Three directions to push forward The Healthiest Goldfish conversation

Reflections on a transition.

In my last essay, I shared some reflections on the themes of these essays over the past year or so, looking back while also looking ahead to the next evolution of the conversation about health. Since then, I have had several readers reach out to me to ask if I was sunsetting The Healthiest Goldfish as a result of that note. Far from it. What I was doing in the last note was looking back on a cycle of essays, to pave the way for a new cycle of ideas. So, I thought today I would do something a bit more self-reflective, thinking though some ideas that have been percolating in my head for some time, and outlining the key areas I am hoping to focus on in my writing in this space in the coming year. As the health conversation has evolved, I have continually asked myself how these essays should also evolve, to do the most good in the moment, not simply reacting to events and ideas that emerge but playing a role in shaping them, nudging them in a more positive direction, ever closer to our goal of health. This means asking now: what role should The Healthiest Goldfish play in the months and years to come? What kinds of conversations should we engage in to create a better world in this moment? 

Looking ahead to the next cycle of Goldfish essays, there are, as I see it, three domains on which I would like to reflect more, areas which might be fruitfully explored towards informing a better conversation about health.

First, I want to engage in a conversation about the functional structure of the academic environments where science and scholarship is done. Public health is downstream of the thinking and ideas that animate our work and thinking, and ideas are the business of academia. I have spent much of my career working in academic public health. I believe in it, and I care very much about the future of schools, universities, and programs of public health. Academia has long intersected with my writing in The Healthiest Goldfish, but it feels like the moment is right to take a deeper dive into how we create academic institutions that meet the challenges—and seize the opportunities—of the moment, to build the future of public health. How can we create academic structures that encourage science, scholarship, excellent publications, and engagement with practice, to move ideas forward? How can we shape institutions that are both rooted in the best traditions of the past and nimble enough to evolve with the times in pursuit of excellence?

Such questions have long interested me in my capacity as Dean of the Boston University School of Public Health and they have taken on new salience as I have begun the process of transitioning out of this role to take on the position of inaugural Dean of a planned new school of public health at Washington University in St. Louis. It is a privilege, and an opportunity, to be able to work with colleagues to build a new school of public health. Creating a great school of public health at WashU means thinking deeply about the philosophy that supports such a school, the best practices that sustain it, and the role it can play in creating health at the local, national, and global level.

A second domain of ideas I would like to explore emerges from my personal transition to Washington University. I am energized by the opportunity it represents to apply cutting-edge thinking and approaches to building something new in the academic public health space. I am also looking forward to pursuing this opportunity in a new place, one quite unlike the east coast city of Boston, where I have spent the past decade. This leads me, then, to a second set of reflections: thinking about health through the lens of a new place. About a year ago, I wrote an essay about engaging with people in places we may disagree with. I wrote that essay as an effort to think about how the work of health should proceed in contexts of disagreement, where populations may not always share our thinking about fundamental issues. In a country, and world, with much polarization, we need to engage squarely with this challenge. We can either retreat into geographic and political bubbles, where an alignment of the values of public health and the values of populations and policymakers creates a near-frictionless translation of our ideas and approaches into practical reality. Or we can choose to reach out—across political, cultural, and geographic lines—to build the connections that take public heath out of the bubbles it can get trapped in and into the rest of the world, a world which badly needs what we do.

There is, of course, much to recommend the first option. It is easier, it does not call for us to persuade, to reach out, merely for us to “preach to the converted.” The second option carries with it the risk of discomfort, misunderstanding, challenging encounters, and the need to continually justify what we do. But it seems to me essential that we take these risks if our field is to continue growing into its full potential. I have written that for public health to meet the challenge of this moment it needs to be at its best. This means becoming a movement that reflects our universal aspiration for health, that engages with everyone who desires to be healthy, no matter where they live. WashU is in St. Louis, which is in Missouri, a red state, where there are many in government and among the local population who do not share the approach to health widely embraced in blue states like Massachusetts. Working there will involve complication and complexity. But public health, as I have written, must embrace complexity, and be at home with complication, if it is to thrive in this moment.  

And third, I see The Healthiest Goldfish remaining, as ever, a place where I will be commenting on issues of contemporary concern as they arise. The past years have seen many events with deep implications for health—from global conflict, to the rise of new technologies, to political disruptions and social movements. As these events have emerged, I have valued the chance The Healthiest Goldfish affords to step back, reflect, and try to articulate how we might best engage with these developments from the perspective of trying to create a healthier world. I have always thought of these essays as conversation starters, contributions to an ongoing dialogue about how to build a healthier world. I appreciate everyone who has taken part in this conversation over the years, and I look forward to continuing the conversation as we collectively work towards better health for all. Please consider this, then, an invitation to join the conversation, if you have not already done so. Feel free to comment on these essays and to share them as we work towards a conversation about health that is maximally inclusive, encompassing a breadth of ideas and perspectives. Just as such a conversation shapes a vital academic environment, it also supports a healthy climate of ideas in the digital space and beyond.

I will close by extending another invitation. I am delighted to share that we have begun recruiting inaugural faculty, at all levels, for our new school of public health at WashU. We are looking for faculty who are much like I imagine readers of The Healthiest Goldfish to be—curious, heterodox in their thinking, and passionate in their pursuit of a healthier world. Learn more and apply here to be part of what we are building in St. Louis. I think this is an exciting and interesting project and I encourage anyone who is interested to apply.

As I navigate a personal transition, coupled with this transition in my thinking, I would like to mark this moment with a simple thank-you to you, the reader, for engaging with these essays for so long. I started The Healthiest Goldfish in 2021 to share thinking about the lessons of COVID and the state of public health at that time. Since then, THG has grown beyond what I could have imagined for it. It is something I do not take for granted, for which I remain grateful. It is a privilege to be part of this conversation with you.

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Also this week.

Thoughts on the role of government scientists and the importance of protecting regulatory science in the latest Observing Science with Michael Stein.

New in the Journal of Psychiatric Research with Caitlin Rancher, Angela Moreland, Faraday Davies, Jamison Bottomley, Mohammed Abba-Aji, Salma Abdalla, and Dean Kilpatrick, “Awareness and use of support services following mass violence incidents.”

A Wall Street Journal story on social media use and childhood mental health, which references our National Academies of Sciences, Engineering, and Medicine report, “Social Media and Adolescent Health”.