. Second, we dwell on instrumental responsibilities that have been implicit in our writing on these topics but that we feel here deserve to be underlined: the responsibility to widen the door for many, to speak when silence is easier, and to the institutions where ideas are generated that shall outlast us. Thinking of these responsibilities finds us following a single thread through this essay, that stewardship is not only about conservation, but it is as much about the willingness to build anew when the forms that are inherited are no longer fit for the purpose of the moment. Let us start with our foundational responsibilities.

In Science as Vocation, Max Weber argues that scholars cannot hide behind their methods; the choice of what to study itself is a moral choice. To have the privilege of time to think incurs an obligation about what one thinks about. This does not mean that science and scholarship need to always have a clear and direct application; it does mean however that stewards of ideas have to ask whether their work serves larger societal goals, a centering of consequentialism that we have previously argued for in health. All too often, we assume that what is ultimately consequential or most important is that work that was funded before, or work that aligns to the goals of the current dominant funder of science. But our responsibility transcends these imperfect criteria, which can and do change over time. Hans Jonas’s The Imperative of Responsibility sharpens the point further. In a world where ideas have consequences at scale, our responsibility extends forward in time, to those who will live with the real-world expressions of what we thought. This obligation feels particularly pressing now, as we live with the real-world expressions of once-fringe ideas. When the public is increasingly skeptical of what we produce, the answer cannot be retreat into technical narrowness, or necessarily to retreat to what we did before, but rather to lean into work of visible consequence, done in the open, with a clear commitment to our larger social purpose.

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A purple public health: Disagreement as a starting point

Studying and practicing public health amid real values divides

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

How do we advance a practical philosophy of health so that we can lean into the goals and aspirations of public health? At a foundational level, that is the central goal of the Purple Public Health Project. We have written on the values that may animate us, and the importance of trust necessary to engage populations to be able to do the work we need to do. All those are building blocks of the context on which we can build the work of public health. We worry, however, that thinking of shared values and trust as foundational scaffold might suggest that our aspiration is to get to a place where everyone agrees with the work and goals of public health. We suggest, rather, that we are doing the work of public health not when there is such agreement, but when there is disagreement that is clearly visible and discussed. To our mind the aspirations of public health—that all can live healthy, fulfilling lives—are so radical, that we cannot truly expect to make progress towards them without an underlying level of disagreement both about the shades of the aspirations, but also how we may get there. Seen this way, disagreement, about the goals and methods of public health, is a feature, not a bug. Stated more eloquently, Hannah Arendt wrote that plurality, i.e., the fact that each of us brings a distinct perspective on a shared world, is a condition of human action, not an obstacle to it. Unfortunately, public health has sometimes (often?) treated plurality as a problem to be managed on the way to consensus. We would like to suggest in this piece that disagreement is a condition we need to learn to work with and within, and even to welcome.

Our dominant orientation in the field, perhaps more so in recent years, has long been that disagreement is best met with more persuasive evidence, and more compelling argumentation to “bring more people around”. If only people understood the data, surely they will side with the goals of public health? However, most of the disagreements that actually matter in public health are not arguments over what the evidence shows. They are in fact disputes about what, in light of the evidence, we should do. They are arguments about cases of values. We made the case in Februarythat data and values belong to different domains and should be kept conceptually separate. This argument extends that one by focusing on the values, recognizing that values differ, and that those differences in values between people seldom narrow through closer contact with better data.

Moving beyond abstraction, it is worth talking, plainly, about the dominant value disagreements that genuinely challenge the work of public health. Thinking through these areas of such disagreement highlights that these issues are not isolated points of contention but features of a challenging moral terrain.

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Health as infrastructure, not intervention

Ebola reminds us of the need for the scaffolding we often do not see until it fails.

