Why we should work with people in places we disagree with

The case against disengagement with Red America.

When Russia invaded Ukraine, I wrote a piece addressing the issue of working with scientists from countries which are engaged in actions that run counter to our values. Russia's invasion is a profound injustice, causing harm to those in the region and amplifying the global risk of nuclear war. This raises the question of whether, by continuing to collaborate with Russian scholars—and by continuing to engage with Russian cultural products more broadly—we are in some way complicit in the country's continued aggression towards its neighbor. This question does not lend itself to easy or comfortable answers. In science, we are centrally concerned with the pursuit of truth, and the truth is that actions that undermine the creation of a just world place at risk the conditions of freedom and equality that sustain human progress and science itself. It is our mission, then, to take seriously the possibility of disengaging with countries and organizations whose actions undermine the shaping of such a world.

Consistent with this, there has emerged within science a concern which asks: should we participate in events, such as professional conferences, that are held in US states that pass laws that are contrary to the values of our field? Should we work with scientists in those states? In recent years, we have seen states pass laws on a range of issues, including regressive anti-LGBTQ laws and abortion bans, which run counter to the opinions and values of many—though not all—who work in public health. This has engendered a debate over what, if anything, public health groups should do in their relations with these states, with some voices arguing for disengagement with states that pass laws we disagree with. As this debate has unfolded, we have seen the emergence of state-level legislation reflecting the willingness to disengage—as in, for example, California’s ban on state-funded travel to states with laws that discriminate against LGBTQ populations.

This debate raises the issue of how public health should respond to disagreement, to ideas that run counter to the values of our field. Core to this newsletter is an effort to think through how we should proceed in contexts of disagreement, when there is a temptation to simply tune out or ignore, rather than engage with, whatever does not align with our worldview. Continuing on a theme, then, and picking up from my piece on individual disagreement, today I wanted to reflect a bit on this tricky question—should we be working in places, and with people, we disagree with, or whose actions may even support conditions of injustice?

This argument for disengagement is understandable. There is a compelling case to be made for total disengagement from entities—whether countries, organizations, or people—that are party to injustice. We saw this, for example, during the days of South African apartheid, when many organizations, including many in the academic world, chose to cut ties with the country while it persisted with its system of institutionalized bigotry. Such actions feel right and, under certain circumstances, can indeed help to change the status quo around issues of injustice. However, I have often argued that we have a responsibility to be pragmatic in our pursuit of health, balancing our values and our data as we consider which steps will be most supportive of healthier populations. This means asking: how much will disengaging with states that take actions we disagree with support our mission? Is disengagement really the best course for our work to take? I would argue that the answer is no, that disengagement, however right it may feel, is not the way for us to meaningfully advance positive change in this moment. I base this thinking on four key reasons, which echo my thoughts about engaging with colleagues in sanctioned countries like Russia.

First, the actions of state governments are just that—the actions of governments, not the actions of the people as a whole. The political actions of states are determined by a small group of individuals, and, while these individuals may represent a broad cross-section of the states they govern, they do not reflect everyone who lives there. This is evident, for example, in the resounding defeat of anti-abortion measures in states which otherwise are broadly conservative. This is a big, complex country where few regions could be called truly politically homogeneous. We should not forget this complexity. Disengagement would be signaling a disavowal of the many, for the actions of the few. 

Second, when we weigh the benefits of engagement against the benefits of disengagement, we can see how the benefits of disengagement are, in fact, few. As in the case of efforts to isolate Russia after its invasion of Ukraine, disengagement can only go so far in changing the behavior of a state or country. Regardless of whether we disengage with them, states we disagree with will remain part of the US, integrated into its economic and social fabric. The extent to which disengagement can meaningfully affect their political behavior will always be limited by this fact.

Third, and relatedly, while the advantages of disengagement are often few, the downsides tend to be many. They include the isolation of scientists and scholars who may be doing good work, work that will go without the support it deserves because it happens to be conducted in states with policies we dislike. Disengagement also means withholding economic benefits from businesses in these states, businesses that may well be involved in resisting the policies we oppose. Finally, disengagement does not just isolate those we disagree with. It isolates us. In doing so, it adds to the climate of polarization, mistrust, and mutual incomprehension that characterizes so much of the public debate in this country. It builds walls where public health should be building the bridges that help get us, all of us, to a better world. Refusing to visit a state for professional events is a short step to refusing to ever frequent states which are home to people who see the world differently than we do. While this may seem like a way to achieve short-term "wins" over the other "side," it is a strategy for long-term failure in the work of creating a big-tent movement capable of delivering on a vision for a better future.

Fourth, the work of public health depends on our capacity to engage with ideas, test theories, and generate data in a context of open scientific inquiry and debate. In science, we refine our ideas by subjecting them to a process of criticism and rigorous review by peers. We do not seek immediate consensus; we do not shy away from criticism and disagreement. On the contrary, we seek out disagreement as a means of “stress-testing” what we think to be true, to come as close as we can to ensuring that it is. It is in this spirit that we should not avoid engaging with states where our ideas may not be warmly received. Even if the conversations we have while we are in these places generate more heat than light, the simple fact that we were willing to personally account for what we believe in a potentially unwelcoming setting will be a powerful statement on behalf of our values and ideas. It may not persuade those who disagree with us to see the world our way, but it can lead, perhaps, to a mutual respect that can pave the way for deeper understanding. There is a solidarity that can develop between those who make the effort to show up for a conversation, even when they may agree on nothing else but the necessity of such engagement. And that is a start.

Simply put, public health should not try to isolate states which pass laws we do not like. Instead, our role should be to double down on engaging and having the conversations that minimize the influence of bad ideas by introducing better ones into the public debate. Public health has a key role to play in advancing these conversations. Public health depends on the principles of free speech, civil debate, and open-minded engagement with ideas, including ideas we might disagree with. This legacy of engagement means that public health can and should help lead the way on shaping a healthier public debate. But it can only do this if we are willing to go not just where our ideas are widely accepted, but also where they are not.