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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Defining the parameters of debate

How to cool the temperature of our often-heated public conversation

In a contentious climate, issues are often reduced to binaries. Time and again, we see the drawing of sharp dividing lines, with the insistence that the correct approach to an issue is found exclusively on one side, the incorrect approach on the other, and no room in the middle for nuance or common ground.

This creates a false choice problem. Complex topics (e.g. immigration, gun control) are framed as all-or-nothing propositions, even though few people actually hold an absolutist view on a given issue. Surveys find that many Americans hold nuanced views, but the public conversation stays polarized in part because moderate voices are drowned out in the public debate. Extreme clarity (or, rather, extreme simplicity) is often rewarded, whereas engaging with nuance can be perceived as weakness or lack of loyalty to one’s “side.” This is perhaps at the heart of the polarization of this moment, and of the growing sway of extremism in our politics and culture. When there are only two sides, this is little room for complexity. Without complexity, we are left with only extremes.

How can we escape this cycle, and return complexity to our conversations? This is a question with many possible answers. A modest step perhaps, but potentially game-changing, could be simply to do a better job of defining the parameters of debate—being clearer about what it is we are actually talking about, rather than ceding the territory of debate to the false choice binaries with which we are so often presented. Voltaire said, “If you wish to converse with me, define your terms.” Such precision helps prevent us from talking past one another, or from mischaracterizing the positions with which we engage.

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On the difference between novelty and insight

And why that matters for the world of ideas

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

We live in a world that often appears to love the new, from new technologies and products, to new policies, to new publications, carrying an inbuilt assumption that if an idea is new, it is worthy of focus. Our brains are wired to light up at new things. Neuroscience shows that our reward system is stimulated by novelty; encountering an unfamiliar idea or object triggers curiosity and attention. This “novelty bias” can be useful, it pushes us to explore and learn, but it also creates a cognitive fallacy: we often assume something is better simply because it is new. Psychologists call this the novelty fallacy, the informal belief that newer equals better. In modern life, we see it everywhere. We rush to buy the latest smartphone or try the hottest trend. The same bias applies to ideas: the latest theory or discovery grabs our interest more than well-trodden knowledge, regardless of its actual value.

Social media and news amplify this bias. Online, algorithms favor fresh content and surprising or attention-grabbing headlines because they are the posts that engage us most. False news (often novel and sensational) spreads far faster and wider than truthful news on platforms like Twitter. Why? Because we are likelier to share novel information, creating an algorithmic amplification of novelty: outrageous rumors and click-bait ideas get disproportionate attention, while nuanced or familiar truths get drowned out. The result is an information ecosystem where the loudest voices (often pushing novel or extreme claims) eclipse the most thoughtful voices. The design of our digital platforms, optimizing for engagement and rapid reaction, fuels this cycle, making it ever more tempting to equate newness with importance as we will discuss in a future essay on ideas and the attention economy.

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“Grace is not weakness but resolve.”

The power of embracing grace in this moment.

We are living in contentious times. In such times, we often face the question: how should we respond? This has been the central question of many essays in The Healthiest Goldfish over the past year. It is a question which implies others: when should we speak out, intervene? When should we accept disruptive change as, potentially, beneficial, and when is it just disruption for its own sake? When does enforcement of policies we dislike—but which are, ultimately, legitimate expressions of the popular will—tip into injustice that demands a response? How should we ensure our responses are both prudent and effective in this moment? How do we maintain our moral integrity in a time that incentivizes expedience and cynicism? How do we address assaults on small-l liberalism without becoming illiberal ourselves?

As I have wrestled with these questions, I have found myself turning to the concept of grace. What is grace? It has many definitions, including “mercy, pardon,” “benevolence, goodwill,” and “ease and fluidity of movement or manner.” It also has a theological resonance, a perspective from which Andrew Sullivan wrote when he described grace as:

“…those precious, rare times when exactly what you were expecting gives way to something utterly different, when patterns of thought and behavior we have grown accustomed to and at times despaired of, suddenly cede to something new and marvelous. It may be the moment when a warrior unexpectedly lays down his weapon, when the sternest disciplinarian breaks into a smile, when an ideologue admits error, when a criminal seeks forgiveness, or when an addict hits bottom and finally sees a future. Grace is the proof that hope is not groundless. “

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The moment

Our role in an unsettled, tumultuous time.

