We may disagree | The Healthiest Goldfish

On ideas, criticism, and the generative debates that shape a healthier world.

In recent writing for The Healthiest Goldfish, I have argued that we are in a post-war moment for public health. By this I mean that the disruption of the pandemic created space for a reimagining of public health, a shoring up of its foundations by integrating the lessons of COVID into what we do, to shape a new practical philosophy for our work. This has meant asking questions about what is most fundamental about what we do. Questions like: What is health for? What are the limits of science? How can we better center proportionality in public health thinking? How do we reconcile the role of individual behavior in shaping health outcomes with the structural drivers of health? How should we think about the influence of context, effort, and ability in shaping these outcomes?  

These questions are consistent with writing I have done for many years in an effort to engage with the issues that matter for public health. I write because I have long believed that this is how ideas shift and change—through a process of thinking, writing, and debate. Participating in this process can, over time, help to change the paradigm around health, getting us closer to a healthier world. I encourage others to engage in this process, toward the goal of a more inclusive public conversation with many perspectives represented. Writing is at its best when it is a conversation, a debate. It is in the space between different views, in the generative conflict of ideas, that we sharpen our thinking and elevate the ideas that create a better world. As long as I have had a voice that people have listened to, I have seen it as part of my responsibility to engage in these conversations. This was the case at the beginning of my career, and it remains core to my current role as Dean of a school of public health. As such, I welcome views that are different from my own, I learn from them, and I would consider my time poorly spent if I did not, in the course of my daily reading, encounter one or two pieces of writing which challenge how I see the world.

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The astonishing privilege of living in a high-income country | The Healthiest Goldfish

On the advantages of resources and geography that shape how we think and what we do.

Part of the work of promoting health is engaging with the role of privilege. There are many kinds of privilege, and essentially all forms of privilege influence health. There is the privilege of getting a good education. There is the privilege of being financially well-off. There is the privilege of having regular access to good food. All of this contributes to our health. But, in addition to shaping our health, privilege also shapes our perspectives, the worldviews we bring to the very work of promoting health. That means that if we are concerned with health, we need to be engaged in an ongoing process of acknowledging our privilege, to see clearly the forces that create a better world, to ensure that the resources that support health are not exclusive to a privileged few.

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Welcome, with a Focus on Inclusion | Dean's Note

On the values that shape our community, as we look ahead to the coming year.

Welcome to the 23-24 academic year. To all our returning students, staff, and faculty, I hope everyone has had the opportunity for a restful summer break. To our new students, staff, and faculty, it is wonderful to have you join our community. I think, and hope, you will like it here.

As we enter the academic year, it seems appropriate to take a step back, to revisit the values that animate what we do. Our mission is to improve the health of populations. We do this through our scholarship, teaching, and engagement with the world of practice. And we do it by contributing to a better world, a more inclusive world, one where everyone is part of the conversation about health, and no one is excluded from the conditions that support a healthy life. Creating this world starts here at the school, where we aspire to be a school community that models the kind of world we would like to see. It is a privilege to be part of a community that embraces these core values, values that have remained constant throughout the school’s history.

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Who speaks for health? | The Healthiest Goldfish

On the role of community voices in the work of public health.

Public health is concerned, correctly, with putting the community front and center in all we do. This reflects our intent to listen to community priorities and to center the needs of the communities we serve. We cannot fully address these needs if we do not engage with communities, making sure that we bring into the conversation those who are affected by the work of public health. One would be hard pressed to find much disagreement with this statement in public health today. And yet, the practice of engagement with communities can be substantially more complicated than this statement might suggest. Balancing the values, data, and often-evolving science that informs the work of public health can at times lead to uncomfortable conflict between the various considerations that inform the work of public health. Starting from a place of appreciation for, and elevation of, the community engagement that is central to our work, I wanted today to ask some perhaps difficult questions about what we mean by “community” and the extent to which our engagement with communities is sometimes complicated and requires careful thinking about what we do, and why we do it.

