Health and the opportunity to freely think

We should not have one without the other

I was never really supposed to be able to do what I do for a living. Where I grew up, the notion that one could find gainful employment by having ideas and working to develop them in the academic space was close to inconceivable. On the island of Malta, where I am from, during the time I lived there, there were really just three options for the intellectually ambitious: doctor, lawyer, or priest. I initially chose doctor, but, over the decades, this role evolved into a privileged position of being able to work in academic public health, where I get to help inform a conversation about how to build a healthier world. Had my teenaged self been able to see into the future and glimpse what I am doing now, he would have been quite surprised.

The longer I do this work, the more I am struck by how extraordinary it is that anyone gets to do it, let alone me. One is reminded of Maslow’s hierarchy of needs, with the basics of food and shelter at the bottom, and engagement with meaning and ideas located somewhere near the top. For much of human history, it has been all most people could do to satisfy foundational needs, to access the material resources necessary to keep body and soul together. That we now have a society which supports the pursuit of ideas as a viable career path is a rare and fairly recent achievement in the grand scheme of history.

At the heart of this opportunity is the ability to think and speak freely—to feel that one can share ideas, agree or disagree, be challenged, but ultimately know that the exchange of ideas will be respected. In a broad sense, this is an inheritance of the Enlightenment, about which I have previously written. As an immigrant, I have long viewed this inheritance through the lens of America, of the unique promise of coming to these shores. This is partly because of my early life in Malta, growing up during the tumultuous regime of Dom Mintoff, where I saw political repression and violent factional conflict firsthand. I remember one incident, in 1979, when supporters of the government burned down the headquarters of The Times of Malta. A key promise of America is that it is a place where such an event could not happen, where freedom of thought and expression is valued and protected. What I did not expect, however, on arriving in the US, was how everybody seemed to have their own individual definition of freedom. Personally, I have always been drawn to the definition offered by the Polish revolutionary Rosa Luxemburg, whose 150th birthday was earlier this month. According to her, “Freedom is always and exclusively freedom for the one who thinks differently.” This, I think, covers most of us. Few could say they have never found themselves in a position of thinking differently—a life without such moments would be empty indeed.

In addition to supporting a rich, meaningful life, this freedom is essential to health. Creating a healthy society is a big task requiring big ideas. Such ideas will necessarily spark disagreements. This is good. We should welcome disagreements, and we should be open to them. This exchange of ideas can only develop in a context of maximal freedom of thought. I would argue we have of late fallen short of supporting such a context. I am raising this point because, as we approach the end of COVID, we are faced with the urgent job of creating a society where contagions can no longer take hold. The next pandemic may well be far worse than COVID, equaling it in infectiousness but surpassing it in its capacity to kill those it infects. We cannot waste a moment in shaping a society without the vulnerabilities that hindered our COVID response. This will take a robust intellectual climate, informed by the liberty to voice ideas, to make mistakes, and to truly innovate. With this in mind, I will suggest three key impediments to creating such a climate, in the hope that by acknowledging them, we can reverse course.

First, we have become less able to distinguish between truth and belief. Years ago, Stephen Colbert coined the word “truthiness” to describe something which feels true even when the facts suggest otherwise. Colbert introduced the word largely as a joke, yet, in 2021, it is arguably the pillar of many a worldview. We have seen it on the right, with “alternative facts,” and we have seen it on the left with the notion of having a “personal truth” which may or may not always correspond with data. The conflation of what is true with what feels true has muddied the waters of thought. Theories must be testable, subject to change according to the facts. When we conflate the truth with what feels true, we are no longer testing theories, we are expressing personal beliefs. This can make every contradiction seem like an attack, an offense, a violation of our deepest values. Such a context is not conducive to free thinking.     

Second, instead of thinking for ourselves, we have at times outsourced to others the business of generating our ideas and opinions. We are living in a media environment full of compelling slogans, charismatic speakers, tribalized division of outlooks and ideologies, and technologies which deliver all this to us at every minute of the day. It can be difficult, amid this, to sort out which of our opinions we formulated through a process of reason, and which we simply absorbed from this cacophony or from other members of our ideological tribe. What is easy, however, is getting swept up in the moment, joining the chorus of prevailing opinion, and, when we find ourselves thinking differently, keeping those thoughts to ourselves.

The great irony of this conformity—let us call it what it is—is that the more we borrow thoughts from others, the less likely these thoughts are to reflect what other people have truly concluded for themselves. This speaks to the third impediment to free thinking: preference falsification and the gap between what we might call the performance of ideas and opinions and what people genuinely think. Achieving health relies on a process of persuasion, whereby we cultivate buy-in for a vision of the world which supports health. If we are not honest with each other about what we think, we cannot know where we stand in this process. It is difficult to advance a change in attitudes when we cannot be sure of the true ideological leanings of those with whom we engage. Nor can we bring people around to our way of thinking when the positions we advance are positions that do not reflect our own internal reasoning. After all, it is difficult to convince someone of something we do not fully believe ourselves.    

In considering this state of affairs, I find myself feeling a sense of loss. It seems the status quo has made it likely we will miss out on truly original ideas, on the perspective of those who think differently. It is hard to imagine easy solutions to this, because the problem reflects such deep technological and cultural shifts. The new normal may well be the public debate carrying on indefinitely in its present form. In which case, this newsletter may, when all is said and done, be more a cri de coeur than a project that helps inform a healthier conversation. Yet I must believe that others have also noticed a shift in the public debate which has posed challenges to our ability to think freely about urgent problems. If so, it is up to us, as individuals, to do what we can to support a conversation that is worthy of the challenges we face. Creating a world free of contagion will take the very best ideas, and these can only emerge in a context of free and open inquiry. In my travels, I have seen what cultures look like when they value such a context, and I have seen what they look like when they do not. It is better, by far, when we prize the opportunity to freely inquire, to debate, to even occasionally be wrong in public, on our way to being right. It is only when we are free to think differently that we are free to think at all.   

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Also.

This week the publisher released the cover of my new book, The Contagion Next Time.  The book summarizes what is to my mind the key story of the COVID pandemic—that it was the forces that surround us, that we have long neglected, that created the conditions for the COVID pandemic to have the devastating consequences it has had.   As I explain in the book the title is an homage to James Baldwin’s brilliant The Fire Next Time, a reminder that forces like racism, injustice, create an unhealthy world, leaving us vulnerable to the next pandemic.  I shall write more about this in coming months, but sharing here the cover of the book, with excitement.  And of course, pre-orders are most welcome, thank you.

In this week’s The Turning Point, Michael Stein and I talk about the ongoing scourge of gun violence in the country that has not paused during the COVID-19 moment.

This week, led by the inestimable Nason Maani, our paper “The commercial determinants of three contemporary national crises: How corporate practices intersect with the COVID-19 pandemic, economic downturn, and racial inequity” was published in The Milbank Quarterly aiming to continue building a body of work thinking about the intersection of commercial activity and health, in this case during the multiple forces that shaped 2020.

And a reminder that coincident with National Public Health Week I will be hosting a series of The Healthiest Goldfish conversations, across time zones. The idea is simple: an opportunity for readers to engage in conversation around some of the issues raised in this newsletter. I do not really know how it will go, but thought we would try it, as an experiment in bringing together written and verbal conversation. Sign-up is here.