The input problem

The challenge of disagreeing on issues when we cannot agree on facts.

Readers of these essays will know that, as a new administration has made significant changes to the country, I have tried to be open to the spirit of accepting new ideas about the reorganization/rethinking of what should be, mindful that the actions we are seeing reflect the wishes of millions of Americans who chose this course with open eyes in the last election. Our criticisms, then, of the changes we are seeing should not be knee-jerk, but, rather, considered and thoughtful, reflecting an awareness of the complex cultural and political forces driving this moment. However, I did want to comment on this week’s announcements about layoffs at the Department of Health and Human Services, the Centers for Disease Control and Prevention, and other health agencies. I have written before about the underfunding of public health, and how it contributed to the disaster of COVID, among many other diseases. This new disinvestment in health agencies is clearly going to make this worse. Leaving aside — but acknowledging — the cruelty of these moves happening quickly and unexpectedly, the threat that they pose to the country’s health cannot be underestimated. I worry, as do many others, that this is setting us on a path to perdition, to an escalation of public health challenges that are going to manifest in the years to come. And that is a worrisome thought indeed.

On a personal note, it is heartbreaking to see longtime colleagues and friends be removed from jobs where they have made significant contributions. I would like to call out, in particular, the placing on administrative leave of Dr. Eliseo Perez-Stable, who has served with distinction as Director of the National Institute on Minority Health and Health Disparities for more than a decade. I had the privilege of serving on the inaugural council of the NIMHD and, through that and multiple engagements over the years, have learned from and admired the contributions that Dr. Perez-Stable has made to health equity in this country. Similarly, Dr. Shannon Zenk has been a tireless and visionary leader at the National Institute of Nursing Research. I have worked with Dr. Zenk over the years, including as she was articulating a bold new vision for the NINR, engaging with the foundations of health that the institute has made its research focus. That these leaders are summarily relieved of their posts after doing so much for health in this country, is, to quote former NIH Director Bertagnolli, unconscionable.

What does this suggest we should do? I am — as I am sure are many readers — at something of a loss, other than to reinforce that this moment requires us to bear witness more than ever, to continue documenting the health of populations, to ensure that the enterprise of population health science thrives even through the storm. As we do so, there will likely continue to be moments, like this week, when we will see actions the administration has taken and think, “How can anyone possibly support that?” Because a difficult truth of the moment is that many people do. We are in a time of polarization. The new administration continues to take a range of actions, many of which are cheered by roughly half the country while evoking concern and, at times, fear, among the other half. This follows the previous administration, which also took actions that were cheered by many while regarded as dangerous, even illegitimate, by many others. Much has been made of the divides between America’s political camps, yet there is something both could be said to share in common. When they see something done that they deplore and others cheer, they are apt to look at those who favor such actions and return to the question: “How can anyone support that?”

The challenge of answering that question is, arguably, the central challenge of the moment. The challenge is twofold. First, there is the difficulty of understanding someone else’s motivations, then there is what might be called the “meta-question” of why it is so difficult to do so. How is it that millions of people can look at the same action or rhetoric and half of them can see something deeply disturbing while the other half sees something justified and necessary? And why, after roughly ten years of intense polarization in this country, are many of us still asking these questions and finding no clear answers?

In our rush to denounce some actions and cheer others, it can be too easy to neglect the essential question of why there is this disconnect between supporters of these actions and their detractors. This makes it all the more important that we take time to pause, step back, and interrogate the “why?” of this moment — the “why?” behind the deep epistemological divide between left and right. If we can do that, perhaps we can begin to navigate our way beyond the political and cultural impasse that has kept this country in such a difficult state and find the common ground that lets us work together toward a better, healthier future.

Why, then, are we at a place where perspectives about ideas and events are so radically different? The answer seems to be, in large part, a matter of inputs. By “inputs” I mean, centrally, our sources of news, information, and entertainment. In the past, there were few inputs and we all, generally speaking, shared them. There were a handful of channels delivering the news, a handful of major newspapers running stories, and when we wanted entertainment, we all chose from more or less the same bestselling books, films, and television shows that were on offer in a given moment. When we debated a news story, we were debating our common experience of hearing, say, Dan Rather report on a story or of reading a newspaper article that was shared around the country.

The internet has disrupted all of that. We now have an abundance of inputs — news sources reflecting every conceivable perspective, available on a range of platforms, including podcasts, YouTube videos, and social media, to say nothing of magazines, television, and newspapers (even as these older forms of media have seen their audiences decline significantly). In 2019, Facebook had 2.4 billion users, and other platforms, such as YouTube, also boasted over 1 billion users. It would not be hyperbolic to call this a communications revolution, akin to the invention of the printing press in the 15^th century. And just as the printing press, by democratizing access to information, caused major social disruptions, playing a key role in shaping the Protestant Reformation, the rise of digital media has reshaped our culture and politics in ways that are still unfolding.

This new era has meant that, for example, when we find ourselves disagreeing with someone, we are no longer disagreeing over different interpretations of what Dan Rather said. More often than not, our disagreement comes from a misalignment of inputs, in which I feel I understand an issue from reading publications A, B, and C, and you feel you understand it from reading publications X, Y, and Z, with each of these publications offering a very different perspective on the matter. Our niche perspectives are then reinforced by social media echo chambers in which we discuss and share our opinions with others who share our views but rarely with those who do not. These trends have also made us more vulnerable to misinformation. When we are not exposed to ideas that exist outside of our ideological comfort zone, it can be easier to lose the perspective necessary for identifying data that are false or founded on shoddy thinking. Or we can find ourselves fed up with the groupthink in our bubbles and become too uncritically enamored with ideas that come from beyond our narrow inputs, embracing the bad with the good simply because they represent the heterodoxy for which we have been starved.

