Centering proportionality in public health thinking | The Healthiest Goldfish

On doing the most possible good while doing the least possible harm.

There is an old saying from the world of competitive fencing, one that is used to teach beginners how to hold the foil—a light, flexible blade used in the sport. The saying is, “Hold it like you would a bird. Too tight and you choke it. Too loose and you let it fly away.” That is proportionality. The pressure applied to the foil must be in proportion to how much is necessary for maintaining control. Too firm a grasp prevents the fencer from wielding the foil nimbly. Too loose a grasp and an opponent can easily knock it to the floor. Success lies in applying the right proportion of strength—no more, no less.

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The right amount of risk | The Healthiest Goldfish

On shaping a better engagement with risk guided by a practical philosophy of health.

I have been thinking a lot lately about risk and its role in our understanding of health. Risk, by definition, is our estimate of the potential for X outcome—that outcome being, in the case of health, sickness or injury. Most of us have an intuitive understanding of the link between health and risk. We regularly make choices about our health that involve our perception of what is risky and what is not. Such choices include choosing not to drive when it is icy, avoiding certain food brands when a recall is announced, and wearing sunscreen to the beach. We also factor in risk when making choices with an eye towards the long-term, such as choosing to live in a safe neighborhood, opting not to skip annual doctor’s appointments, and embracing regular exercise. We make these choices based on a calculation of risk. We think about the risk of taking or not taking certain actions and we decide to do what we think will keep us safe and healthy.

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Leaving behind values disguised as science | The Healthiest Goldfish

On shaping a science that supports a new, post-war vision for public health.

In my book, Healthier, I proposed that the work of public health is best served not just by the generation of data but also by the promotion of values, and that positive change happens at the intersection of science and values. We shape a healthier world by building a base of knowledge while working within the broader culture to advance the values of public health. This means working to build collective engagement with the foundational determinants of health—the social, political, commercial, environmental, and technological forces that shape the health of populations—with special care for how these forces affect the marginalized and vulnerable. These are our values, the first principles of our field. Shaping a healthier world is as much the work of these values as it is of our data.

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The potential, and limits, of science | The Healthiest Goldfish

On shaping a science that supports a new, post-war vision for public health.

Improving the health of populations depends on science, on building a foundation of knowledge that helps guide our actions. I have previously written about how the work of public health rests on the work of population health science. My book, Population Health Science, co-written with Dr Kerry Keyes, and several other commentaries such as this 2017 article in Epidemiology, were efforts to help advance the fundamentals of the field—the science at the heart of all we do. 

At this post-war moment, when we are looking to build new foundations for public health, a focus on science to help us to ground these efforts has never been more important. Therefore, today’s Healthiest Goldish is the first of two essays on the role of science in the work of public health—on its strengths, its limits, and its intersection with the values of those who practice it. 

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The ineluctable role of persuasion | The Healthiest Goldfish

On the importance of working to convince rather than compel.

“A quarantine officer cannot just introduce restrictions and rely on the threat of military force to implement them; he must also seek to persuade people to adhere to those restrictions of their own volition.” 

This passage is from Nights of Plague, the novel I am reading now, by Orhan Pamuk, one of Turkey’s most decorated contemporary writers. The novel is about the arrival of a plague to a religiously and culturally divided island in the Ottoman Empire in 1900. Nights of Plague contains much that is relevant for how we think about pandemics, the societies they strike, and the public health authorities tasked with addressing them. The passage above speaks to something that we arguably do not talk about enough in our conversations about how to encourage compliance with public health best practices in both normal times and in times of crisis: the value of persuasion. In the last Healthiest Goldfish, I wrote about the value of performance, about how the roles we play can help us to better support the health of the public. Persuasion is a natural extension of this conversation about how our public presentation can best serve our work. Some thoughts, then, on the importance of persuasion and the steps we can take to become more persuasive as a field.  

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The right amount of performance | The Healthiest Goldfish

On ensuring the roles we play are consistent with our values.

We live in a culture that values authenticity. It is never hard to find books, articles, films, songs and other media extolling the virtues of being our authentic self, of transcending the barriers that keep us from showing the world who we truly are. In this context, it can be uncomfortable to consider the ways we might embrace a level of performance in how we present ourselves. Yet I will start today’s essay with a perhaps countercultural assertion: We perform all the time. We perform in what we say, what we do, how we dress. For example, as I write these words, I am wearing what I usually wear to work: A formal suit with a jacket. I am writing the way I tend to speak in professional settings, with formal language. This is, to an extent, a performance. I am choosing to present in these ways in the hope that doing so will help me to better navigate the spaces I inhabit and better serve the interests of public health. In this sense, performance is a tool, a means to the end of helping to advance our mission.

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The Turkey-Syria Earthquake and the Challenge of Disasters | Dean's Note

On our responsibility to create the conditions that mitigate disasters—preventing them when we can and supporting the physical and mental health of survivors when we cannot.

It has been hard to look away from the stories and images coming out of Turkey and Syria in the wake of the recent earthquake in the region. As many as 15,000 people have been reported dead, a number which will undoubtedly rise. Each day brings a new haunting image, a new story of how the disaster has affected individuals and families, a new reminder of the devastating effect of mass traumatic events. As the tragedy continues to evolve, my thoughts are with all of those who have been touched by this disaster, particularly the members of our school community with connections to the region. The process of recovery will be long. The physical and mental health effects of disasters can last years, even a generation. Thank you to all who are working in concert with global public health efforts to assist with the recovery. 

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On a new practical philosophy of health | The Healthiest Goldfish

Public health after COVID-19 is in a “post-war” moment, a time for revisiting the philosophical underpinning of our field, to ensure it aligns with the evolution of our collective values.

Recently, it was announced that Noma, often called the world’s best restaurant, is closing. This announcement was even more notable for the reasons behind it. Noma is not closing due to lack of demand—which, given the restaurant’s reputation, remains high. Nor is it closing because the co-owner and head chef, René Redzepi, is retiring. He is still relatively young and has already stated his intention to turn the Noma brand into something new, transitioning to a food lab with occasional pop-up restaurants. Instead, Noma in its current form is closing because Redzepi feels the business model is unsustainable, resting as it does on punishingly long hours and the labor of interns who, until recently, went unpaid for sometimes grueling and monotonous work. Redzepi said of this model, “Financially and emotionally, as an employer and as a human being, it just doesn’t work.”

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