As of now, over 1,400 suspected or confirmed cases of Ebola, and at least 200 deaths from the disease, have been reported in the area of Congo and Uganda. Outbreaks like this are challenging in the best of times, as communities and health workers do all they can to contain the spread. Such efforts helped to limit and ultimately end the 2013-2016 West African Ebola outbreak, which could have been far worse without the presence of global health infrastructure—the network of NGOs, government agencies, public and private investment, and international bodies dedicated to supporting health and preventing disease around the world. When such programs are well-funded and working, the world is a safer, healthier place. When they are not—when they are subject to firings and funding cuts and a collapse of political support, as they have been over the last year or so—this creates a difficult context for global health. That the present Ebola outbreak has emerged in such a context is cause for concern indeed. That we have entered a time of disinvestment in global health infrastructure reflects what could be fairly called a blind spot in how we in the US think about health and the infrastructure that supports it at home and abroad.

We tend to treat health like something to be fixed when it breaks. Under this paradigm, we are healthy until we are not, and it is then that we should apply the best possible healthcare solutions to return us to the world of the well. Our investment in health largely follows this lead, with vast sums going to the development of the drugs and treatments that do this work of fixing. To be clear: there is nothing wrong with having the best possible healthcare at our disposal when we are sick—there is nothing wrong with fixing. Indeed, my early training is as a doctor, and I spent the first part of my career engaging in the work of repairing health when it “breaks.”

Yet, as an overarching framework for how we think about, and invest in, health, this model can fall short. It is not enough to have the best possible fixes if this comes at the expense of addressing the root causes of health and disease in society. Just as, in individuals, we would not be content just to treat the symptoms of disease and leave the underlying problem unaddressed, in societies, we should not put all our eggs in the curative basket without investing in the prevention that makes cure less necessary, populations healthier.

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When public health succeeds and no one hears it, does it make a sound?

Thinking about how we communicate public health better

This piece was co-authored by Dr Matthew Kreuter and Dr Rachel Garg.

We have written here often about the challenges facing public health, and about the slow erosion of public trust in the field. Those challenges have many roots — partisanship, the inconsistencies of pandemic-era communication, the perception that public health speaks more in the language of values than in the language of evidence. We have taken up several of these elsewhere. There is, however, one further piece that deserves more attention than it tends to get, and it has to do with the story we tell about ourselves.

The dominant national narrative about health is, on most days, a narrative of foreboding. Things are bad and getting worse. Every week brings another headline of imminent risk. That story is not entirely false. Many of our health indicators are indeed troubling, and public health draws much of its public license from sounding the alarm when the alarm is warranted. But foreboding is not the whole picture. Some health problems are getting worse. Others, quietly and with very little fanfare, are getting better. When the public hears only the first half of that story, it shapes how people understand what we do and whether the work is worth supporting.

This matters because public health, more than most fields, depends on a citizenry that believes the work we are doing is effective, is worth investing in. Belief in that proposition is not automatic. It has to be cultivated, and it can be lost. A poll out of St. Louis, recently fielded, captures the problem with unusual clarity.

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A Purple Public Health: The individual and the public

Rethinking autonomy in a field that serves populations

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

Public health is concerned with health at the population level. Most of the time our work as public health scientists and practitioners, expands rather than restricts what people can do with their lives. Clean water, safe food, and the countless quieter interventions that constitute public health have given people more years, more options, and more freedom to live the lives they wish to live. But sometimes, the pursuit of public health requires that individuals accept constraints on their choices for the sake of the population’s health.

There is nothing particularly new about this restricting feature of public health. But this feature was brought to the fore in an unprecedently visible way during the Covid-19 pandemic. Vaccine mandates, mask requirements, and restrictions on movement and gathering all surfaced a national conversation about the role of public health: when is it right for the field to infringe on an individual’s autonomy in the name of the population’s health, and when is it not? The debate has not settled since. If anything, it has widened, as the field faces questions about harm reduction, policies to tackle obesity, and many other issues where the line between protecting populations and respecting individuals is less clear than we sometimes think.

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Ideas that crowd out alternatives

Why the most prominent ideas are not necessarily the best.

