What are universities for?

Part one of a three-part series on universities, science, and the promotion of health as our social purpose.

Summer break offers a bit of an opportunity reflection about what one does, why one does it, and how to do it better. Over the past few weeks, I have found myself thinking about something at the heart of all we do in health—the process of knowledge generation. What we do is upstream of what, and how, we think. As we look ahead to the end of summer and a reengagement with a livelier pace of work, I would like to use this space for a three-part series of reflections on the thinking that drives all we do, the institutions that shape this thinking, and the social purposes that our knowledge helps to define and advance.

I will start with a reflection on the institutions where I have worked for the past 25 years—universities. For thousands of years, universities have served as centers of thought around the world. Clark Kerr memorably noted that roughly eighty-five institutions in the Western world have existed in recognizable form since 1520. They include the Catholic Church, a few parliaments, some Swiss cantons, and some seventy universities. Some universities go even further back. The University of Bologna, for example, was founded in 1088 and is now the oldest university in continuous operation in the world.

Institutions do not survive five centuries and beyond by accident; they survive because they do something civilizations cannot do without. Through social and technological change, universities have remained hubs for the creation and dissemination of knowledge, for the intellectual formation of the next generation. There are many reasons for this—perhaps the key reason is that universities have always been physical spaces where smart, committed people have come together to discuss ideas, work out problems, and cultivate a life of the mind. This will remain true even in the AI era, with its potential to change so much about how we create and engage with knowledge. No matter what AI can do, it cannot be a physical campus where students and teachers come together for the shared pursuit of knowledge. This simple, powerful feature of universities have kept these institutions robust through the ages and will likely continue to do so.

However, this does not mean that universities do not sometimes find themselves faced with moments of challenge—moments like right now. The university, this most durable of institutions, now finds itself, in the United States, under a level of attack unmatched in living memory. Universities are being challenged politically, financially, and culturally—through federal actions against research funding and international scholars, congressional scrutiny, state-level interventions, and a broader collapse of public trust. The share of Americans expressing high confidence in higher education fell from 57 percent in 2015 to 36 percent in 2023 and 2024, recovering only partially to 42 percent in 2025, with confidence sharply divided by party.

Driving these challenges is a central question: what exactly are universities good for? While this question has often been posed somewhat antagonistically, it is actually a good question, one that is worth engaging with. We should not assume the worth of anything, even of what we value most, is self-evident to all. Universities depend on a level of public support (which includes public funding), and it is perfectly reasonable in this context that universities should be asked, from time to time, whether they still justify their privileged place in society. This moment should then push us to be clear about our purpose. If we cannot answer in language a skeptical fellow citizen would accept, we should not be surprised that the skeptics are winning.

Answering the skeptics, and making the case for universities’ worth, means first acknowledging where those who are critical of universities have a point. It so happens, in my estimation, that much of the critique that has brought us to this moment is not incorrect. There is, for example, the critique that the academy is ideologically orthodox, that universities lean overwhelmingly to the left, that this has limited their capacity to be spaces for free and open debate and that this leaves open the possibility of bias in the scholarship they generate. It is true that the academy does lean heavily left and, ideologically speaking, does not look like the country it serves. Democrat-to-Republican faculty registration ratios exceed 10 to 1 at elite liberal arts colleges, and there are ratios of over 17 to 1 in philosophy departments, more than 40 to 1 in English and sociology departments, and large shares of departments with no registered Republicans at all. Then there is the criticism that universities have become too insular, too self-referential. This, also, has some truth to it. We too often talk to ourselves, publish for ourselves, and mistake consensus within our walls for truth beyond them. Public health has its own version of this, which prior essays have addressed at length.

These criticisms have, correctly, produced calls for reform, and arguments in favor of institutional neutrality policies in the spirit of the Kalven Report by a growing number of universities. It has also prompted viewpoint-diversity and civil-discourse initiatives, renewed debates about admissions, governance, and the institutional voice, and a fair bit of genuine self-reflection. One need not agree with all of the criticisms prompting these developments to feel like this is to the good, acknowledging that institutions tend to improve when challenged.

