At core, public health aspires to strike a balance between the moral and the empirical case for health. I have long thought that at times public health arguably did not go far enough in advancing the moral case. This is what motivated me to argue in the past for an epidemiology of consequence. In that, and subsequent writing with Katherine Keyes, I argued for an approach to public health which, at its core—guided by the moral imperative of generating health for the greatest number of people—aims to apply its empirical knowledge to the pursuit of a healthier world. This means prioritizing, on moral and empiric grounds, engagement with the issues that matter most for health, our research guided first and foremost by the demands of human need, with an eye towards doing the most practical good.
In recent years, the pendulum has indeed swung in this direction, towards a consequentialist public health guided by the moral case for health. Our collective balance, our effort to find the right mix of moral and empiric motivation has been tested perhaps like never before during COVID-19. This is understandable. Issues of consequence for health are, by definition, matters of life and death, which concern the wellbeing of everyone—both present and future generations—and matter with particular urgency when we are all, or some of us are, vulnerable. COVID-19 has been particularly troubling as we often found ourselves needing to make a moral case faster than empiric evidence was readily available. And yet, despite this challenge, it continues to seem to me important to make sure that for our arguments to most successfully support health, they should aspire to strike a balance between the moral and the empirical. And that this is perhaps even more the case in a time of crisis. Today’s Healthiest Goldfish reflects some thoughts on how we can regain, and maintain, this balance.
The below grid is meant to help visualize how we might approach this. It was inspired by Donald Stokes and his book, Pasteur’s Quadrant: Basic Science and Technological Innovation. Each of the grid’s quadrants contains an action which could arguably help create a healthier world. The quadrant at the top left is for steps for which the empirical case is strong, but the moral case needs development. The bottom left is for steps for which both the empirical and moral case need development. The bottom right is for steps for which the moral case is strong, but the empirical case needs development. The top right is for steps for which both the empirical and moral cases are strong—this is where all our arguments should aspire to live.
Read the full post on The Healthiest Goldfish.