When our biases get the better of us | The Healthiest Goldfish

Reckoning with the often-invisible biases that shape our work.

The work of creating the conditions that generate health is, at its best, about the pursuit of truth. To improve the health of populations we must engage with the truth about the world in which we live—the reality of the systems and structures that generate health. Just as we would not build an aircraft based on distorted design specifications, the work of public health needs to be grounded in foundations that reflect reality. Yet, if we are honest with ourselves, it is hard to escape the conclusion that we sometimes fall short of this ideal. We are human, and, as humans, our relationship with the truth is refracted through how we see the world. And we do not always see the world the way it is. Much of the time we see the world through our own lens, and that lens can be colored by biases. Perhaps my favorite definition of bias is “a preference or an inclination, especially one that inhibits impartial judgment.” That seems about right. It is our own take on things, and that take inhibits us from seeing the world as it should be. This is true in our daily lives, in all we do, and, for today’s reflection, in our science.

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Reflecting on the Lessons of Juneteenth | Dean's Note

We need to acknowledge the worst of our past to shape a better future

On Monday, we will celebrate Juneteenth, a day that commemorates the issuing of General Order No. 3, which freed enslaved persons in Texas, the last place in the US where slavery still continued in the final days of the American Civil War. Union General Gordon Granger issued the order on June 19, 1865, two months after Robert E. Lee surrendered his forces at Appomattox Court House, and over two years after President Abraham Lincoln gave his signature to the Emancipation Proclamation. 

Despite its significance, Juneteenth was only recognized as a federal holiday in 2021. This is typical of the delay which too often accompanies the work of addressing the realities of racism in the US. Slavery existed for centuries before it was abolished, the Emancipation Proclamation was signed years before its effects were fully felt in the South, and the Civil War had been over for two months before enslaved persons in Texas gained their freedom. Delay, deferral, the “bad check” Dr. Martin Luther King, Jr. spoke of America giving its Black population—these have been defining characteristics of America’s engagement with its history of racism and the effects of this history in the present. This has kept the legacy of slavery and racism part of the American landscape long after General Granger issued his order, an influence which pervades much in the current moment. Part of the conversation about race that has emerged over the last few years has been about how it has been possible to overlook this, to fail to notice the many ways the effects of an unjust racial status quo still permeate American life. If we are willing to look closer at what we have called progress, we can see the many ways it is incomplete, reflecting the unfinished work that is America itself. 

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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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