The Healthiest Goldfish

Why health, why here, and why now

I would like to talk to you about health.

This is, of course, practically all we have been doing for the past year, as the Covid-19 pandemic has raged. However, I would argue we are at a unique point in our history, a time for a new focus on our conversation about health.

This week, the US saw both the inauguration of a new president and its Covid-19 death toll surpass 400,000. With the pandemic looming so large, it is possible to forget that other issues even exist outside of Covid-19. But it is precisely because this moment is so acute that I think it is important to step back, and focus on some of these very issues that will be with us long after Covid-19 has passed by.

My overall approach is told perhaps most efficiently by way of a story, one you may have heard before, if you have read my work or attended one of my public talks.

Imagine you have a goldfish. You want it to live a long, healthy life. So, you feed it nutritious food. You buy it a tank with ample room for exercise. You put toys in the tank, so it has plenty of stimulation. When it is sick, you take it to the vet, who prescribes treatment. You think you have given your goldfish all it needs to live healthy. Then one day, you wake up and find your goldfish dead. Why did it die? You forgot to change its water.

This story reflects how we tend to think about health. We think health means exercising, eating right, taking the right medicines, and generally making good decisions about what we do, how we live our lives. All this is intuitive. It is also wrong. Certainly, what we do makes a difference for health. But far more important than anything we do as individuals is the state of our water. What is our water? It is the fundamental context of our lives, the social, economic, environmental, and political conditions in which we live.

We are in the midst of a health crisis which has exposed just how cloudy our water truly is. The Covid-19 pandemic began with the emergence of a novel pathogen, but it was our already deeply unhealthy context which caused us to face something like the worst-case scenario of the virus in the US. Covid-19 exploited our societal weaknesses with precision, using all of the ways we were unhealthy to begin with to make us even sicker.

As the pandemic unfolded, our waters have also been muddied by a public discourse, much of it on social media, which has not always well-served the cause of health. It has been disheartening to see how the health conversation has become increasingly subject to the incentives of platforms like Twitter, where a glib phrase often generates more engagement than detailed analysis. This is, in my opinion, the wrong way to have these conversations. In order to have clear water, we need clarity of thought around the issues central to health.

I have held back from engaging with the back-and-forth happening on social media, in an effort to avoid much of what I see as counterproductive in the current discourse. I have instead worked on books and papers, all compiled on my website. With this newsletter, I am aiming to introduce a set of long-form conversations about health, using a forum that, I hope, can generate less heat and more light. I aim to send this newsletter every Saturday, titled, The Healthiest Goldfish. The newsletter will cover what matters to health—issues like politics, economics, culture, urban design, transportation infrastructure, trust in national institutions—everything that influences our water. 

Creating a healthy world is the business of creating the healthiest possible conditions, the cleanest possible water, to support the healthiest goldfish. To do so, we must widen our focus beyond the science of novel drugs and treatments. This is not to say I will not be talking about science, only that the discussion will not be limited to the science of medicine. We need a science which supports a better understanding of the foundational forces that shape health. With this in mind, expect to see lots of data here about the link between health and the conditions which constitute our water—from the link between economics and mental health, to the health effects of climate change, to how racism makes our society sicker.

You have received this newsletter because our prior interaction suggests you might be interested in following this conversation. And this is indeed meant as a conversation. I encourage you to leave comments on The Healthiest Goldfish homepage weighing in on the subjects I discuss. Agree, disagree, share stories, or suggest topics you would like me to cover. I will feature some comments in this newsletter, selecting the strongest insights with which to engage. I will also add new content in the months to come. If you wish to unsubscribe, simply do so. Though I hope you will choose to lend your ear, and maybe your voice, to this conversation.

I am not by profession an opinionator. I have for two decades been part of the academic public health community and I see my identity first and foremost as a population health scientist. This has implications for how I think and write. My experience has convinced me that creating a healthy world is inextricable from a progressive project to advance a better society. I mean “progressive” in the sense of pursuing progress regardless of the direction in which it leads. I have tried to advance this pursuit in my public writing, in my books, and, now, in The Healthiest Goldfish. Thank you for joining me. I look forward to continuing the discussion.