Placing Transgender Health at the Heart of Public Health | Dean's Note

On public health’s responsibility to support the dignity and health of transgender people.

Last Tuesday, the US Senate passed the Respect for Marriage Act, which would codify marriage rights for same-sex and interracial couples. The bill passed with bipartisan support in a vote of 61-36. The drafting and passage of the bill happened in a context of uncertainty around the future of marriage rights. This uncertainty was informed, in part, by Justice Clarence Thomas’ stated belief, with the recent overturning of Roe v. Wade, that the Supreme Court might consider revisiting its ruling supporting marriage equality. These comments were part of a larger ecosystem of backlash to LGBTQ+ rights we have seen in recent years, making it all the more urgent that these rights be protected. It is progress indeed that Congress acted decisively to ensure that the fundamental right to marry will no longer be subject to such uncertainty.

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Reimagining How We Support Persons Living with Disability | Dean's Note

It is time for public health to contribute to a world where disability is not merely accommodated but uplifted.

A key theme of my writing has long been the question of what health, fundamentally, is. Is health just the ability to treat disease? Or is it the creation of a world where everyone can access the resources—the dignity and material assets—that support health? I argue that health is the latter, that a healthy world is one that is maximized to allow as many people as possible to flourish and thrive. In many ways, we have made remarkable strides towards the creation of such a world. People are living longer, healthier lives than ever before. We have shown greater willingness to address the inequities that underly health gaps, recognizing the historic injustice that often informs these inequities. Yet the continued existence of health gaps reflects the reality that our progress has not gone far enough, that there are still areas, and many, where we are falling far short of where we should be.

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Our moral obligation to show compassion for migrants | The Healthiest Goldfish

We have a responsibility, informed by history and our common humanity, to support those who migrate in search of a better life.

Last summer, a tractor-trailer was found abandoned in San Antonio, Texas. Inside the truck were migrants from a range of Latin American countries including Mexico, Honduras, and Guatemala. By the time they were found after being left by smugglers in sweltering heat, 53 had died.

More recently, Florida Governor Ron DeSantis flew two planeloads of migrants to Martha’s Vineyard, in a political stunt aimed at criticizing President Biden’s border policies. The purpose of the flights was made clear by DeSantis’ communications director, who said, “States like Massachusetts, New York, and California will better facilitate the care of these individuals who they have invited into our country by incentivizing illegal immigration through their designation as 'sanctuary states' and support for the Biden Administration’s open border policies.” This action by DeSantis was part of a growing trend of governors of conservative states sending migrants to liberal states, or even to the homes of politicians perceived to support more relaxed border policies. Actions like these are truly appalling.

A surprising, hopeful election | The Healthiest Goldfish

Thoughts on the midterms and, perhaps, the beginning of a return to useful radical politics.

Last week, the country went to the polls to vote in the midterm elections. While the full results are not yet in, and likely will not be for some time, it looks like Republicans may narrowly win the House, with control of the Senate still undecided. These results have implications for a range of key issues, from guns, to climate change, to reproductive rights, to economic inequality, to addressing social and racial injustice. Fundamentally, such issues share a common link: they are all deeply consequential for health.

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Debating tradeoffs, sharing ideas | The Healthiest Goldfish

Some thoughts, informed by recent conversations, about the role of public health in the present moment.

Last month, Dr. Sarah Dupont and I published a paper in The New England Journal of Medicine on science, competing values, and tradeoffs in public health decision-making. We looked at these issues through the lens of masking during the COVID-19 pandemic. The piece was animated by a concern for balancing the core values of public health with the pragmatic demands of advising policymakers in a context of incomplete or evolving information. We argued that public health should shift away from the all-or-nothing dynamic that characterized many pandemic-era debates (over masking, lockdowns, school closures, etc.), recognizing that the local context in which decisions are made can involve a level of nuance often lost in the broader public debate. It is up to us to provide data-informed guidance to policymakers as they weigh this nuance and consider the tradeoffs inherent in choices about health policy. In doing so, we should continue to be guided, always, by our core values: the pursuit of healthy populations, with special concern for the marginalized and vulnerable.

Read the full piece here.

Calling out the horrors of mass incarceration | The Healthiest Goldfish

Addressing a uniquely American problem.

The US incarcerates more people than any other country in the world. There are currently two million people in prisons and jails in this country. Yet mass incarceration, for all the lives it touches, does not affect all lives equally. Black men are six times likelier than white men to be incarcerated. Latino men are 2.5 times likelier to be incarcerated than white men. These numbers reflect a system that arguably does not simply punish those who have committed crimes in proportion to their offenses. Rather, it reflects a deeply biased system that has created a crisis in this country.

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Not in the name of public health | The Healthiest Goldfish

When the goals of public health are used to justify authoritarian overreach, we have a responsibility as a field to say “No.”

One frequently overheard phrase in our field is “in the name of public health” or some equivalent like “in the interest of public health.” This phrase is often applied to the interventions we promote with an eye towards shaping better health for all. Through the years, we have done much in the name of public health. We have promoted handwashing at a time when the practice was still novel and distrusted. We have argued for better sanitation systems and city design to slow the spread of disease in urban spaces. And we have urged greater focus on engaging with the socioeconomic drivers of health as a means of creating a healthier society and preventing disease from taking hold. The range of this work illustrates the breadth of the initiatives we can pursue in the name of public health.

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Advancing Health Equity: Learning from Other Countries | The Commonwealth Fund

Area of focus: Advancing Health Equity

The COVID-19 pandemic has exacerbated longstanding racial disparities in health in the United States and highlighted the need to address inequities across a range of health system functions. All countries face their own unique inequities in health status or in the distribution of health care resources among different population groups. We looked at how eight high-income countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, and the United Kingdom) have sought to change the mindsets of health care leaders and professionals, measure and dismantle racism in care delivery, and promote equitable access to care. The eight countries finance health care very differently than the U.S. and are affected by racism and income inequality in varying ways. Nevertheless, they offer lessons and practical strategies for supporting historically marginalized groups and reducing health inequalities.

Read the full piece here.