The obligation for humility and compassion

The values at the heart of our work in health

In this series of Healthiest Goldfish essays, which started more or less at the beginning of 2023, I have been aiming to articulate a practical philosophy of health. In so doing, I have intermittently mentioned the importance of humility and compassion as values that should inform what we do and how we do it. However, I have never focused on the former as a central thought in a full essay. I thought I would do so here, coupled with compassion, which I think emerges from the former.

In truth, I have been dithering a bit on whether to write more fully about this topic. Partly, I am concerned that a discussion of humility runs the risk of sounding, well, preachy, and partly because I am always reminded of the uncomfortable maxim that humility is a strange concept in that once you think you have it, you have lost it. Yet the aim of these essays is to raise topics which may be uncomfortable, even when the discomfort may be primarily that of the writer. We should not shy away from certain topics because we fear addressing them may cast us in an unflattering light. So, with due awareness of the dangers of writing about humility and compassion, and with self-awareness of the many ways I fall short on both, here are some thoughts on why, despite all this, it seems important to write of the obligation for humility and compassion for anyone who is concerned with foundational thinking about health.

Readers of these essays will know that I like, when discussing concepts, to start by rooting their abstraction in a definition. So let us start with the various definitions of humility.

Merriam-Webster defines humility as: “freedom from pride or arrogance: the quality or state of being humble.”

The Cambridge Dictionary defines humility as: “the quality of not being proud because you are aware of your bad qualities.”

Dictionary.com defines humility as: “the quality or condition of being humble; modest opinion or estimate of one's own importance, rank, etc.”

These definitions strike me as serviceable, but incomplete. It is notable that many definitions of humility are tautological, centering on the quality of being humble. They are also laced with the idea that humility is about low self-regard. I’m not sure I completely buy that as a full accounting of what humility truly is. One of my favorite definitions of humility comes from C.S. Lewis, who said, “Humility is not thinking less of yourself, it’s thinking of yourself less.” This definition suggests that humility is not about denying one’s gifts and talents but about using what we have to serve others. This service means being open to learning from others—recognizing that they, too, have much to offer the community—and placing the needs of our neighbor before our own.

The importance of humility to the work of health echoes the emphasis placed on humility in other traditions, such as Taoism, which counts both humility and compassion as two of the “Three Treasures” (the third is frugality) that support a good life. In Taoism, humility means emphasizing the virtues of others without trumpeting our own. It also means emulating water in the sense of being yielding, eschewing stubbornness, in a manner that allows us to “go with the flow” by appreciating and seizing the opportunities around us rather than being blinded by visions of what we may not yet be able to grasp. Such humility, for example, might allow us to welcome into our movement people who agree with us on most, but not all, matters—people we might otherwise hesitate to associate with. We yield to these associations not in the sense of repudiating what we believe, but by being humble enough to remain in good faith dialogue about points of contention—points on which we may well have much to learn—while still welcoming into the fold those who think as we do on most everything else. A less humble approach might see us being too prideful in holding the “right” positions to deign to engage with people who may have different views, causing us to exclude them from our work and, in doing so, undercutting our capacity to build an appealing, effective movement.   

These definitions make sense to me, and, I think, have direct applicability to a philosophical grounding for the work of health. To achieve better health for all, we need people who are committed to health and who bring their skills to helping to create a healthier world. This means we need a humility that does not deny expertise, but, rather, attracts it and puts it to work for a greater purpose. We can attract such expertise by remaining humble, staying curious and open to what others have to teach us. We do not have to deny our strengths. On the contrary, we should continue to cultivate them, always pursuing excellence. But in defining the focus of who we are and what we do, we should constantly be placing emphasis on “we” not “me,” on recognizing and elevating the contributions of others, on making the cause of health—which is bigger than any individual—the central aim of all we do.

Such humility can also help ensure the focus of our movement is and remains in service to others. This may seem like an obvious goal, one that is already core to our work, because, after all, the health of the public is at the center of all we do. However, we can sometimes forget the central fact that what we do we do for the health of the many, for all. This of course has enormous implications, because it means thinking about all—including the many who disagree with us. It takes real humility to commit to using our expertise to create space in our conversations for people we, frankly, may not like, and who may not like us. It takes humility to hear them out from the perspective of feeling like there may genuinely be something we can learn from them. It takes humility to work towards a healthier world for everyone, even those who may be careless with their health, who ignore our advice, who vote against what we perceive to be their best interests. Our work is incomplete unless we engage with these populations as much as with populations that are friendlier to our efforts. Yet our lack of humility can cause us to shirk this responsibility, to rationalize our evasions, or to simply not see where we are falling short.

