The integrity of the mission to promote health

On being clear on values that guide both thought and action

In “Letter from Birmingham Jail,” Martin Luther King Jr. wrote “In any nonviolent campaign there are four basic steps: collection of the facts to determine whether injustices exist; negotiation; self purification; and direct action.” This is an interesting statement for several reasons, each deserving of its own essay. But what has long struck me most about it is its call for anyone looking to create a better world to first engage in “self purification.” I take this to indicate the importance of carefully examining our values and motivations, to ensure that they support actions that can build a better world. Such work is difficult, and it is on us to make sure that before we do anything we think deeply about the first principles of our work—the values that underlie all we do. Are we truly acting on behalf of better health for all, or are we looking to posture and grandstand?  If we find ourselves alone in taking a position, have we thought deeply enough about what we believe to be able to hold to our convictions when the winds of controversy blow? Such examination is a central goal of these essays. Values help guide our efforts, providing a lens through which to view the world, helping us determine the best application of our scientific data, towards shaping approaches that create better health for all. This is particularly true in this post-war, post-COVID moment.

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An imperfect health | The Healthiest Goldfish

On creating a world that allows all of us to live healthy lives, no matter how we may define doing so.

In writing these essays, and in much of my past writing, I often invoke health. In addition to essays and articles, I have written several books, all of which are centrally concerned with creating a healthier world. Two of my more recent books, Healthier: Fifty Thoughts on the Foundations of Population Health and Well: What We Need to Talk About When We Talk About Health, are efforts to help shape a vision of health that can get us closer to a radically healthier world. The pursuit of such a vision is informed by the assumption that we have, collectively, a shared understanding of what health is: I know what it is to be healthy and so do you. Our goal is to help each other get there by creating a world that is better, healthier.

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Having the conversations we should have when we can have them | The Healthiest Goldfish

On creating frameworks that ensure our conversations are truly generative of a better world.

In a recent piece for the London Review of Books, Judith Butler wrote:

“The matters most in need of public discussion, the ones that most urgently need to be discussed, are those that are difficult to discuss within the frameworks now available to us.”

In the context of the moment we are living in, this makes me think, and quite a bit, about what it means to have conversations, and whether and when certain conversations are even possible. I have long believed in the power of conversation. A healthier world is downstream of the ideas that shape such a world, and ideas emerge from conversation and debate. It is through an ongoing process of disicussion that we decide which ideas are good and which are not, where we stress-test our beliefs and opinions through engagement, and sometimes generative conflict, with the beliefs and opinions of others. As I have written before, the goal of this newsletter is to seed such conversations, helping to create a substrate from which productive conversations can emerge to help shape a healthier world. It is in service of such conversations that I have specifically pushed back against ad hominem statements and the use of shorthand via social media to distill complex ideas into grandstanding soundbites, urging us instead to have conversations, the kind that advance understanding and truly make progress.

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Again and Again. Mass Shootings Continue Unabated in the United States | The Healthiest Goldfish

The mass shooting in Lewiston, Maine is the latest example of a uniquely American phenomenon. But there is hope, progress we are making, in the face of tragedy.

On Wednesday, a gunman killed at least 18 people and injured at least 13 in a series of shootings in Lewiston, Maine. As of this writing, the gunman is still at large and the community in and around Lewiston has been urged to shelter in place, with many businesses and schools closed. The shooting is the latest in a country where such tragedies have become sadly routine. There have been over 560 mass shootings in the US so far this year. Over 35,200 people have been killed by guns, and over 30,600 have been injured by them in 2023. Mass shootings this year include a shooting in Goshen, CA, which killed six people, a shooting in Monterey Park, CA, which killed 11 people, and a shooting in Half Moon Bay, CA, which killed seven people.

Mass shootings touch the lives of those who had previously, like most of us, looked at the gun violence epidemic from the outside. And yet these mass shootings all are part of a long-term, familiar dynamic, a broken status quo we have not yet been able to fix. Over the past decade we have heard an increasing drumbeat of “thoughts and prayers” from politicians, a growing outcry on social media, and yet we continue to have more gun violence deaths and injuries than ever before, punctuated by periodic mass shootings that penetrate the public consciousness. And so, again and again, we search for words that can find meaning, that can shift our thinking. But perhaps there is little new to say, because the arguments have been made, and what is left is for us to act. I went back and looked at what I have said over the past eight years about the topic, since becoming dean of the Boston University School of Public Health. And in many ways what I have said over time still holds today, all of it. The headlines, the stories, are the same. We have been living these stories over and over.

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10 seconds | The Healthiest Goldfish

On creating space for reflection about the right response to tragedies.

