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Sandro Galea — How US Public Health Has Strayed From Its Liberal Roots

Within Reason: A Liberal Public Health for an Illiberal Time (book cover)

The Covid-19 response was a crucible of politics and public health—a volatile combination that produced predictably bad results. As scientific expertise became entangled with political motivations, the public-health establishment found itself mired in political encampment.

It was, as Sandro Galea argues, a crisis of liberalism: a retreat from the principles of free speech, open debate, and the pursuit of knowledge through reasoned inquiry that should inform the work of public health.

Across fifty essays, Within Reason chronicles how public health became enmeshed in the insidious social trends that accelerated under Covid-19. Galea challenges this intellectual drift towards intolerance and absolutism while showing how similar regressions from reason undermined social progress during earlier eras. Within Reason builds an incisive case for a return to critical, open inquiry as a guiding principle for the future public health we want—and a future we must work to protect.

Shermer and Galea discuss: his immigrant experience in the U.S. coming from Malta • why he left practicing medicine for public health • public health vs. private health • mask/vaccine recommendations vs. mandates • the case against moralism in public health • Medicare for all, UBI, generous social safety net, reparation for slavery, liberal immigration policies, commonsense gun safety reform • public health and: race, class, sex/gender • moralizing and public health.

Dr. Sandro Galea is a physician, epidemiologist, author and the Robert A. Knox Professor at Boston University School of Public Health. He previously held academic and leadership positions at Columbia University, the University of Michigan, and the New York Academy of Medicine. He has published more than 1000 scientific journal articles, 75 chapters, and 24 books, and his research has been featured extensively in current periodicals and newspapers. Galea holds a medical degree from the University of Toronto and graduate degrees from Harvard University and Columbia University. Dr. Galea was named one of Time magazine’s epidemiology innovators and has been listed as one of the “World’s Most Influential Scientific Minds.” He is past chair of the board of the Association of Schools and Programs of Public Health and past president of the Society for Epidemiologic Research and of the Interdisciplinary Association for Population Health Science. He is an elected member of the National Academy of Medicine and the American Epidemiological Society. He is the author of The Contagion Next Time and Well: What We Need to Talk About When We Talk About Health. His new book is Within Reason: A Liberal Public Health for an Illiberal Time.

Shermer and Galea discuss:

  • his immigrant experience in the U.S. coming from Malta
  • why he left practicing medicine for public health
  • What is public health?
  • public health vs. private health
  • mask recommendations vs. mandates
  • vaccine recommendations vs. mandates
  • the case against moralism in public health
  • Galea’s progressive views: Medicare for all, UBI, generous social safety net, reparation for slavery, liberal immigration policies, commonsense gun safety reform
  • public health/healthcare and: race, class, sex/gender
  • moralizing and public health.

Show Notes

Stigma: smoking: “We can now plausibly say the choice to smoke or not smoke is, in a sense, a choice between right and wrong. The same was to some extent true of COVID-19. We did know that wearing masks and limiting our physical interaction would reduce the spread of the disease. Taking these steps was—there’s no getting around it—a matter of personal responsibility, a moral consideration, and it was right for us to acknowledge this.”

Working remotely adversely affected the poor over the rich, as did closing schools, restaurants, etc. “If we ignore the populations whose lives are shaped by conditions different from those that shape our own, we are acting contrary to the spirit of liberalism. COVID provided many examples of how such conditions create gaps in the lived experience of populations. We know, for example, that there is a clear link between income quartile and ability to physically distance by working remotely. Data from the Bureau of Labor Statistics has shown that 62 percent of earners in the top twenty-fifth quartile were able to work remotely, compared with just 9 percent of those in the bottom twenty-fifth. In stigmatizing those who do not adhere to physical distancing protocols, we risk targeting those with the least personal control over whether they do so.”

At a fundamental level, it would be characterized by social and economic justice. By economic justice, I mean a world where economic systems are geared toward fairness rather than the inequality that currently benefits the well-off few at the expense of the less well-off many. By social justice, I mean a world where no one is unfairly held back by characteristics of identity—whether race, sexual orientation, or gender.

John Hopkins University DEI Office, Diversity Word of the Month

Privilege is a set of unearned benefits given to people who are in a specific social group. Privilege operates on personal, interpersonal, cultural and institutional levels, and it provides advantages and favors to members of dominant groups at the expense of members of other groups. In the United States, privilege is granted to people who have membership in one or more of these social identity groups: White people, able-bodied people, heterosexuals, cisgender people, males, Christians, middle or own class people, middle-aged people, English-speaking people. Privilege is characteristically invisible to people who have it. People in dominant groups often believe they have earned the privileges they enjoy or that everyone could have access to these privileges if only they worked to earn them. In fact, privileges are unearned and are granted to people in the dominant groups whether they want those privileges or not, and regardless of their stated intent.”

Galea: “To answer every challenge with a call for complete upheaval of all that came before is to be neither serious nor effective as a movement. We may not want to use the language of overthrow when pragmatic reform is called for, just as we may not want to talk about incremental reform when our speech might support something bolder. If we continually cry “revolution” when we really need basic, commonsense reforms, we are liable to drive otherwise sympathetic partners out of our coalition. We also risk being taken less seriously when systemic change really is necessary, with our calls for bold action falling on ears that have long since ceased to listen.”

Great Barrington Declaration

It claimed harmful COVID-19 lockdowns could be avoided via the fringe notion of “focused protection”, by which those most at risk could purportedly be kept safe while society otherwise took no steps to prevent infection.

5 Obstacles to a Full Restoration of Public Health Liberal Ideals
  1. Science/public health have become politicized
  2. We have forgotten our roots (free speech and thought, reasoned methodology, pursuit of truth)
  3. We have become poor at weighing trade-offs
  4. Media feedback loops have become the new peer review
  5. We have prioritized the cultivation of influence over the pursuit of truth.

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This episode was released on February 13, 2024.

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