Why hope matters now, more than ever

On thinking carefully about our approach to the coming years

Earlier this week, after the recent federal election, I offered some thoughts about the implications this moment has for those of us whose role is promoting health. I have since then spent much of the past week in conversation with many colleagues and friends on this very question, and I thought I would follow-up today with a note, co-written by Dr Nason Maani, about how we may think about our approach in the coming years.

We shall start with a reference to the writing of someone we both admire immensely. Martin Luther King, in his address to Cornell College in 1962 argued that extreme pessimists, and extreme optimists, agree on one point: that the best thing to do, when faced with challenges, is to sit down and do nothing. Dr King argued rather for a realist view, that is, a perspective that suggests that we cannot ignore where progress has been made, acknowledging hope, but doing so while also being mindful of the immense challenges one may face, acknowledging despair.  However, a strong theme to his writing was that not acting is simply not an option.  In particular, when there may be a sense that the wider systems around us might have capacity to inflict suffering, we must match that by our capacity to endure and to create a better world.

We can think of no better time to lean into hope—recognizing that matters may be improved through action—leavened perhaps by a modicum of reasonable optimism, believing that things will turn out ok, than the current moment.

As we approach the end of 2024, we are at a pivot point for health.  We are exiting the acute COVID period, five years after the pandemic upended the world, and pushed us to protect health in ways that were, perhaps, clumsier than they could have been, resulting in a dramatic loss in public trust.  We now are exiting from a US national election won by a candidate who has long taken positions that are inimical to the health of the public, including potential appointments of political figures who are robustly on the record as antagonistic to some of the core pillars of public health. 

Anyone who thinks about health can well picture the potential consequences of the moment.  The bottoming of trust in health and science can lead to our voice being marginalized, leaving no countervailing force to push back on those who may wish to act in ways that may harm health, particularly for the most vulnerable.  Adoption of any number of proposals that have been floated in the latest political campaign are likely to result in poor health for those who are already left behind on health, widening inequalities, at the same time as putting the health of all of us at greater risk.  As always happens in downturns in our investments in health, it is the health have nots who will undoubtedly bear the brunt of the moment. Think only of reproductive rights, the threats to the well-being of immigrants, the consequences of climate change on those who are living in areas and housing that makes them particularly vulnerable to extreme weather events, and least able to rebuild after the fact.

Might this then be a recipe for despair? Is this a moment for cynicism and pessimism? 

We argue that the opposite is the case.  Understandable, and perhaps unavoidable as such sentiment might be initially, this is not the moment to indulge in despair.  Despair is, in some ways, a luxury that is available only to those who already inhabit privilege. Those who are likely to be most affected by the coming years, who are most likely to find less solace in the work of science and health, are those who are more likely to be facing flood or natural disasters, unsafe working conditions, contaminated water, and with nowhere to go for safe reproductive care. And those who face these threats to their health cannot afford to despair, to lose hope. Neither should then any of us who have the privilege of being in a position to actually act, to help and support them. Rebecca Solnit, an author whose work we have long admired, noted recently that “In reality, not acting is a luxury those in immediate danger do not have, and despair something they cannot afford.”  We could not agree more.

What does this mean then for those of us who are the day-to-day practitioners of health, those whose work it is to generate the ideas that shape the work of health?  It means, we would suggest, three things.

First, a bit of a lean into optimism.  Insofar as optimism is a frame of mind, a belief that matters will indeed work out well, then it is time for optimism.  We do not mean the extreme optimism that leads to inaction, but rather the habits of mind that move beyond the negative, that acknowledge progress, that this is a healthier time to live in than ever before in history, and that encourage us to believe that, even with setbacks, better is possible.  Why optimism? Why belief?  For one, optimism and belief are healthier, and substantially better than the dark alternatives.  But, perhaps more pragmatically, it is optimism and belief in the possible that can bring populations along with our mission.  And there is very little at all we can do without having populations along.

Second, our responsibility is to act.  Balancing optimism with hope requires a commitment to action that leads to a better and healthier world. And what action do we speak of?  We have long felt that there are any number of actions that can create a healthier world. Those who are in academic spaces can, and should, write, and more, and use their platforms to convince the world of the pathways to health.  Those who are in the public health practice space can, and should, commit to serving as the bulwark against incursions into the necessary work of health, and to continue doing the work that they are doing to advance public health.  Our colleagues in medicine and clinical care bear a heavy burden in ensuring access to health for all, making sure that reproductive health needs are met, particularly in the face of new restrictions that are having a growing impact on women’s health. It is action from across the constellation of work that builds health that ultimately materializes the ideals of hope.

Third, our optimism, hope informed by action, will fall short if it remains limited to what we do only by ourselves, engaging those who think only like ourselves. The challenge before us—perhaps bigger than moving beyond despair, leaning into optimism, grounding our hope in action—is to do so while engaging the very populations who have lost trust in the work of science and health, and who are choosing leaders who are at best uninterested in the actions that may generate health. And yet, work with all populations we must. All too often, political narratives reduce populations to “us” and “them”. But we know all too well that in the context of population health, there is no “them”. There is only us. Because that is the only way in which our optimism, our hope, and our action will take root and change what we think about, what we talk about, and what we as a society invest in, to generate health for all.

Onward.

This note was co-written by Nason Maani