On Schools of Public Health and the Need to Engage Difficult, Complex, Competing Ideas.

Before I begin today’s note, a quick word about the SPH This Week publishing schedule. As we have done in the past, respecting the heart of summer, we will pause SPH This Week for the next four weeks, starting up again on August 27. We will continue to update the community about events and announcements via SPH Today, and research stories and other school news will continue to appear on our website. I hope everyone has opportunity for a restful break during the coming month.

On to today’s note. These are rancorous times, characterized by a divided country, and, increasingly, a divided world. The present climate has generated plenty of heat, but often little light. In this context, we have seen the rise of disposable, insubstantial ideas—even falsehoods—that can distract from meaningful thinking. This distraction is heightened by the sheer pace of news and information. With an online media fueled by “clicks,” and a range of television networks all driven to keep pace with the 24-hour news cycle, it is easy for nuance to get lost. In these changing times, the role of academic institutions is more important than ever. Schools operating within universities can lend clarity to the public debate by allowing for discussion and a free exchange of competing, data-informed ideas. Yet we have seen, especially in recent months, the value of schools and universities questioned, as our charged political climate has influenced how some Americans view higher education. A Pew Research poll released this month, for example, reported that 58 percent of Republicans and Republican-leaning independents feel that higher education has “a negative effect on the way things are going in the country,” while 19 percent of Democrats and Democrat-leaning independents say the same. A note, then, on how we can best be a positive force at this difficult moment, focusing on three reasons why the academy can play a unique role, three challenges we face in doing so, and three potential approaches to meet these challenges.

In our present environment, we are increasingly likely to believe deeply in our own ideas, but are less likely to engage with those of others. This can lead to a degree of polarization that can be quite jarring. Compounding this polarization is the challenge of misrepresentations, or “alternative facts,” that have proliferated in the media and cultural landscape. The 2016 election seemed to fuel this proliferation, until, by the end of the campaign, it was possible to question whether facts still have a place in American public discourse at all, opening the door to the idea that anything can be made true if enough people believe it. Oxford Dictionaries even selected “post-truth” as its 2016 international word of the year. This is particularly troubling from a public health perspective. From vaccine skepticism to climate change denial, the acceptance of a post-truth landscape threatens the basic underpinning of facts that are necessary to create policies and best practices that safeguard health.

To mitigate this polarization and distortion, it seems to me rational that society needs spaces where facts are respected and ideas can be interrogated and discussed. The academy represents such a space, for three central reasons.

First, the academy is an environment where we are empowered to critically examine the ideas we pursue; where fact-based debate remains key to advancing understanding. Peer review rests at the heart of the academic enterprise, an explicit engagement of all our ideas with careful, informed scrutiny, to the end of pushing forward tested and tried concepts that can advance knowledge.

Second, we pursue reasoned argument not just to learn about new perspectives, but also for the sake of the debate itself—the insights that can spring from the opposition of two arguments creates an intellectual value that is, I think, greater than the sum of its parts.

Third, a school is a physical space where students and scholars of many different backgrounds can interact on a regular basis over a period of months and years. In a digital age, this face-to-face engagement is perhaps more valuable than ever. This is not to say that we do not also embrace the tools of our electronic era, seeking an ever-greater fluency in emerging forms of media; however, our campus life reminds us that the most valuable kind of connection will always be the links that develop between people when they gather together and communicate in a common space.

The corollary here is that we need to speak up for these values, even when doing so means making sure that our ideas are tested by those who have a priori different perspectives than ours, and, at times, providing a platform for those with whom we disagree. To forfeit these approaches would be to deny ourselves the chance to test our convictions against the deeply held beliefs of others, and to risk reinforcing the divides that have done so much to undermine the public debate in recent years.

If we indeed subscribe to this view of the academy’s role, what then are the challenges that we face in ensuring that it remains at the core of what we do as a school of public health? I suggest that there are three key challenges confronting us in this regard.

First, while facts are facts, the conclusions we draw from them can occasionally be wrong-headed, sometimes dramatically so. The discredited theory of eugenics, for example, was once very much in the academic mainstream. To hear eugenics used as an argument against immigration and “intermarriage,” and framed as a means of building “a better world” at the beginning of the 20th century, is chilling, especially when we consider that such beliefs were once espoused by leaders at some of our country’s most prestigious schools.

Second, we sometimes think that conclusions are straightforward, and we jump to them, when the truth is actually more complex. This has been well-illustrated by the debate over salt. I have written before on the challenges that the field has faced in the calls for a reduction in dietary sodium as a means of saving money and saving lives. However, the data are truly complicated, suggesting that calls to reduce sodium in general populations (as opposed to in high-risk groups) may need careful consideration. This speaks to the importance of putting our facts before our conclusions—not the other way around—even when doing so means we must countenance a period of ambiguity and doubt.

Third, we face the challenge of at times asking questions that are informed by our biases. This is in some respects what earns us the enmity of those who devalue our work, and science in general. As I have written previously, our work is informed by our knowledge and our values, i.e. what our data tell us is true and what actions we choose to prioritize based upon our vision for building a healthier world. Sometimes our knowledge and values overlap with the broader public consensus—as seen, for example in the worldwide push for polio eradication. However, sometimes this alignment does not occur—as on the issue of gun violence in the US, where public opinion has yet to fully mobilize in support of the data-driven policy solutions that are key to solving this problem. Progress on this issue has been hindered, in large part, by the success of gun control opponents at framing the issue as a question of values, a question that public health, with its understandable bias towards data, has yet to fully engage with.

How to avoid these pitfalls?

First, we must remain skeptical, leaning always on data rather than received wisdom or consensus. Just because something has become mainstream does not mean that it is immune to criticism or reevaluation. Second, we must take nothing for granted in our pursuit of the facts, returning often to first principles to ensure that even our most complex investigations are grounded in the core tenets of our field. This is, of course, not always feasible, but it should remain a goal. Third, we must invite discussion and debate, both among ourselves and with those outside our community, seeking new perspectives to enrich our thinking and challenge our assumptions. While this engagement can sometimes be uncomfortable, even disorienting, it is nevertheless central to our mission. As a school, we have the enormous privilege, and responsibility, of being a part of an enterprise that thrives on the exchange of ideas to help foster a healthier public debate, and, ultimately, a healthier world.

I hope everyone has a terrific week. Until August 27.

Warm regards,

Sandro

Sandro Galea, MD, DrPH
Dean and Robert A. Knox Professor
Boston University School of Public Health
Twitter: @sandrogalea

Acknowledgement: I am grateful to Eric DelGizzo for his contributions to this Dean’s Note.

Previous Dean’s Notes are archived at: https://www.bu.edu/sph/tag/deans-note/