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From opposition to banning harmful substances like cigarettes and soda to widespread resistance to the COVID vaccine, public health work has long faced these moments of pushback. What may at first seem like run-of-the-mill political debates (about, say, taxes), often refer primarily to values.
The fact is that many populations do not share public health values, and this mismatch can create impasses that complicate our ability to be effective in our work. This leads to the notion that the populations are working against their own interests, that somehow the populations misunderstand the values they must respect. That the populations are thinking “wrongly” and that our work is based on correcting these misunderstandings.
Understand the different values
But perhaps there is a different, more productive way to understand values that differ from our own. In a different light, we can move beyond seeing value clashes as a conflict between right and wrong (with public health on the side of good), and rather see these conflicts as two different understandings of what is right. .
I have long been inspired by the story of British Prime Minister Clement Attlee as an example of how to achieve this balance in the political space. Attlee was a modest man, with few of the charismatic gifts we associate with transformational leaders.
However, he had a talent for engaging with all sides of the political spectrum, working pragmatically to promote change without compromising his core progressive principles. As a result, his government approved much of what would become the foundation of the UK’s strong social safety net, including the national health service. In his review of a biography of Attlee, Adam Gopnik wrote in the new yorker:
[T]The true progressive giants are radicals of the real, those who accept that democracy implies pluralism, and that a plural society is obviously made up of many people and types, only a few of them truly exploitative and criminal, most simply pursuing their own interests. . version of the good life as tradition and conviction have offered it. The swing of power between them is not a sign of failure; it is a sign of life. Attlee’s example reminds us that it is possible to cling to moral absolutes—there was no peace under Hitler, and it was better to die fighting than try to make it—along with a appetite for a conciliation so abundant as to be more prolific… than merely pragmatic.
This is, I believe, a powerful theory of the case for a constructive engagement with values. Some values are fundamental and inalienable. They include respect for personal autonomy, inclusion, kindness, and trust in data and facts.
These echo fundamental Enlightenment values, including those reflected in our country’s aspiring promise of “life, liberty, and the pursuit of happiness.” At the same time, we should always be encouraged by an “appetite for conciliation” informed by a willingness to recognize the validity of different values and different points of view, and to see how these values can inform a framework that can be no less grounded. ethically than ours, even as it supports different conclusions about the right path to follow.
In search of public health and different values
How can we support health in a country and a world where populations can have such different values?
First, we should not expect everyone to share the values of public health. This is important because if everyone shared our values, shared our understanding of what is best for the public good, it would mean that anyone who expresses views contrary to these values could be accused of acting in bad faith, rather than just acting. according to their own set of values.
For example, if we all agree that vaccines are good and that data supports their safety and efficacy, someone who advocates for vaccines could well be accused of knowingly spreading misinformation, rather than expressing skepticism based on a set of values. genuinely different. By rejecting the fiction that we all share the same values, we can avoid the waste of time and energy that comes with demonizing those with whom we disagree, because we will be able to see where their disagreement stems from a difference in values and work to address it.
Second, we need to shape a public conversation that is capable of recognizing different sets of values in order to better understand them. On a practical level, this means that public health cannot simply “preach to the choir” when it comes to building a movement that can truly shape a healthier world.
Those of us in public health tend to run in circles with those who share our values; we need to reach out to other populations with all the humility and courage that such outreach implies. Public health work is not a theoretical exercise. It is the work of compassion and radical solidarity. It means putting ourselves at risk.
Not just the risk of long journeys or contact with disease, but the risk that our assumptions will be challenged and our convictions tested by those who don’t share them. This reflects a process of open participation that can help us stay focused on the core mission of public health: serving all populations, no matter who they are or what they think.
Finally, we need to work to change hearts, to move the “Overton window” toward widespread adoption of values that support healthy populations. This does not mean trying to impose our values on those who do not share them. It means engaging in dialogue and participating in a national debate in which we respect differences, prioritize empathyand demonstrate that we see and understand the values of others, even when we stand up for our own values with conviction and clarity.
Progress comes from this process. Appreciation for ideas that create a better world comes as a result of patient work over time, and the most lasting victories for health are those that are based on changes in our collective values, not just our laws.
Such progress depends on commitment, persuasion, a willingness to listen and a commitment to understand the values of those with whom we disagree. Only by understanding these perspectives can we, in the long term, change them.
A value mismatch need not, should not, be the end of a conversation. Rather, it should be the start of a new one, as we remember that our job is to improve the health of all populations, not just those who share our values.
A version of this post also appears on Substack.