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Centering human rights and autonomy for all | The Healthiest Goldfish

On centering a concern for the dignity, autonomy, and values of the populations we serve.

One of the most important intellectual strands in public health over the last century has been the development of a health and human rights approach. This approach reflects the understanding that health is inseparable from the social and political rights that support the dignity and autonomy of the individual, and that efforts to improve health must engage with these factors. This echoes the concern for human rights as a global aspiration that emerged in the aftermath of World War II and that is expressed in documents like the Universal Declaration of Human Rights. As our concern for human rights has evolved, so has our understanding of what human rights means in a context of health, our focus broadening beyond healthcare to include the core drivers of health. Such a focus aligns with the spirit of the Declaration, which says:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

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When our values are not shared | The Healthiest Goldfish

On the misalignment of values that can cause the public to reject our efforts.

When we understand that the health of populations is shaped, in large part, by the world around us, it becomes clear that our work is to create a world that generates health. Concretely this means a world with less violence, safe water to drink, clean air to breathe. Creating such a world requires the promotion of a radical vision of the right way to create health and commensurate efforts to discourage approaches that harm health. Reduced to its core element this becomes work that is engaged with a fundamental conflict between right and wrong.

How do we determine what we consider to be right?  In large part that emerges from the empirical foundation of population health science that should be core to all we do. But, data alone cannot tell us everything about which actions to take. Our choices about what is best for the health of populations should be shaped by a balance between our data and our values. This pushes us then to ask: what are the values we embrace in public health and adjacent fields that take as their core goal the creation of a healthier world?  Through this recent set of essays on shaping a new practical philosophy of health I have been hoping to support a process of reflection about this question. But, of interest today, and just as importantly, what should we do when our values are challenged, even forcefully rejected, by the populations we aim to serve?

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The biases we bake into our systems | The Healthiest Goldfish

Our human tendency towards bias can become entangled with the networks and institutions we create.

On November 30, 2022, OpenAI launched ChatGPT, an artificial intelligence chatbot. Since its launch, ChatGPT has already done much to influence how we work, communicate, and think about the role of artificial intelligence in our lives. The speed at which this influence has been felt calls to mind the early days of the internet as we engage with an emerging, potentially world-changing technology. The speed of AI development has raised concerns about AI safety, including the worry that AI could become too powerful too quickly, generating humanlike consciousness with the power to outpace us, in a scenario echoing many a science fiction film. While AI likely has a long way to go before it reaches this stage, if indeed it ever does, in one respect it may already have shown signs of being all-too human. As users familiarized themselves with ChatGPT, concerns have emerged about what appears to be a political bias in its “thinking.” Recent analysis found ChatGPT to have a “pro-environmental, left-libertarian ideology.” In a commentary for Brookings, Jeremy Baum, and John Villasenor wrote of testing ChatGPT by asking it a range of questions about political issues. OpenAI CEO Sam Altman has commented on the issue, saying that ChatGPT has “shortcomings around bias” which the company is “working to improve.” These biases reflect more than just the growing pains of a new technology. They reflect how a tendency towards bias—to which we are all susceptible—can become embedded within the systems we create.

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Affirming Our Values in a Post-Affirmative Action Era | Dean's Note

On continuing to pursue equitable admissions practices.

This week the Supreme Court issued a decision ruling against the consideration of race in higher education admissions. While this decision had been long expected, it is still disappointing, a setback for the work of shaping more equitable admissions processes. The ruling poses a challenge to the promotion of diversity within higher education and runs counter to a vision of work founded on creating pathways for underserved communities. President Brown, in his note to the community, reaffirms Boston University’s values, and sets the stage for the University’s further work in reviewing our admissions practices. 

As this evolves, I wanted to reflect on this moment from the perspective of public health. As a School we remain committed to shaping a diverse, inclusive community that is representative of the populations we serve. As with past Court decisions, while the legality around key issues may change, often with implications for public health, the core principles which underlie our work will continue to be as they have always been. Our commitment to diversity and inclusion remains a central value which serves as an organizing principle for all we do. 

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