Welcoming (back) complexity and contradiction in 2023

To shape a healthier world, we need to resist Manichean narratives and engage with reality in all its messy nuance.

We have been living in divided times. It is hard to pinpoint exactly when this started, but a strong contender for that moment would have to be 2015, which, not coincidentally, was around the time of the rise to prominence of Donald Trump. Before then, the country had known divisions, our political system characterized by entrenched ideological positions, but we more or less felt we knew where we were collectively headed. Our future seemed to be one in which the push and pull of two different views of the country continually jostled for space, with one occasionally prevailing over the other. This jostling would sometimes result in constructive engagement, with both sides recognizing the complexity of issues. We in public health found ourselves working to promote ideas and policies that generate health, reaching whenever possible across partisan divides to achieve this goal. That the world and country were getting healthier was testament to our achievements. That there was so much we could do better, so many getting left behind, was testament to how much more we still had to do.

Around 2015 however, the world changed, plunging us into a deepening of divisions that is unprecedented in recent memory. In five short years, by the 2020 election, about nine in 10 registered voters said they thought a victory by the political party they opposed would do “lasting harm” to the country. This captures succinctly our drift towards binary thinking, in which we have come to regard issues as black or white, where anything but our preferred option is devastating, and where there is little room for complexity and nuance. Now, there are unquestionably times when particular actions are devastating to the health of a country—such as recent legislation that hinders access to healthcare—but in most cases the answer, and what our approach should be, is far less clear. And yet, it is hard to avoid the observation that in the past near decade, binary thinking, and an unwillingness to embrace nuance have characterized how we address issues of consequences.

It is worth noting, if perhaps guardedly, that this has been true on the right and on the left of the political spectrum. From the perspective of those on the political left, the ascent of Donald Trump did much to drive this thinking. Everything associated with Trump, every position he seemed to be for, was perceived as unambiguously bad, and everyone who seemed to oppose him was, if not completely virtuous, then at least in service of a cause that was. This made it possible for progressives to live in a world that seemed divided into good and bad, black and white, with few shades of gray. On the right of the ideological aisle, as president, Trump was consistently hostile to civic institutions and relished attacking and insulting his foes. Understandably alarmed by this, some on the left, in opposing Trump, embraced approaches that echoed his illiberalism. This included a willingness to raze, rather than reform, institutions for their participation in historic injustice. It also included a tendency to shout down and attack opponents for a range of reasons—from voicing genuinely abhorrent views to simply disagreeing with progressive positions. Just as progressives saw Trump as a threat to democracy itself, many conservatives saw what progressivism had become as a threat to the liberal order. (This is not, of course, to say some were not motivated by darker impulses like racism, misogyny, and xenophobia.) This further reinforced a Manichean dynamic on both sides of the American divide in which what once might have been seen as areas for mere disagreement become seen by many as cause for political and cultural war.

And all of this was complicated by COVID. In an alternate universe, the pandemic was a time when we came together, setting aside our differences in the name of the common good. We had civil, data-informed conversations about best practices, with the understanding that nobody would conduct themselves perfectly and everyone would occasionally stumble in their approach. In this universe, measures like masking, testing, and lockdowns were implemented with concern for nuance and the assumption of good faith on the part of leaders making hard choices about what to do and when.

Unfortunately, this universe proved to be very different from the world we live in. In reality, the pandemic deepened division and further eroded our ability to engage with the complexity and contradiction inherent in choices about health. Examples of this abound—from those who compared masking and vaccine mandates to Nazi Germany to those who called the CDC’s policies eugenicist. This language, heightened by the COVID crisis, reflects a denial of complexity and a belief that there is a right and wrong way of engaging with issues, and that the right way often aligns with the most maximalist political position. For many in our field, this means that the work of supporting health becomes largely a matter of picking the correct side and then charging into battle, heedless of complicating nuance.

It is worth asking—has this perspective served us well? I think not. When we insist that everything is binary, we misalign our efforts with the reality of the world. The real world is defined by complexity, paradox, contradiction, and, within each of us, a blend of good and bad motives. Choosing to see only rigid categories cannot advance a healthier world in the messy, complex here and now.

A key example of this is the role of lockdowns during a pandemic. During the early months of COVID-19, our knowledge of the disease was limited, and it made sense to take broad precautions to slow the spread while we learned more about the challenge we faced. As we learned more, however, about both the virus and the effect of lockdowns on population health, we could see the need for a more nuanced, balanced approach. Yet the pursuit of this approach was characterized by some in public health in terms suggesting anyone supporting it wished to see continuing death and misery. Such a characterization is only possible when we have chosen to willfully tune out complexity. That many in public health have done so reflects the need to rethink our approach.

It is important to note that acknowledging complexity does not mean embracing moral relativism. It just means recognizing that good and bad, right and wrong, are rarely unadulterated within a given policy or person. Advancing a healthier, better world does not mean simply keeping our own positions as pure as possible. It means wading into the muck where real life is lived and real politics are practiced. It means understanding that we will compromise and, at times, be compromised in our efforts to achieve our goals, if we want these goals to remain more than merely rhetorical. It means understanding that there are genuinely malign actors in this world, but even their natures have better angels, and most people are a mix of good and bad. We can engage with this complexity while retaining our moral compass. Indeed, such engagement is core to keeping that compass in proper order; the moment we are most convinced of the rightness of our cause is the moment we are most in danger of doing something truly misguided.

It is perhaps worth taking the start of 2023 as a time to reengage with complexity. Such engagement can serve as a uniting force, an antidote to the divides driven by a binary view of the world. It can defuse conflict by helping us to see how even those we may regard as enemies can be motived by a concern for what they regard as fairness, justice. It can also help those of us who are privileged to work with students prepare the rising generation for living and working in a world defined by nuance and contradiction.

We are all amalgams of light and dark, creatures of complexity. In this, we reflect the reality of the world around us. Complexity can be disconcerting, tempting us to embrace easy narratives of heroes and villains. We should resist this, and welcome complexity and contradiction in the new year. The world is not as simple as we might wish it to be, but it can be far better than it currently is. We can help make it so, if we can learn to engage with it on its own terms, in all its messiness.  Here is a hope that 2023 represents a return to a fuller view of the conditions around us, towards productive and generative work that advances a healthier world.