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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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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