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

Today’s essay is part of our Ideas about Ideas series, a running theme of which is the notion that ideas have social lives. This may seem strange. How can ideas have social lives? It is not as if they are alive, with personalities and independent agency. This may be so. Yet, like living things, like people, ideas have origins and conditions that shape them. Ideas can grow their influence in a variety of ways. They can spread slowly and steadily simply by being good, workable notions that many are happy to adopt. They can advance through patronage, their wagon hitched to powerful people or social movements who use this power to encourage, even force, the adoption of favored ideas (and discourage disfavored ones through censorship and suppression). Or they can catch on through sheer prevalence and dominance in the public conversation and influential institutions, crowding out alternatives to become the only lens through which a problem or issue is viewed.

It is this form of influence that we would like to discuss today—ideas crowding out alternatives. It is a phenomenon that is of central importance to the work of science and public health, characterizing how many ideas gain traction and stay ubiquitous in our field. The better we understand this tendency, the more we can contribute to an intellectual ecosystem where ideas rise to the top because they are genuinely the best ideas, rather than simply the most widespread or intractable (it is not always the case, of course, that ideas which are ubiquitous are necessarily bad or mediocre, but when such ideas rise for reasons other than pure meritocracy, even when they are good, it is always worth asking why).

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To the public health class of 2026

As a new cohort of public health professionals start their careers, some thoughts on the aspirations that guide our work.

We are in the midst of graduation season, which I have long considered to be the happiest time of the year. It is a joy to gather with graduates, family, and friends and wish the next generation of public health professionals well—as I had the privilege of doing last week at the Andrew M. and Jane M. Bursky School of Public Health at Washington University in St. Louis, where I serve as dean. The commitment of these graduates to the work of public health, and to the values that support this work, is a source of hope indeed, as much a sign of renewal as the flowers that accompany this time of year.

Graduation season is also a time when I find myself reflecting on the first principles, the aspirations that guide our mission, a mission this year’s public health graduates have now made their own. It is worth reflecting on these aspirations as a reminder of why we do what we do, and, on a perhaps deeper level, of the power of aspirations to endure through a range of historical moments, outlasting, and even changing for the better, times of challenge. It is important to recognize that public health, at its most essential, is a series of aspirations. An aspiration is simply something we are reaching towards, whether that is an idea, a manner of conducting ourselves, or a set of policies. This reaching is what helps us clear the distance between the world as it is and the world as it should be. Sometimes, the simple act of expressing our aspirations can help lay the groundwork for a better world, by setting a marker for future progress. This is perhaps most true in difficult moments, like the one public health is arguably now in, when it can be easier to see challenges than opportunities and when the distance between the world as it is and the world as it should be seems far indeed.

So, I would like to share some thoughts about the aspirations of public health in this moment. In keeping with the season, I will address these remarks to the public health graduates of 2026, with excitement for all they have achieved and for all they will do next.

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Into the light

During commencement season, toward a brighter day for public health

Last month, the Artemis II mission successfully flew to the moon and back. Astronauts Victor Glover, Christina Koch, Jeremy Hansen, and Reid Wiseman crewed the Orion spacecraft, which they named Integrity, in the first human-led flight beyond low earth orbit since the Apollo 17 mission in 1972. The lunar flyby was conceived as a test flight in support of further Artemis missions, with the goal of returning humans to the moon’s surface.

The Artemis II mission was a unique moment in the history of science and exploration. Yet, in many ways, it was reflective of work that is happening all the time, here on earth. The work of science, the building of social movements, the pursuit of knowledge, the shaping of policies that promote better lives, better health—these are all, in a sense, moonshots. They all represent aiming upward, marshaling time, data, and resources in pursuit of progress, of a better world for all. They are not solitary efforts. They involve working in teams, in communities, across disciplines and sectors. They can be deeply rewarding, helping to bring about much improvement, providing a glimpse—like earth seen from a spaceship window—of a brighter future we can all play a part in helping to build.

But these efforts can also include times when we feel isolated, when the way forward is obscured, when we are cut off from sources of support on which we have long relied, when we even feel, perhaps, a bit of existential anxiety about the future of our work and world.

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