What are the implications of all this? Certainly, it means we all see the world through a particular lens, and there is nothing intrinsically wrong with this. It is good to have a diversity of perspectives in our society, as long as in holding these perspectives we also listen to each other. The problem is that we often do not, and this can lead to misunderstandings and mistakes. I have written about this in the context of research about salt. There are two schools of thought on population-level salt intake, one that holds that it benefits population health to regulate it, and one that holds the data on population-level intake are inconclusive. These camps rarely speak to each other, and largely cite articles that support their view, creating two self-sustaining ecosystems supporting two mutually exclusive ideas, both of which look quite intellectually respectable from the inside.

We see a similar dynamic in our media, culture and politics. If one only consumes content from NPR, The Atlantic, The New York Times, Threads, and Bluesky, one will draw from a very different set of information — and develop very different priors about the world — than someone who only consumes content from The Free Press, X, The Joe Rogan Experience, Marginal Revolution, and National Review.

I have occasionally encountered, in conversations with people from across the political spectrum, a phenomenon where a contentious political topic is introduced to the conversation and the person with whom I am speaking does not just disagree with one side of the debate, the person is actually unaware that there is any debate about the topic at all. Or, if they are aware of the debate, they are unaware that there could be any good faith disagreement with their preferred point of view — thinking all objections to it are just a consequence of misinformation or the actions of bad faith political actors. Now, it is true that misinformation and bad faith political actors are real, and they do influence the national debate about topics of importance. But it is also true that for many of the key issues we face, there are at least two sides to the conversation, and it is possible to fall on either of them for perfectly humane reasons. The extent to which we believe this is not so is often the extent to which our inputs are not as varied as they could, and should, be.

What, then, can we do to address this? First, we should maintain an awareness of the problem. We need to be aware of the challenges of bias and the importance of being aware of the problem as the first step to solving it. Just as we should remain aware of biases driven by region or socioeconomic position, we should be aware of biases driven by different inputs. When we are speaking to someone with whom we disagree, and we find ourselves thinking “How can they possibly believe this?,” we should bear in mind the likelihood that there is not just a gulf in beliefs but a gulf in inputs. The question then becomes “If our inputs were aligned, if we each consumed the same news sources, would this person still hold their present position on this issue? Would I?” Even if the answer to these questions is “yes,” simply being in the habit of asking them is a de-escalatory practice in a time when the public debate badly needs de-escalation. It is a starting point for rebuilding the sense of common understanding of the world that has gradually eroded over the last decade. And that is worthwhile indeed.

Second, we should make an effort to expose ourselves to other inputs. Do we read articles, watch videos, and listen to podcasts made by people with whom we disagree? Do we invite people with whom we disagree to our gatherings and welcome them into our communities? And do we expose ourselves to inputs that are accurate, fair, reasonable, balanced? Being able to answer yes to these questions is not easy. It takes effort, and no small measure of courage, to engage with inputs and people we do not agree with, whose perspectives may even anger or disturb us. But we are in a moment when, for many, being angry and disturbed is the order of the day, an inescapable reality, whether we like it or not. We cannot avoid the unsettling feelings caused by those with whom we disagree. Either we can engage with these people and perspectives face-to-face, or we can live with the consequences of engagement that only come through zero-sum political fights. It is up to us to choose the ground on which we engage. Will it be that of conflict, when engagement is forced by a clash of perspectives? Or will it be one of dialogue, where we take the uncomfortable steps necessary to bring people together for the conversations that shed light, not heat?

Third, we can encourage ourselves, as a habit of mind, to write and speak in ways that build bridges to others with different inputs. We are in a moment when basic norms of civility and respect are often downplayed or neglected. Yet they are essential for creating an environment in which constructive engagement can happen. This begins with simply giving others the benefit of the doubt, with assuming that they might be coming from a place of different inputs rather than one of ignorance or intentional malice. When we extend the benefit of the doubt, we can then cultivate modes of engagement that lead with the respect that draws people in, that starts conversations rather than ends them.

The input problem is not going away. There is likely no going back to an era when we all received news from the same networks or to a cultural ecosystem where almost everyone saw the same films, watched the same shows, and were familiar with the same books. The fragmentation of media and culture is a central fact of the present moment — we cannot change it. What we can change is us. We can decide how we are going to navigate this moment, whether we will allow ourselves to become as fragmented as our culture or instead choose to become, as people and as a movement for health, bigger than the division around us. This means doing the hard work of engaging with voices we might not generally be disposed to hear, of considering viewpoints we might once have dismissed. The world has changed. The question is: can we?

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Also this week

New in Observing Science, with Michael Stein: on the value of null research findings.

New in the Journal of Primary Care & Community Health, “Standardizing Virtual Healthcare Deployment: Insights From the Implementation of Telerobotic Ultrasound to Bridge Healthcare Inequities in Rural and Remote Communities Across Canada.” Thanks to Amal Khan and Ivar Mendez for their partnership on this.