What is being asked of public health leadership in this moment?

On exercising leadership in pursuit of a healthier world.

I recently had the privilege of speaking at a European Public Health Leadership Course. I very much enjoyed being among the next generation that will lead public health in future. Most importantly, the event pushed me to pause, to note, through conversations with many in the group, that there is a universality of questions that public health is currently asking, questions like: what is leadership in public health? What are priorities for future leadership in public health? How does public health lead in a way that creates confidence in what we do? These questions are resonant worldwide, and even more so in the US in the aftermath of the national election where these very questions were of central importance to the national conversation and to the forward march of history. We are indeed in a time when leadership in health matters perhaps more than ever. Public health, along with science generally, faces a crisis of trust in the post-COVID moment. Challenges like chronic disease, addiction, gun violence, and persistent inequities continue to hold health back nationally and globally. We are seeing a rethinking of the institutions and social structures which, depending on their alignment, can help the health of the public or hinder it. Our capacity to address these challenges, to engage with this moment, is complicated by shifting political winds and voices from both within and outside the field calling for radical changes to how we do what we do. In such times, it is on all of us to rise to the occasion by showing the leadership the moment demands.

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Certainty as the great enemy of tolerance, part 2 of 2

Are we still sure about that?

In last week’s note, I introduced the idea that the certainty we adopt about issues can lead, not infrequently, to us being very wrong, and that this is true for ideas that emerge across the political spectrum. I highlight this perhaps as a caution to all of us, including those who may feel particularly certain of the rightness of their approaches in moments of electoral triumph or defeat. Today I want to build on that and return to Robert Harris’s line that “Certainty is the great enemy of unity. Certainty is the deadly enemy of tolerance.” Why did this grab me, why do I think it matters?

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Certainty as the great enemy of tolerance, part 1 of 2

Are we sure about that?

As the days post-election turn into weeks and months, there is much that is emerging that is alarming for health. There is also much that is speculative, with little clarity about the real implications of particular proposed actions by the new, emerging, federal administration. Trying to heed my own words, I am refraining from over-investing in comment or dispositive certainty about any of this, aiming to keep an open mind, and to think carefully about how I can be most effective, towards hope. If anyone is interested in comment on the more acute contemporary swirl, I offer thoughts on LinkedIN, and a brief note to our internal Boston University School of Public Health community is here.

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The Power of Culture

What causes a change in scientific interest? A new theory can produce a paradigm shift. Funders from the public sector have great influence in driving research teams down particular tracks. Researchers are sometimes also influenced by what has commercial potential. One other driver of scientific interest, much less discussed, is culture itself. We can think of two important examples, one related to brain science, the other related to reproductive health, where culture shifted and with it shifted the focus of science.

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Challenging the Challenges to Science

The 2024 election has made clear that public health will need to continue its outreach, its defense of important health values, and its ongoing commitment to translating science fairly, humbly, and without partisanship. Not only engaging in conversations, but also trying to influence them is now, more than ever, part of our mission. Given this, we are re-sharing a recent essay on combatting misinformation and restoring trust in science.

In his 1997 book “The Art of the Comeback,” then future President Donald J. Trump said that asbestos was “100% safe” and “got a bad rap.” The science on asbestos as a risk factor for a broad range of cancers has long been settled, with little meaningful dispute about the product’s harms. But Trump’s book, which was a bestseller, had reach, and was part of an effort to sow doubt about a product that seemed to have inconvenienced his efforts in construction projects. 

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The Political Uses of Science

During the COVID-19 pandemic it often seemed as though science was at the heart of every public discussion. Public argument flared about the science behind novel vaccines, masking recommendations, and decisions around school closures. Much of this discussion was entirely reasonable debate about still contended and new science. But some of it was fueled by political actors, aiming to advance particular political—and heavily partisan—agendas. Science tries to identify truths about our natural and social world. Politics aim to advance a vision of the world informed by a particular ideology that often looks to whatever means are available, including science, to advance its own ends. 

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Elitism and Science | Observing Science

Science is carried out by experts. More than a century ago, the rise of German universities as forerunners of the modern research university created a model whereby certification—usually in the form of a doctorate—creates a class of working scientists. This approach suggests that the work of science is being carried out by the meritorious few, a class that anyone, through hard work, can join and contribute to.  

But, as is often the case, merit is not exactly what it seems at first glance. In the past 50 years, the proportion of U.S. PhD students who have a parent with a post-graduate degree has tripled. For most fields, more than half of PhD students have parents with post-graduate degrees, and fewer than a fifth have parents without a four-year degree. When one recognizes that fewer than 40% of Americans have a four-year college degree, it becomes clear that the work of science continues to be carried out by a very select slice of the population.

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Three directions to push forward The Healthiest Goldfish conversation

Reflections on a transition.

In my last essay, I shared some reflections on the themes of these essays over the past year or so, looking back while also looking ahead to the next evolution of the conversation about health. Since then, I have had several readers reach out to me to ask if I was sunsetting The Healthiest Goldfish as a result of that note. Far from it. What I was doing in the last note was looking back on a cycle of essays, to pave the way for a new cycle of ideas. So, I thought today I would do something a bit more self-reflective, thinking though some ideas that have been percolating in my head for some time, and outlining the key areas I am hoping to focus on in my writing in this space in the coming year. As the health conversation has evolved, I have continually asked myself how these essays should also evolve, to do the most good in the moment, not simply reacting to events and ideas that emerge but playing a role in shaping them, nudging them in a more positive direction, ever closer to our goal of health. This means asking now: what role should The Healthiest Goldfish play in the months and years to come? What kinds of conversations should we engage in to create a better world in this moment? 

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