Into the light

During commencement season, toward a brighter day for public health

Last month, the Artemis II mission successfully flew to the moon and back. Astronauts Victor Glover, Christina Koch, Jeremy Hansen, and Reid Wiseman crewed the Orion spacecraft, which they named Integrity, in the first human-led flight beyond low earth orbit since the Apollo 17 mission in 1972. The lunar flyby was conceived as a test flight in support of further Artemis missions, with the goal of returning humans to the moon’s surface.

The Artemis II mission was a unique moment in the history of science and exploration. Yet, in many ways, it was reflective of work that is happening all the time, here on earth. The work of science, the building of social movements, the pursuit of knowledge, the shaping of policies that promote better lives, better health—these are all, in a sense, moonshots. They all represent aiming upward, marshaling time, data, and resources in pursuit of progress, of a better world for all. They are not solitary efforts. They involve working in teams, in communities, across disciplines and sectors. They can be deeply rewarding, helping to bring about much improvement, providing a glimpse—like earth seen from a spaceship window—of a brighter future we can all play a part in helping to build.

But these efforts can also include times when we feel isolated, when the way forward is obscured, when we are cut off from sources of support on which we have long relied, when we even feel, perhaps, a bit of existential anxiety about the future of our work and world.

Public health is arguably in such a moment now. Since the pandemic, we have faced declines in the public’s trust in us, and, to date, we are far from reestablishing the credibility we once enjoyed. Over the past year, this collapse in trust has left us vulnerable to political attacks that have seen public health institutions defunded and dismantled. We have also seen a broader disinvestment, at the federal level, in the work of science.

This is all the more jarring for happening after many generations of public health, and science more generally, achieved great success in improving living standards, preventing injury and disease, and working both within the US and across national borders to build a healthier world. We have traveled far as a field, yet we now find ourselves feeling, at times, like we are far from the sources of our initial momentum—public support, federal investment, and a clear understanding, and ability to articulate, the guiding values of our work.

Such times recall the roughly 40 minutes of the Artemis II mission’s lunar flyby when the astronauts found themselves on the far side of the moon—sometimes known as the dark side of the moon—cut off from earth in a planned communications blackout. During that time, they were the farthest from earth any human beings have ever been, surpassing the distance records set by prior moon missions. A lonely place to be, yet those 40 minutes were essential to the completion of the Artemis II mission. Had Artemis II not spent time on the dark side of the moon, its lunar view would not have been complete, nor would it have gathered as much data as the mission ultimately yielded.

Perhaps the most essential fact of Artemis II’s time on the dark side of the moon was that it was, ultimately, just a moment in time, from which the astronauts emerged, returning to light, to human connection, to a warm welcome back on earth. This is the case with most dark moments—that they are just that, moments, which yield sooner or later to a return to light. This is important for us to remember, as public health undergoes its own darker moments. In such times, it is worth reflecting on how far we have come, how much distance we have traveled towards building a healthier world for all. This is the healthiest time in human history—due, in large part, to the successes of public health. Just as the astronauts traveled far before rounding the moon, we have come far to reach this moment. The fact that we have come so far reflects the fundamental resilience of the work of public health, a resilience supported by our collective desire—shared by all—to be healthy. This wish for health has supported public health’s work through generations, in the face of epidemics, political pushback, and moments when public health itself has gone astray, deviating from its core values.

It is also important for us to remember that public health’s successes continue, even in this challenging moment, as green shoots in public health spring up across the US and around the world. These efforts are helping to renew public health in this moment. History has long shown how moments of adversity can yield much of value; can even be essential catalysts for the ideas and movements that help build a better future, and this remains true today. This is not to say, of course, that we should celebrate when our work comes under attack or embrace as a virtue alienation from communities and the public’s trust. Only that, when we find ourselves in such positions, we can use these moments to reflect on where we are, how we got here, and emerge better for having spent time on “the dark side of the moon.”

This means, centrally, using such times to reflect on our values, on the core principles that guide our work. The Healthiest Goldfish has long aimed to be a place for such reflection, for thinking about the values that guide public health. These values include scientific rigor, a commitment to improving the health of all, not just some, an embrace of reason and conversation in a context of free speech and open debate, and a pursuit of partnerships towards building a big tent movement for health. Guided by these values, we can navigate this moment, emerging from the dark into a brighter day for public health and for the world.

There are reasons to hope we are already starting to see this brighter day. There is hope in the many who are showing up each day to do the work of public health—in government, in universities, in the private sector, and in communities. There is hope in public health’s continued commitment to its core values and its vision of a healthier world for all. And there is hope in the willingness of many in our field to engage honestly with our strengths and our shortcomings, to shape a new public health for a new global era, informed by the lessons of the recent past and present.

Most of all, perhaps, during this graduation season, there is hope in the public health graduates—at the WashU School of Public Health, where I am dean, as well as around the country and world—who are about to launch into the next phase of their careers as public health professionals. Their talent, their commitment to building a healthier world, is reminiscent of all who have dared greatly in pursuit of a vision of a better future. Each day, at WashU, I am privileged to see how our new graduates are working towards this future. Today’s graduates have been through much, navigating a once-in-a-generation pandemic before some of them had even graduated high school. Yet rather than grow demoralized by this experience, our graduates have chosen to become active, engaged participants in history, determined to bend the arc of the universe towards better health for all. They make it possible—indeed, easy—to imagine public health emerging from this moment into a brighter, better day.

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Also this week

For our Ideas Matter podcast, I spoke with Alex Broadbent of Durham University and Pieter Streicher of the University of Johannesburg—authors of a new book on science during the COVID moment.