Three steps to securing the foundations of a healthier world

Three steps to securing the foundations of a healthier world

via Thrive Global by Dr Sandro Galea

I have written previously about the aspirations of public health, seeing public health more as a journey, a path on which we should always be traveling, towards creating a better and healthier world, rather than as any specific set of actions, prescribed by narrow strategies. The challenge in that vision is that it risks being too broad, too all-encompassing. It then often falls on us to ask: what matters most? What should we be acting on to best advance our aspirations?

These questions can seem abstract. But the COVID-19 era has made them perhaps sharper in our minds than ever, providing urgent, real-world examples of their relevance. I have, with colleagues, written previously about what matters most to health from a technical perspective, but in a year when we are (hopefully) emerging from COVID, I find myself asking—what values and aspirations should we be foregrounding, as we look towards creating a healthy future?

I was recently reflecting on this question by thinking about parallel universes, which, in my disciplinary home, epidemiology, we call counterfactuals. These counterfactuals allow us to model how the introduction of a given variable might shape health. We do so by comparing a real world where someone may, say, smoke, with a counterfactual universe where that same person, with everything else held exactly the same, does not smoke. This allows us to compare counterfactual universes where all is the same except for that one variable, whereupon we can then conclude that if the person we are observing gets lung cancer in the universe where she smokes—and avoids it in the universe where she does not—we might say with some confidence that smoking causes lung cancer.

Of course, this model has limitations. For one thing, it is a fictionalized scenario—it does not exist. For another, it is hard to conceptualize a universe where everything is the same, save for one detail. And this paradigm seems even less grounded in reality when framing more complex variables, such as race or gender. But, notwithstanding all this, counterfactuals remain an invaluable tool for conceptualizing the conditions that shape health. It is easy to imagine, for example, future historians using counterfactuals to parse what we did wrong, and right, during COVID. To some extent, we have already begun this process, in evaluating our performance over the last year-and-a-half. The long-distance view of history will likely only deepen the perspective we bring to these efforts…

… keep reading the full & original article HERE