On understanding, patience, and finding clarity to do better

Our responsibilities to the health of all in a time of challenge

It is perhaps true after any national election that we should spend some time reflecting both on the results, and what they shall mean for the coming four years.  This is undoubtedly even more true after an election as contentious as the one that has just unfolded, bringing back to power a president who has been overtly inimical to many of the goals of health. It is not my role to speculate on the whys of this particular electoral outcome—I leave that to our colleagues in political science and to a legion of opinionators in the media—but I do see it as my role to reflect on the implications this election has for those of us whose preoccupation is the health of the public. 

So, where do we start?  On the morning of the 2016 election, after it had become clear Donald Trump had won, I wrote a note expressing concern about what his election would mean for the country, for the world, and for the health of populations. I concluded the note with the hope that he would govern differently than he campaigned, and that his administration would not prove as hostile to health as his rhetoric and promises suggested it would. Sadly, his administration was indeed harmful to health in many ways, doing much to undermine the foundations of a healthy country and world. With the election of President Biden in 2020, it was possible to hope we had, as a country, moved beyond a vision of politics rooted in division and hate, and which posed such challenges to health. But had we? Now, of course, we realize that there are ways to go before this hope is fully realized. 

Over the past year, I have done a fair bit of writing about what we owe each other in times of challenge and uncertainty.  Today then, I have been asking myself, what might our responsibilities be in this moment?  I offer three thoughts.

First, we have a responsibility to try to understand.  Our role is to promote the health of the public, not the health of half the public.  Insofar as the public is divided in red and blue, public health should be purple. There shall be much analysis about why the public voted as it did, and there are some excellent books that provide useful insight.  While I do find this interesting, I am here much more concerned with understanding how we can find common cause, and common ground with as many of our fellow citizens as possible.  When I have the opportunity to engage with persons who are broadly on different sides of the political divide, I have often found that health is perhaps one of the few truly universal aspirations. We all want to be healthy, and we all want our children to be healthy. That then should be ample seed for the tendrils of understanding to grow.  It is simply inadequate to say that we cannot understand how someone could vote for the candidate we do not like. It is wrong to attribute this all to misinformation, or worse ignorance.  Our assumption should be that rational people have chosen to vote for candidates we may not agree with and therefore it is on us to understand why that is, so that we may find ways to bridge gaps. That is hard, and in moments like this seemingly insurmountable, but that is exactly what we must do. I have written before that those of us with a responsibility for the public’s health need to fully inhabit that responsibility always, and that means rising above the rancor of this moment and to do the work to say—however we may have voted as individual—how do we find agreement on the issues that matter to health with the 50% of us who voted differently? 

Second, the moment calls for patience and tolerance. Patience with the moment, with each other, with ourselves.  It calls for compassion for those who are having a challenging time with the moment, to acknowledge each other’s emotions, to listen and reflect before we speak. I cannot think of a more important moment to invest in patience and tolerance as we navigate the coming transition back into an era of American history to what perhaps many hoped they had seen the end. The moment will take time to clarify, the contours of the challenge at hand shall take months to come into focus. That will take patience.  It also seems perfectly reasonable for some, many, to grieve in the moment, and it will take time before many of us will be able to see clearly past our acute feelings to the work that needs to be done with suitable dispassion. While this election outcome was always a possibility, we should not minimize the shock that it is for many whose work is concerned with the promotion of health.  2024 was imbued with hope, by a candidacy with the potential to give the US its first female president. That was again frustrated by the victory of a candidate with a history of misogyny. This then pushes us to be patient with one another.  It also calls for us to find patience with ourselves, to give ourselves the license for feelings, while also committing—as we always should—to finding ways to weave those into what we must do to the end of fulfilling our mission.

Third, efforts to understand, to be patient and tolerant, should not be a fig leaf for fuzzy thinking about what is needed to promote healthier populations, even as we make such calls with due humility and aware of our biases. Unlike the morning of the 2016 election, there is now a record to look back on as a basis for concerns over an incoming administration. From the administration’s travel ban targeting people from Muslim-majority countries, efforts to restrict legal immigration, to withdrawing the US from the Paris Climate Accord, to nuclear brinkmanship, to the President-Elect’s willingness to use language that incites hate and division, the Trump years were a time of significant challenge for health. The upcoming Trump administration, featuring actors who have been openly skeptical of foundational health-promoting tools like vaccines, promises to be even more so. It is important to note that these are not meant as partisan observations. They are simply statements of fact about actions the Trump administration took, actions which posed challenges to health. In expressing concerns about what a second Trump administration will mean for health, my aim is indeed to be nonpartisan, while also engaging with the observation that certain policies are better for health than others, and an ideal of nonpartisanship does not mean denying this reality. And the reality is that the first Trump administration produced a host of policies which harmed health. The prospect of returning to that time is a source of justifiable anxiety about what the future may hold.

I conclude with a note of hope. It is important to remember that in the first Trump term we were still able to make progress on our mission. If the presence of Trump on the political scene can be said to have a virtue, it is his capacity to surface much about the country that needs fixing, much of which has long been with us. The Trump years made unignorable the racism, misogyny, and xenophobia that has been a factor in American life for generations. These past few years allowed these problems to come to a head in a political era which forced us to reckon with them fully. During the first Trump administration, we saw the beginnings of this reckoning—from the Women’s March that marked the start of that era, to movements for addressing climate change and gun violence, to the racial reckoning of 2020 after the murder of George Floyd, to the mass awakening during COVID to the importance of shaping a world that generates health. These were all encouraging signs. However, these efforts remain incomplete. Today’s result is, yes, a disappointment to many. But most fundamentally, it urges a re-investment in our core mission, the actions that we need to take to advance health. And there are hints that the seeds of action have been sown. Ballot initiatives to protect reproductive rights have passed in many states, as have other initiatives to create better social protections. It says our work is not yet done, that we still have far to go in pursuit of a better world. We have promises to keep and miles to go before we sleep.

I have written before that public health is definitionally political, but must work hard to be non-partisan. Nothing I write here should be seen as an endorsement of a party over another. Rather, this is an effort to be clear eyed about efforts that harm or help health. We may disagree about the right party and candidate to vote for in any given election.  My hope though is that we can see past that to work on what we agree on—our mission of heath for all.  At a moment like this it seems important to remember that making history, shaping the arc of the moral universe, is not just the privilege of presidents. We make history too, every day. We have agency, no matter who is in power, to make a difference in the moment, with hope for a better future ahead. Thank you for your commitment to this work, for providing hope even in times of challenge.