Tradeoffs, Inequality, Social Media, Division, and COVID

We have been living with COVID for over a year. It has been, by any measure, an impossible year. There have been over 31 million COVID cases in the US, and more than 560,000 people in the country have died. The story of our engagement with the virus is complicated, and we have had moments when we have lost sight of what matters most in our pursuit of health. As the moment evolves, four broad points have emerged in my mind which, I think, are worth revisiting, in this time of realignment toward a post-COVID future.

Tradeoffs

An enormous part of the pandemic moment has been tradeoffs—such as the choice between reducing risk and shutting down economies. These are of a piece with the tradeoffs inherent in any decision affecting the health of populations. What is, I would argue, unique to this moment is the extent to which the conversation about these tradeoffs has been politicized, making it difficult to have this discussion at all.

This is perhaps because to acknowledge tradeoffs is to acknowledge there may be some measure of truth to both sides of a given issue, an increasingly uncommon perspective in the context of our current tribalized moment. It also means not making the perfect the enemy of the good, with the understanding that choices—especially choices made during a crisis—often entail picking from least-worst options. To know this is to also think twice about vilifying those in positions of leadership during such crises, mindful that there is no path through a disaster like a pandemic which is entirely without pitfalls and imperfect choices made on the basis of incomplete information.

Uneven burden

Much of why the conversation about tradeoffs has been so challenging is that the groups most actively engaged in it—political leaders and media figures—are largely exempt from the consequences of pandemic decision-making. This reflects my second key point: The effects of the pandemic have been most heavily felt by populations that were already socioeconomically vulnerable when COVID struck, and most lightly felt by those which were not. If you are a politician whose wellbeing is not tied to the need to sell goods or attend school, if you are an online opinion-writer who can easily write and broadcast from home, or if you just happen to be reasonably well-off, it will not matter very much to your wellbeing whether, say, a lockdown order stays in place indefinitely or schools remain closed until COVID rates are down to zero. On the other hand, if you live in a low-income community where you and many of your neighbors work in the service industry, or if you are a child who has not been in a classroom in a year, choices about lockdowns have a direct effect on your health every day. The disconnect between those who make high-level decisions and those who most feel their effects has kept the pandemic unequal, and the conversation about it polarized.

Challenged decision-making

Third, decision-making has also been challenged by the rapidity of the moment; in particular by the real-time incentives of social media. COVID is not the first pandemic in human history, but it is the first pandemic to strike during a time when digital technologies have incentivized the expression of feeling over facts, have reinforced partisan echo chambers, and have enabled the instant spread of misinformation and rumor. This has distorted our perception of the pandemic and many of the choices we have made—as individuals and collectively—in response to the virus.

Underlying divides

Fourth, partisan divisions are undermining the sense of common purpose necessary for working toward a healthier world. One of the pillars of my thinking and writing about health has long been that health is a public good, sustained by our collective investment. We all want to be healthy, and to live in a world where our children can be healthy. This desire is not mediated by partisan affiliation—it is universal. However, partisan status has strongly shaped how we talk about getting to such a world, and the steps we take in its direction. As a result, partisan division is preventing us from getting what we all want, creating gridlock and diluting our sense of engagement with the common project of working toward a healthier world.

There are many reasons for the rise of this division, and no simple way to reverse it. But one solution I would suggest—a solution we can all begin to implement as individuals—is to try not to assume bad faith on the part of those with whom we disagree. This can be difficult, perhaps, at times, impossible. However, it is necessary to make the effort, if we are to advance a common vision of health. A healthy world depends on a robust, honest discussion of the factors that shape health, and such a conversation can only unfold when we regard ideological opponents as people, just like us, with a mix of motivations, hopes, and fears, whose ideas are worth hearing even when they challenge and upset us.

Providing a societal framework for such a conversation is, to my thinking, a core achievement of the small-“l” liberal project, an inheritance of the Enlightenment which allows us to develop the ideas which shape a better, healthier world. In this sense, public health is fundamentally an Enlightenment project, characterized by reasoned thinking, aimed at gradual reform. By embracing the tenets of liberal thought—the scientific method, pluralist values, and the pursuit of progress as a common goal worth striving toward—we can rebalance the public conversation toward a healthier mode of expression. This reflects what is, I think, motivation for our work to come: to see beyond the urgent of the moment, to the important, toward maximizing a reasoned approach to health in the long-term.

This piece was also posted on Substack.