We should talk

On doing the difficult work of engaging in conversation

We live in bubbles. And our bubbles think and speak in similar ways. We spend most of our time talking with people who think like we do, who see the world through lenses not unlike our own. This is true across our professions, our social circles, and our political affiliations.

A recent study found that, “A large proportion of voters live with virtually no exposure to voters from the other party in their residential environment,” communities where nearly everyone they interact with votes and thinks the same way. While more and more attention is being paid to these “partisan echo chambers,” the pattern extends beyond politics. We see it in how we socialize, the workplaces we choose, the schools where we send our children, the churches we go to — or do not. There are many consequences of this siloing of our daily lives, but perhaps none is more consequential than the fact that our conversations tend to reinforce what we already believe.

I have written before about the importance of understanding people with whom we disagree. It is tempting to treat “understanding” as a purely intellectual exercise — something that happens at a comfortable distance. But understanding demands more than the dispassion of so stating it. It requires conversation.

Talking with people whose worldviews diverge sharply from our own is hard work. It makes us uncomfortable. It demands restraint, humility, and a willingness to listen without rushing to correct. It can feel safer to avoid the exchange altogether. Yet without conversation, we never truly experience the pluralism that we may claim to value as a core of our open-minded approach to understanding all people. Absent conversion we run the risk of remaining ensconced in our own bubble, mistaking comfort for clarity.

And the harms of not talking are real. Silence allows caricatures to harden. When we disengage, we deepen the divisions that we say we should aspire to mend. We hand momentum to those who profit from polarization, and we alienate potential partners in building something better. In refusing to talk, we help to create the very world of distrust and exclusion that we most lament. Talking may be uncomfortable, but surely the alternative is much worse.

There is, of course, the argument that some beliefs, and those who hold them, are so abhorrent that dialogue itself seems impossible. Perhaps that is sometimes true. But such cases are rare, and the threshold for disengagement should be high. I do indeed respect the idea that some values are so dear to us that to engage with those who advocate challenges to those values is tantamount to treason. But there are also other values that matter to us, including that our work concerns the well-being of all people, even those we disagree with. And to do that we need to keep open the possibility of engaging those people. In addition, the idea of a liberal, pluralistic society depends on the conviction that conversation, not avoidance, brings us closer to understanding and, occasionally, to change.

About a year ago, I moved from Boston to St. Louis, to be part of building a School of Public Health in the middle of the country. In part, my motivation was to put myself in a place that was different from anywhere I had lived before, where I expected to feel uncomfortable, to be around people whose life experiences were different than mine, to live in a place where the assumptions around me would not always mirror my own. And it has been, at times, difficult. It also has been deeply rewarding. The impulse to put myself in an unfamiliar environment, to learn from different perspectives, has been rewarded. I have had many occasions to value what those differences teach me about the country, and about myself, a topic I hope to come back to in one of these reflections in future. That is, of course, the experience of just one person, but perhaps that experience, that exercise, is helpful as one example where we, in the business of promoting the health of populations, can learn from one another through deliberately exposing ourselves to those who have long been explicitly outside of our particular bubbles, and where we are better for it.

I often lean back for guidance on observations that colleagues make that I find shed light, help me better understand the world. One of those statements that has stayed with me is this: If we still disagree, perhaps we have not talked long enough. That seems to capture the fundamental point better than anything I could write about.

I am not so naïve as to think that with enough conversation we can always reach agreement. Far from it. Conviction matters. We each hold values that shape our sense of right and wrong, and so do those with whom we differ. But conversation is not about erasing conviction; it is about illuminating it. Through conversation, we can at least begin to understand where others are coming from, and they can understand us. From a place of shared understanding there is sometimes room to build common ground — ground rooted not in perfect alignment, but in shared aspirations for a world that works a little better for all of us.

Talking is not capitulation. It is courage. It is the work of democracy and of public health — the work of creating a world where more people are heard and where progress, however slow, becomes possible. It is, in the language of radical incrementalism, the articulation of a vision of a better world, coupled with the patient, daily labor of small acts that together move us toward a better whole. Conversation is one of those small acts — rarely dramatic, often uncomfortable, but ultimately indispensable.

So today, a short note in praise of talking. Because the healthiest societies, like the healthiest people, are those that can face discomfort, stay in conversation, and keep finding their way forward, together.

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Also this week

An article, “The Consequences of Selective Defunding of Health-Relevant Research Areas,” focuses on the implications of defunding women’s health in particular. Complementary to that, I also recorded a podcast titled “The Centrality of Women’s Health to a Population Research Agenda“ with Roza Gonzalez-Guarda, who wrote an excellent related article, “The Continued Invisibility of Women in Population Health,” in JAMA Health Forum.