Humility helps us to acknowledge that it is not for us to decide what people do with their health, it is only for us to see to it that they are indeed healthy. Service to others means doing our best for the people around us even as they remain others—in the sense of perhaps having other ideas of how the world should operate or even about the worthiness of our cause. It does not matter. We should work for their health all the same.

Humility also helps us to broaden our understanding of the world by keeping us open to all we can learn from others. This comes up a fair bit in modern public health thinking about engaging with communities. As I have written before, I fear sometimes that we talk about this much more than we think about it carefully. This is why it is important for us to actively seek out opportunities to learn from others. We need to have conversations with those who think differently than we do, and we should not delude ourselves into thinking these conversations will somehow spontaneously occur. We need to reach out to these people by going where they are, engaging with open minds and a true willingness to learn. Doing so means first accepting that we do not know everything, and that other people might indeed have something to teach us. This takes humility. Such humility helps us to see that it is our responsibility to better understand what may at the moment be hard for us to reckon with. If others are engaging in thinking and behavior we regard as unfathomable (which is often reflected in cultural expressions that are vastly different from expressions used by those who are setting the “health agenda”), it is on us to make the effort to better understand what we are seeing. If, for all our supposed sophistication, we cannot manage to do that, then we truly are in need of the humility that helps us to reach out, to engage with all communities.

Finally, humility serves the elevation of others’ needs, which is core to much of what we call health equity, but which, like community engagement, can be something we talk about more than we do to the fullest extent that we might. A healthy world is one where all policies are optimized for health, supporting the health of all populations with extra care for groups that have historically been excluded from the conditions that create health. This means creating polices from a place of being conscious of the unique needs of different populations, working to support the health of the many by keeping in view the range of ways health is held back from the various groups that comprise the many. There is a temptation, in the policy space, to embrace the philosophy that “a rising tide lifts all boats,” and a pride that can accompany the successful pursuit of policies that reflect this philosophy. The perspective of humility helps us to see where this philosophy falls short, that, in fact, we have not succeeded when we raise the baseline of health for all if health gaps remain between groups. In this way, humility keeps us rooted in the core aim of our work—to ensure everyone can live the rich, full lives that health enables, with no one left out.

So where does this leave us? I think it leaves us with humility as a guiding concept that unites a number of threads that we talk about in the work of health. It allows us to combine expertise in pursuit of health for all with community engagement and a thoughtful focus on health equity. Yet it is important to note that, while humility serves as a useful concept for guiding our work, it is still, frankly, difficult to embrace humility to the degree that we should. If it were easier, we would have widely done so already, and this essay would be less necessary. For this reason, it seems apt to suggest the value of a companion to humility, one I have written about before: compassion. Compassion, like empathy, helps us to engage with the perspectives of others, to imagine seeing the world as they see it. Empathy does this by allowing us to “walk a mile in the shoes” of someone else, to better understand them. But I see compassion as different from empathy in that it motivates us to improve the lives of people we cannot understand. Compassion helps us to see the structural forces that underlie a person’s life and health. We do not need to fully see the world from their perspective to see these structures; we can address them towards our goal of better health for all while recognizing that there are differences between groups and that not all of these differences are easily overcome. This recognition can help inform the humility that lets us reach out and engage with those with whom we may feel we do not have much in common. Humility allows us to embrace approaches that do right by the many, including by people we do not see eye to eye with, while letting us see less of ourselves as we see more of what is relevant to supporting the health of these diverse populations.

I end with a simple observation: all of this is hard. There is a reason religions and philosophical systems have talked about humility and compassion for millennia. Embracing them in a sustained and serious way is very difficult. But, of course, just because something is hard does not mean it is not necessary, foundational. Humility and compassion should be core to our intellectual architecture in health, anchoring us in what matters most: our aspiration to improve the health of all.

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Also this week.

A Dean’s Note on reaffirming the dignity of LGBTQIA+ populations this Pride Month.

A recent piece in The Milbank Quarterly about the role of politics in shaping health, with thoughts on how we can engage with politics throughout 2024. 

Thoughts on science and safety with Michael Stein in the latest Observing Science.