From this context of self-reflection has emerged a subtler pressure on universities worth examining, the pressure to act, to take positions, to be ideological combatants, to deliver visible change. This pressure comes from both directions—from critics demanding universities doing a better job of fulfilling their historical roles and from allies demanding activism. And it is particularly relevant to academic public health, a field that is repeatedly asked, and asks itself, to change the world, a demand heard in every crisis from HIV/AIDS to COVID-19 to the present moment.

The temptation is to accept the framing, to justify the university by its activity, or lack thereof, in pursuit of a better world. But this framing, however well-intentioned, mistakes what a university is. Universities do act in the world, but what they do is different in kind from what governments, companies, movements, and service agencies do, and the difference is precisely what makes them valuable.

So, what, then, are universities for? Fundamentally, universities generate ideas, teach students, and translate ideas toward a better world.

The generation of ideas is the core of what universities are for, from which flows everything else these institutions do. The generation of ideas is the university’s irreplaceable contribution. More than that, it is perhaps the best action we can take for ourselves as a species, because it is difficult to see how else we could elevate ourselves collectively without engaging with old ideas and generating new ones. This has been said and said again. For example, Neuman in The Idea of a University reflects on knowledge as an end in itself; Flexner, in The Usefulness of Useless Knowledge, well summarizes world-changing discoveries that began as idle curiosity and Whitehead in Universities and Their Function makes a compelling argument about the university’s ability to weld imagination to experience. All of these works argue for the importance of idea generation as a fundamental human endeavor, central for human health and well-being.

Next, and following closely from universities’ role as knowledge-generating institutions, is their function of transferring this knowledge to the next generation through teaching. Universities are where each generation is equipped to think—not told what to think but taught how—and where the thinkers and doers of the next fifty years are formed. In a school of public health, this means training students who will staff health departments, run health systems, and shape the next generation of ideas. This process of teaching is not just about supporting students; it is also about supporting ideas themselves. We teach because ideas without inheritors die. Teaching is the university’s most democratic function, providing a route of access to intellectual and social mobility and sustaining a climate of ideas from which progress towards the common good may continually emerge.

Finally, universities are essential engines of translation—the process through which ideas are put to practical use in the “real world.” Translation matters; this is a longstanding personal commitment, expressed over a decade of writing on a public health of consequence, and The Healthiest Goldfish has consistently argued that our science must matter beyond our journals. But translation is not service provision. With the exception of clinical care in relevant settings, universities are not, and should not become, delivery organizations; when they try to be, they do badly what others do well, and they compromise the independence that makes their ideas credible in the first place. Translation, as I have written before, means partnership: working with health departments, communities, governments, and practitioners who own the doing. Universities have long been critical partners to a range of organizations and sectors, and they are poised expand these partnerships in the coming years as social, political, and technological change creates new openings for our data to drive progress.

So, what are universities good for? Universities are good for being the places where ideas emerge, where people are trained to carry them forward, and where, through partnership, ideas are bridged to a better world. Some institutions do some of this work, but no other institution does all three; that is why seventy universities have outlasted almost everything else built since 1520. The contemporary criticisms of universities are real, the reforms are needed, and we should pursue them with humility and without flinching. But reform is renovation, not demolition, and as we improve what we do, challenge what we do, and open our doors and our minds wider, it would serve us, and the health of the public, not to lose sight of what universities are truly for—the work they do that cannot be replaced.

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Also this week

In Health Affairs Scholar:

Medical debt and subsequent use of alternative financial services among US adults – with Hridika Shah, Kyle Moon, Katherine Miller, and Catherine Ettman

In Journal of Traumatic Stress:

The prevalence and distribution of traumatic events and stressors: Insights from eight countries – with Salma Abdalla, Madison Pickerel, Samuel Rosenberg, Bernard Banda, and Catherine Ettman

In the BMJ:

Artificial intelligence as a new commercial determinant of health – with Itai Bavli, Joel Lexchin, Nicholas King, and Nadav Davidovitc

In JAMA Health Forum:

Policy Approaches to Ensuring an Adequate Nursing Workforce in Coming Decades – with Angela Clark

Thank you to the colleagues who guided our thoughts on this work.