We are all aware of the deeply challenging time we are in for the world at large, and in particular for our friends, loved ones, and colleagues from the Middle East. I recently wrote about my thoughts on the Hamas attack on Israel. My thoughts in this prior writing, and since, have been shaped by conversations with colleagues, staff, students, faculty, alumni, in person and online. I have found all conversations thoughtful, condemning the brutal killing of civilians in Israel, while also with honesty recognizing the horrors faced by Palestinians for so long. For these conversations, I am immensely grateful.

As the Hamas-Israel war progresses, and I have continued to engage in these conversations, I have realized that much of what these discussions have addressed intersects with themes I have discussed in The Healthiest Goldfish. Centrally, these include the importance of elevating conversations that are compassionate, respectful, open to all perspectives, and reasoned in their pursuit of truth in a complex, at times chaotic and uncertain, historical moment. With this in mind, I wanted to reflect a bit here on continuing to shape a conversation that reflects these qualities, an effort that is particularly necessary in emotionally charged moments of crisis. In grappling with a moment when there is much heat, and much less light, how can we engage in a way that lives up to our responsibilities in public health? Let me here offer four thoughts that emerge from this moment but that perhaps also have valence for all matters we deal with that require a thoughtful engagement in difficult times.

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The moral, aesthetic, and intellectual case for health | The Healthiest Goldfish

On creating the strongest possible philosophical foundation for our efforts.

A couple of weeks ago, I wrote a rather pragmatic essay about our engagement with colleagues in states that differ in their values. Today, I hope the reader forgives me for a bit more of an abstract essay, one that I have been mulling in my head for some time.

These Healthiest Goldfish essays are fundamentally about making a case for health. These essays, and the books they have helped shape, are, in a sense, efforts to bring together thoughts that have been germinating for a long time about how to create a healthier world. This process has been sharpened by the experience of COVID-19, arguably the most serious threat to public health in a century, which exposed how far we still have to go before we get to a world that is truly optimized for health. Underlying these efforts at sharpening my thoughts about health is the assumption that health matters—that it is a necessary factor for accessing everything we value in life, from the capacity to pursue productive, meaningful work to being able to spend time with family and friends. We all, I think, share the sense that health matters. Yet it is often just this—a sense, rather than a fully-formed idea or philosophical framework. The goal of this newsletter and its associated publications has been to shape a conversation—in partnership with you, the reader—that helps develop this sense into a new practical philosophy of health, one that can help ground our efforts towards a healthier world in the years to come.

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Radical incrementalism, the case for | The Healthiest Goldfish

On successfully achieving the goals of an aspirational public health.

It is not difficult to feel, these days, that we are living in a revolutionary moment that demands a re-ordering of the status quo and a re-thinking of how we structure our world. 2020 brought with it a novel coronavirus pandemic that claimed nearly seven million lives worldwide. The consequences of COVID-19 and the subsequent economic upheavals were not evenly felt, with their burden falling disproportionately on persons of color and persons with fewer socioeconomic resources, occasioning civil unrest that rivaled any the US has seen in the past 50 years. Three years on from the acute phase of the pandemic, we face again a presidential election with the potential to upend the status quo, with the perennially disruptive figure of Donald Trump possibly on the verge of a return to the White House. Living through this moment suggests indeed that much is awry with the world, that transformative change is needed to move us to a better place, and that the turbulence of the moment may provide a once-in-a-generation opportunity to bring about such a change.

Health, and the sharply felt divides that characterize it, has been at the heart of the storm we have lived through in the early years of the 2020s. The pandemic served as a powerful reminder of two long-ignored, yet fundamental, realities: Health is shaped by inequity, and poor health anywhere is—to borrow from Martin Luther King Jr.—a threat to health everywhere. It seems appropriate, therefore, to think of the pursuit of health as a catalyst for necessary transformations, for the creation of a world that is resilient to future pandemics, and one that apportions assets in such a way that the disproportionate burden of poor health does not accrue to a few groups, and that all have the opportunity to aspire to, and fairly achieve, a richly realized life, free of unnecessary and preventable illness.

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Why we should work with people in places we disagree with | The Healthiest Goldfish

The case against disengagement with Red America.

When Russia invaded Ukraine, I wrote a piece addressing the issue of working with scientists from countries which are engaged in actions that run counter to our values. Russia's invasion is a profound injustice, causing harm to those in the region and amplifying the global risk of nuclear war. This raises the question of whether, by continuing to collaborate with Russian scholars—and by continuing to engage with Russian cultural products more broadly—we are in some way complicit in the country's continued aggression towards its neighbor. This question does not lend itself to easy or comfortable answers. In science, we are centrally concerned with the pursuit of truth, and the truth is that actions that undermine the creation of a just world place at risk the conditions of freedom and equality that sustain human progress and science itself. It is our mission, then, to take seriously the possibility of disengaging with countries and organizations whose actions undermine the shaping of such a world.

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