Acknowledging challenge, engaging with hope

Some thoughts, inspired by the class of 2025, on the challenges and opportunities of the moment.

Last Monday, I had the privilege of attending the Commencement ceremony at Washington University in St. Louis, where I serve as dean of the School of Public Health. I have long felt that graduation is the happiest day of the academic year, an enduring source of inspiration and joy. Coming together as a community to recognize the achievements of our graduates always ends the academic year on a hopeful note.

That perhaps fits uneasily in times of challenge and disruption, such as the current moment. It has been a disorienting few months. The election of a new administration has led to an array of proposed changes, some countermanded shortly after being introduced, some leading to court challenges and stays that change little but leave a policy Damoclean sword hanging over a lot of the work we do. Some of these actions directly affect what we do both in the academic world and in a world where we are aspiring to promote the health of populations. While I have written about where I see these policies endangering the health of populations, I also have tried hard to keep an open mind about the remit that should be afforded any administration to implement the agenda it feels it was elected to pursue.

And yet there are some elements of the current moment that tug at the conscience. It is one thing to give space for policy differences, it is another thing altogether to countenance actions that create human suffering, and that invite — even encourage — indifference to cruelty. We can disagree about whether the federal bureaucracy is too big and, as such, whether we should be enacting cuts to various federal agencies, as we have been seeing in the past month, but it is hard to accept that these cuts have to be carried out erratically. We can disagree on how the cuts to federal agencies such as the Department of Health and Human Services or the Centers for Disease Control and Prevention will affect health, on whether we should as a country be supporting international aid, and even on whether the cuts are strategic or simply idiosyncratic, but it is hard to accept these cuts being made abruptly and threatening programs that, simply put, are lifesaving.

Some of these elements are perhaps most evidently clear in the country’s handling, in the past two months, of the issue of migration, a topic that is of particular concern for me for both personal and professional reasons. There are reasonable policy differences that can shape how we see this issue. We could argue for the correctness of open border policies, that such policies override outdated notions of national boundaries, recognizing that such boundaries are often artifacts of colonial conquest that have embedded unfairness for centuries. We could, however, also argue that no one country can be all things for all people, and a country that has, in no small part due to hard work and ingenuity, created a safe haven for its people has to put bounds on its generosity so that its citizens may, first and foremost, have jobs. That is a policy argument that we can have. Yet even as we remain open to reasonable differences of opinion with respect to policymaking, we should not give a pass to cruelty when we see it. We would not do so at the individual level, and we should not do so when considering the laws, norms, and practices that shape our national life.

So, this is a difficult moment. It is a time for being honest about what we see, for staying engaged with the challenges posed by shifting political winds. At the same time, it is important to remember that there is much else happening in this country, that this is not only a time of challenge, that, even now, there is much cause for optimism, and many opportunities for creating a better world if we allow ourselves to see them. In the spirit of hope and renewal that comes with the season of Commencement, I would like to suggest the following three areas as places we might look to find cause for hope in this moment.

First, we are being reminded of what matters most in the pursuit of health. Recent challenges to the structures and institutions that support health have been a reminder of their central importance to creating a healthier country and world. They have reminded us of the critical role the NIH plays in funding essential research, the role of the CDC in offering guidance and implementing programs that sustain health, the role of academia in generating the knowledge that helps the U.S. lead the world in a range of sectors, and much more. More broadly, perhaps, we have seen in the new administration’s rhetoric and tone why it is necessary to embrace a language of tolerance and inclusion, toward creating a context from which better policies, and better health, can emerge. Just as the first Trump administration helped spark a still-ongoing conversation about the structural forces — social, political, and economic — that shape health, a conversation that had led to much positive change, the second Trump administration stands to have a similar effect, reminding us of what matters most for health so we might reinvest in addressing these forces in the future.

Second, we are seeing opportunities for forging new partnerships. The work of health has always been interdisciplinary, depending on people and groups collaborating in pursuit of a healthier world. This includes partnerships between public health, government, and the private sector. Continuing to support health in this moment means continuing to find new areas for such partnerships. As health institutions and longstanding funders face strain and the federal government proves less reliable, at least for the moment, in its commitment to health, now is a time for working to protect and shore up existing partnerships while also building new relationships across a range of sectors, to shape a public health that is more resilient, diverse, and effective in its capacity to pursue its mission. This means, for example, continuing to develop public health’s relationship with the private sector, which can yield opportunities for better leveraging our data toward large-scale efforts to improve health. Public health also can build partnerships through a reevaluation of the language and symbols we embrace in our work, to assess how our communication style may have played a role in the backlash we are seeing against many health institutions. This is a difficult moment for health, but if it can motivate a reevaluation of how we do what we do, and where our ideas and actions may be stopping us from being fully inclusive as a movement, it will have served as the basis for a stronger future for our field.

Third, the rising generation is deeply committed to building a better world. As the dean of a school of public health and a father of two Generation Z kids, I am regularly in a position to engage with the rising generation, the young people who will shape our future. This has allowed me to see firsthand how this generation is developing an awareness of the challenges of the moment and a willingness to commit to addressing them that is truly inspiring. While much has been made of the many distractions available to this generation — the digital technologies that have intersected with so much about their lives — the truth is that they are anything but complacent and are deeply engaged with shaping a better world. From climate change to gun violence to racial justice, they are focused on the issues that matter for health, marching, organizing, and pursuing educations that will equip them to deal with these challenges. What I saw at Monday’s Commencement ceremony, and what we see all around us at graduation season — the promise of the rising generation — reflects a powerful force for making the world a better, healthier place. While the challenges of this moment are, in part, a reflection of the failures of previous generations, my own included, the commitment of the young to addressing these mistakes, building on progress, and forging a better path forward is encouraging indeed.

There is a saying, attributed to many, that “it is better to light a candle than to curse the darkness.” This is, to my thinking, exactly right, and reflective of the spirit that has long animated the work of public health. Public health has seen some dark historical moments, but it has always, in such times, aspired to light a candle. What is more, it has worked in these moments to understand the darkness, using reason, science, and compassionate engagement with the structural forces that shape our world to develop a clear-eyed view of where we are and how we can lay the groundwork for a better future. Maintaining this perspective is itself a way of lighting a candle, of making the moment better. When we light a candle, we can better see where we are, becoming aware not just of challenges but of opportunities we might otherwise have missed. Thank you to all who are lighting candles in this moment, with special gratitude to the many young people who are this month collecting their degrees, celebrating with loved ones, and then turning to the urgent work of this moment — the work of creating a better world.

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Also this week

A local note. At least two tornadoes touched down in the St. Louis region Friday, injuring multiple people and killing at least five. One of the tornadoes directly hit our campus, causing substantial damage to the campus and to property of many in our WashU and neighboring communities. As far as we know, all members of our WashU community are physically safe, which is an extraordinary relief. And yet, these large-scale events have consequences that extend throughout populations affected, an area that has long been a feature of my own science. So, a note of care for all members of the local community and their loved ones who have been affected by the Friday tornadoes, a reminder of the importance of our whole health.

New in Observing Science, with Michael Stein: a reflection on whether it is advisable to speed up the translation of science.

An animated tour of our 4x4 Plan — our strategic, interdisciplinary vision for building an outstanding School of Public Health at WashU.

New in the European Journal of Epidemiology: a reflection on the preliminary results of the Global Flourishing Study and the role of health as a means of promoting human flourishing.