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Key points
- The work of public health is best served not just by the generation of data but also by the promotion of values.
- Americans report lower trust in public health in the wake of the pandemic.
- Public health needs to shore up the distinction between science and values to improve its standing with the public.
In my book, Healthier, I proposed that the work of public health is best served not just by the generation of data but also by the promotion of values, and that positive change happens at the intersection of science and values.
We shape a healthier world by building a base of knowledge while working within the broader culture to advance the values of public health. This means working to build collective engagement with the foundational determinants of health—the social, political, commercial, environmental, and technological forces that shape the health of populations—with special care for how these forces affect the marginalized and vulnerable.
These are our values, the first principles of our field. Shaping a healthier world is as much the work of these values as it is of our data.
Balancing the generation of science with promotion of values
In order for this balance of science and values to work, we need to have credibility in both spheres. This means drawing a clear line between the generation of science and the promotion of our values. We need our science to reflect a process of reason and analysis, to be as free as possible from the biases and priors that can sway our conclusions away from the findings of pure empiricism. At the same time, we must remain firm in our values. We should not be afraid of moral clarity in our statements and actions.
Yet we should also not be afraid of pursuing science that may lead to conclusions that contradict or complicate our preferred narratives and the values these narratives reflect. It is important to maintain a distinction between our science and our values, even as we remain committed to shaping a field that is founded on both.
Public health's credibility problem
This is particularly true in the present moment, as public health faces a credibility problem. Americans are reporting lower trust in public health in the wake of the pandemic, and about 30 states have passed laws limiting public health authority, moves supported in part by a backlash to public health’s overreach—real and perceived—during the pandemic.
This credibility problem should be of central concern to the public health community. It points to a level of distrust that could impede our ability to take actions that promote the public’s health in the future.
There are many reasons for this problem. Certainly, one of the reasons has been the willful spread of misinformation about public health and a concerted effort by bad faith actors to discredit our work for political gain. These efforts reflect an attempt to undermine both the science and the values of public health and pose an undeniable problem for our work.
It is important to acknowledge this, to be clear-eyed about the challenge it represents. But I have never been comfortable always pointing fingers at “the enemy” as a means of advancing the work of public health. While recognizing that there are those who have intentions that run counter to ours, and while being clear about the need to push back against this, I am much more interested in what we do, toward the end of doing better as a field. And one area where we can do better indeed is in shoring up the distinction between our science and our values to improve our standing with the public and the integrity of our efforts.
The tension between science and our values
Why do we sometimes struggle to maintain a distinction between our science and our values? It is possible to see how this challenge is shaped by the nature of our science itself. Public health is often concerned with the social sciences. In engaging with the social sciences, we can find ourselves doing work that is fraught on the grounds of values—where what we believe as a field pushes us in a particular policy direction, but where we still must practice empirical, open-to-all-possible-conclusions analysis.
This tension is clearly present in epidemiology, my core area of scientific inquiry. Many branches of epidemiology are based on the study of diseases (e.g., cancer epidemiology, infectious disease epidemiology). The central aim of this study area is to find the causes of these diseases, so we can intervene to support health.
This focus has contributed to the understanding, supported by a weight of empirical evidence, that the root causes of disease do not stop at the biological processes from which sickness emerges. If we are committed to following the data wherever they lead, they inevitably take us to the social conditions that create a context for disease to take hold. This has informed the emergence of other branches of epidemiology—social epidemiology, lifecourse epidemiology, environmental epidemiology, etc.—which focus on how these conditions shape health. Just as data from “classic” epidemiology point to the importance of engaging with these conditions, the data generated by these new fields point to the need for certain policies and political priorities as the key to ameliorating poor health.
Our responsibility to become aware of bias
To my mind, this leaves us in a place where we have an extra responsibility to be aware of our biases and to make sure our science is conducted as dispassionately as possible. As we reexamine the core philosophical underpinnings of our field, it is important to include an honest look at the interplay of science and values, the need for a balance between them, and the consequences of failing to strike it. Our values point towards the better, healthier world we wish to see, but getting there requires us to proceed one careful step at a time. We must be scrupulously aware of our biases, reckon with them, and conduct science that stands up to the scrutiny of all who engage with it.
This post also appears on Substack.
