Performance and Public Health

We live in a culture that values authenticity. It is never hard to find books, articles, films, songs and other media extolling the virtues of being our authentic selves, of transcending the barriers that keep us from showing the world who we truly are.

In this context, it can be uncomfortable to consider the ways we might embrace a level of performance in how we present ourselves. Yet, I will start this essay with a perhaps countercultural assertion: We perform all the time. We perform in what we say, what we do, how we dress. Each day, many of us play what is to some extent a role—on social media, in our engagement with colleagues, in classrooms, and at professional conferences. We play these roles, in part, because doing so allows others around us to also play roles, and because we believe that these roles collectively become shared efforts to create healthy communities and a better world.

Our performances can become so second nature to us that we may not even notice that we are spending much of our lives on a kind of stage. Yet we are. And such as we are, it seems worth examining how, and why, we perform.

The nature of performance

There are two main definitions of performance. First, performance is the act of working in front of an audience or playing a role. Second, performance is our aptitude in carrying out a task—the effectiveness with which we do our job.

To my mind, these two definitions should inform each other. Our performance, defined as our success in the pursuit of health, is shaped by our ability to inhabit and project the roles we play. And, conversely, our inhabiting of the roles we play should be in service of success in our goal—improving health and narrowing health gaps.

This suggests that performance has utility when it is linked to the task we are trying to achieve. So, key to our interrogation of the role of performance should be the question: When is performance useful and necessary in the pursuit of a healthier world? And when is performance counterproductive? When does it become less of a means to an end and more an end in itself?

I was struck by a recent piece in The New York Times by Nicholas Kristof on changing linguistic norms. Kristof wrote, “[M]uch of this effort seems to me performative rather than substantive. Instead of a spur to action, it seems a substitute for it.”¹ Now, it is indeed important for us to revisit the language we use in order to avoid terms that have taken on a stigmatizing connotation. The performance of specific language scaffolds some of what we are trying to build in public health. It is important, for example, to use person-centered language around disease, so that we can see the humanity of all who we are trying to help. However, Kristof’s case that this can sometimes become a performance that takes the place of substantive change is one that should resonate with us. It seems to me that we need our performance to match what is necessary to achieve our goal of healthy populations without exceeding necessity to become something we pursue for its own sake.

It is worth asking, then: What do we want our performance to do? What do we want it to help us accomplish? For the purposes of public health, we might say we want to use performance to advance our work, to help elevate good ideas, and contribute to the creation of spaces that inspire the best of what our field can do.

Ritual and performance

History provides many examples of the intersection of performance and the movements and ideas that change the world. Consider religion. People regularly attend churches, synagogues, and mosques where ritualized performance plays a key role in affirming and upholding belief structures. These beliefs have persisted throughout the ages, in some cases for thousands of years, in part because of the durability of these rituals, reflecting the power of performance to act as a vessel for ideas in history.

Performance can in a similar way shape and sustain the ideas of public health. I have long believed that building a healthier world starts with changing the conversation about health. This conversation is only partly about words. Performance, the roles we play, how we project ourselves in the world, is a form of communication, of participating in the health conversation by engaging with the broader narrative of public health. Performance can help embed in our collective consciousness ideas that become the framework for new approaches that support a radical vision of health.

In many ways, we are already using ritual and performance to do just this—to support processes that help generate new knowledge and practice in pursuit of a better world. In my own field, academic public health, we embrace rituals in which performance helps reflect and uphold our values, values we aim to spread in the wider world to advance public health.

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The most notable of these rituals is perhaps Graduation Day, when we celebrate with pomp, circumstance, and the wearing of regalia the achievement of our students as we look ahead, with excitement, to their future. The ceremony hearkens back to the past, reflecting universities’ medieval origins, while helping carry into the future our values of free inquiry and the pursuit of truth. In the graduation ceremony, these abstract values intersect with the tangible reality of students about to take their knowledge and skills into the arena of history, to engage with the forces that shape health and build a better world. We help them do so through performance, which provides a familiar, time-honored framework for their first steps into an uncertain future full of challenge and potential.

It is worth noting that in each of these areas—religion and academic ceremony—performance is used to point attention not at the “performers” themselves, but towards a higher value, towards ideals seen as worth preserving and advancing. In religion, this includes ideas about how humanity can better understand, and achieve alignment with, the will of God. In the case of academia, our rituals point to the pursuit of truth and the business of educating the rising generation. This highlights, again, that the constructive use of performance is taking care that our performance is in service of some greater good. And we should challenge performance that falls short of that goal, calling it out when it fails in that aspiration.

This piece also appears on Substack.