Reconciling context, effort, and ability | The Healthiest Goldfish

Can we expand our thinking to better engage with the full range of forces that shape our lives, and our health?

In recent years, a highly polarized political discussion has emerged about meritocracy in the US. On one side of the debate is what might be called the classic view of American meritocracy, the Horatio Alger-esque story of striving one’s way to success through individual ability and effort. In this framework, all have more or less equal potential to rise, and it is only differences in individuals’ talent and effort that shape differences in life outcomes. This has arguably long been the dominant narrative about meritocracy in the US. More recently, however, a new narrative has emerged, one that in many ways aligns more closely with our public health paradigm. This narrative says that what has passed for merit (for example, doing well on exams, being promoted, or simply being healthy) principally is a product of engrained social systems. Structural forces—such as systems of historical injustice, present-day inequality, or marginalization due to identity status—have created a context which advantages some and disadvantages others. Forces like structural racism or class endowments which one is born with can generate both privilege and marginalization, and these are the key factors that determine how one does in life. While individual ability and action has a place in this framework, it is considered less significant than is the context within which we operate. This then leads us to an understanding of the world where seeming differences in ability and achievement are mostly differences in an individual’s relation to the foundational forces that shape our world. We should, this thinking goes, always take this into account in evaluating and rewarding what might seem to be the fruits of individual effort alone.

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Pride, Progress, and Challenges to LGBTQIA+ Health | Dean's Note

On celebrating Pride Month in a context of gains and setbacks for LGBTQIA+ rights.

I have long felt that public health is more than a series of policies and proscriptions against disease. It is also a celebration of community, of mutual respect and care, of the love and connections that support a rich, full life, of the diversity that makes our world a better, more varied place, and of the progress that advances a healthier status quo. This is what we celebrate each June, as we mark the arrival of Pride Month. Pride Month is a time for celebrating the LGBTQIA+ community, for acknowledging the many contributions of our LGBTQIA+ friends, family, students, and colleagues, for marking progress towards the full acceptance of this community, and for recognizing the challenges it still faces.

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What is reasonable? | The Healthiest Goldfish

On defining what is reasonable in pursuit of health, guided by our values, a sensitivity to context, and a pragmatic assessment of human nature and our own capabilities.

Most of us aspire to be reasonable. We do not set out to be irrational, to be easily swayed by emotion and bias. Rather, we try to ground our actions in reasonableness, with the understanding that such a standard is a good basis for living as individuals and as a society. The neuroscientist and philosopher Sam Harris wrote, “There is no society in human history that ever suffered because its people became too reasonable.” This seems to me, well, reasonable. We understand that, when our actions are informed by reason, we tend to make better choices for ourselves and for our world.

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Revisiting the question of “why health?” | The Healthiest Goldfish

We aspire to be healthy so that we can live full lives.

Let’s talk about health.

How we think about health is often wrong. In fact, we often do not think about health at all when we think we are thinking about health. What we think about is disease. We worry if we have a pain somewhere. We wonder if we are maybe diabetic. We brood about the possible causes of a chronic itch. We ask ourselves, “Did I just pull a muscle?” We may believe this constitutes thinking about health. But it does not. We are, in fact, thinking about the absence of health. We are thinking about disease. This mis-think extends to the public conversation. When health is written about in the media, it is more often than not in writing about disease.

I am sometimes asked to comment in the media on issues of consequence for health. Typically, I am asked to look at the world through the lens of disease—of how to avoid or treat sickness. I am asked about a particular new virus, about diseases of the heart or of other organs. This impulse to seek this perspective is understandable. There are few experiences in life more all-consuming than that of disease. When we are sick, our affliction is often all we can think about, and this is the case at both the individual and societal level. When we are in pain, when our body does not work as it should, it can become the central fact of our lives.

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On Choosing What We as a School Endorse | Dean's Note

Defining when we speak collectively as a community.

We are an activist school of public health, committed to creating healthier communities at the local, national, and global level. This is reflected in our school’s values statement:

We are committed to igniting and sustaining positive change that leads to health and well-being around the world. We strive for a respectful, collaborative, diverse, and inclusive community within our School of Public Health. We aim to promote justice, human rights, and equity within and across our local and global communities.

This means applying our knowledge and practice towards the goal of better health for all. It also means sometimes using our collective voice to support measures that will get us closer to this goal and speaking against policies that may harm health. There is, however, a range of issues, measures, policies that pertain to health and that may call for our collective attention.  At a simple operational level, the question therefore arises: should we as a school endorse a particular position, should we lend our collective name to a particular approach? In last week’s Note, I shared thoughts about how we can best support free and respectful academic speech by individuals within and at SPH. In today’s Note, an extension of last week’s theme, I will share some reflections on speech that we may—or may not—choose to endorse as collectively.

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On Supporting Free and Respectful Academic Speech | Dean's Note

Defining the limits of speech to help make space for debate that is truly open and inclusive.

Over the last few years, I have written several times about speech in an academic context. It is a topic which reemerges fairly regularly in our space, a natural result of working in a community of ideas supported by the values of free inquiry and expression. It is healthy to revisit these first principles, to ensure we are living up to our core ideals and that these ideals do indeed continue to reflect the best we can do as a community. Few principles are as fundamental to our community as our engagement with speech, the expression of our ideas.

The work of public health is, in large part, the work of acting on ideas and data that emerge from a context of free inquiry and open debate. This is reflected in our school’s mission to “Think. Teach. Do.” We are able to do because we can think and teach in a context where our minds can be truly open to the ideas and practices that shape a healthier world. It is important, then, to continually reexamine what we are doing to ensure our community supports such a context. With this in mind, today’s Note will be the first of a two-part reflection on speech and our community. Today will focus on the challenge of defining and engaging with objectionable speech and those who express views with which we do not agree. Next week will address how we speak collectively as an institution on issues of consequence, including issues of speech.

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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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