It is not my role, or aspiration, with these essays, to comment in real time on all that is happening in the world around us. I try to use this space to pause, to step back and reflect on the bigger picture—the longer arc of the issues that shape the world around us and that, in turn, shape health. It is, however, difficult to ignore events when they occur so fast and with such implications for our work—our mission of thinking, writing, and acting in pursuit of a healthier world. This feels like such a moment, one that bears reflection. Globally, we are seeing a fraying of a world order that has held for the past 75 years, as old alliances are being called into question like never before in recent memory, leaving us to wonder what shape geopolitical forces will assume and what implications this realignment will have for war and for peace. Conflicts continue to rage, from the war in Ukraine to the Iranian government’s recent killing of as many as 30,000 of the country’s citizens. Nationally, we have seen a threat to foundational political structures that we have long taken for granted, as the executive branch strains against the judicial branch. Aiming to deliver on campaign promises to change immigration in this country, the administration has launched increasingly alarming and cruel immigration enforcement measures, culminating in deaths. Protests against these efforts in Minnesota have galvanized national and global attention. All this is unfolding against a backdrop of ever-more-apparent extreme weather events, such as the one we are living through across much of the US this week, even as the drivers of climate change are neglected in federal policy.

This, then, is a moment that calls for reflection. In such times, it can feel simultaneously as though so very much is happening everywhere, all at once, and also as if the world is standing still. So much is happening that it seems like the pace of events cannot long continue at this pitch—there is disequilibrium here, and it feels like something must soon give. We are holding our breath, waiting to see what that might be, what new form the world will take. We wonder how we might act to be helpful in the moment. What can we do to help ensure the new world that emerges is better, not worse? We can sense the danger, and also perhaps the potential, all around us. This reminds me of a useful aphorism by Antonio Gramsci: “The old world is dying, and the new world struggles to be born; now is the time of monsters.” So yes, it is a moment of danger—one that affects many of us in deeply personal ways. It affects those who, like me, are immigrants to this country, facing the ever-present threat of “othering” that has become normative in the public political conversation, and the very real threat of expulsion. It affects those who have lost jobs, or have family and friends who have lost jobs, in sectors radically transformed over the past year. It affects families who continue to find the country’s economic imbalances unsustainable and have a hard time making ends meet. It affects communities devastated by climate disasters, forced to rebuild their lives amid increasingly volatile conditions. The moment is not abstract. It is real, tangible, and affecting humans every day.

This brings me back to the question: how can we constructively engage with this moment? What is the role of those of us in the community of thinkers and doers focused on the health of populations? What should we do when the world seems to teeter on the brink of…something? How do we help nudge an unstable world in the right direction? I have found myself reflecting on this time and again over the past tumultuous decade, and perhaps never more so than in this past year, when that tumult seems to be approaching some sort of crescendo. In reflecting, I keep returning to three principles. I share them here—partly to sharpen my own thoughts through writing, and in the hope that they may be useful to those who read this

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Introducing the Purple Public Health Project

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

America needs public health. It needs public health to address urgent challenges—from obesity and cardiovascular diseases, to gun violence, to mental health and addiction, to persistent health inequities shaped by factors like economic status, race, and geography. It needs public health because we have already seen one global pandemic in the 21st century and will likely see more. It needs public health because climate change is real and poses significant risks for health, including for the health of the growing population of migrants forcibly displaced due to climate-driven shocks. It needs public health because the world needs public health, and America, for all the ruptures of recent years, still has the capacity to underwrite much that is good for the world.

America needs public health. Unfortunately, American public health is facing some daunting challenges.

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The art of being ourselves

Balancing pragmatic engagement with maintaining our identity and values.

We are in a moment that is marked by political upheaval, social division, and urgent challenges that demand engagement. The turbulent national and global moment has made it increasingly clear that if there ever was a post-Cold War “holiday from history”, it is certainly over. We may not yet be sure of exactly what the moment demands of us, but we sense it demands something, that passivity in the face of this new era is not an option. History moves, and we must move with it.

And the moment calls us to do, to take constructive steps towards a better future. We have a vision of where we want to go, a vision informed by our deepest values. We are moved to build a world where no one is excluded from health, where injustice and inequity no longer exist. This is a radical vision, and it is central to who we are in public health. The values that inform this vision give public health its meaning. Without our vision of better health for all, we would not be able to be who we are, do what we do.

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The time to build is always

Meeting the moment in the new year.

As we all return from hopefully a restful holiday season, I start 2026 with a nod to the seasonal. In A Christmas Carol, three spirits visit Ebeneezer Scrooge. The Ghosts of Christmas Past and Present are quite loquacious. But the third spirit—the Ghost of Christmas Future—says nothing. It shows Scrooge possibilities, a vision of his fate if he does not change his miserly ways, but it keeps its own counsel about what will ultimately be. Scrooge asks, “Are these the shadows of the things that Will be, or are they shadows of things that May be, only?” The ghost says nothing.

It is the start of a new year, and we face the same unknowability. We look to the future, wondering what 2026 holds. We try making predictions, as some years seems possible. In January 2024, for example, we could reasonably expect the year to be dominated by the American presidential election, and it was. Other years, however, events are a right hook coming out of nowhere. We thought we had some sense of the future in January 2020, then a pandemic came and knocked us off our feet. We spent the years since getting, sometimes unsteadily, back up. We learned much from the COVID moment; nothing more so, perhaps, than that the future always reserves the right to defy augury. We might do well to remember this.

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