- People tend to distrust institutions that seem to behave unreasonably, particularly when this behavior is in service of restrictive policies.
- Much of the work in public health rests on the assumption that most people will always prioritize safeguarding their health, but they don't.
- Pursuing the elimination of all risk is to believe in a fantasy.
Most of us aspire to be reasonable. We do not set out to be irrational, to be easily swayed by emotion and bias. Rather, we try to ground our actions in reasonableness, with the understanding that such a standard is a good basis for living as individuals and as a society.
This leads naturally to the question: What is reasonable? The Cornell Law School Legal Information Institute defines “reasonable” as “just, rational, appropriate, ordinary, or usual in the circumstances.” To be reasonable, then, is to be sensitive to context and to aspire to a standard of justice and rationality.
How can we in public health better agree on what is reasonable, to do right by the populations we serve? I suggest the following four observations to help us better define, and do, what is reasonable in pursuit of our work.
People don't always safeguard their health
First, much of our work in public health rests on the assumption that most people will prioritize safeguarding their health under all circumstances. This assumption is false. People will prioritize their health under many circumstances. However, it is a simple fact of human nature that people sometimes take risks. They drive fast cars. They eat unhealthy but delicious foods. For a thrill, they jump off cliffs into the sea. This is just the reality of our collective human experience. Public health can do much, but it cannot change human nature, nor should it try to. What public health can do is provide data about risk and offer advice about how to balance the mitigation of risk with living a rich, full life. This seems like a reasonable focus for public health, helping to orient our efforts no matter the context in which we find ourselves.
We cannot rid the world of all risk
Second, our work is often shaped by an unreasonable assessment of our own capabilities. To believe we can rid the world of all risk is to believe in a fantasy. Yet it is a fantasy we often buy into. We do so because, arguably, we fail to think through the full implications of what eliminating risk would entail. For example, many in public health would likely acknowledge that a world without alcohol would be a much healthier one. Yet alcohol is not just a product subject to taxes and bans. It is a vast industry. This industry is rooted in powerful cultural and market forces which render unreasonable any effort to completely shut it down. In public health, we are sometimes liable to lose sight of these limitations in pursuit of outcomes that are, at the core, about the elimination of all risk. We should avoid these diversions so that we do not make the perfect the enemy of the good.
People resist unreasonable policies
Third, people tend to lose trust in institutions that seem to be behaving unreasonably, particularly when this behavior is in service of restrictive policies. I have written previously about the diminishing returns that can set in when public health seems moralistic, heavy-handed, and unreasonable. We should be judicious about the steps we take and the battles we choose to fight. We live in a society that, at its best, aspires to an ideal of small-L liberalism. Such an ideal prioritizes the autonomy of the individual; measures that seem to limit this autonomy can generate backlash, as we have seen. This does not mean we should stop advocating for sensible steps which support healthy populations—far from it. What it means is that we should maximize the good such measures can do by ensuring that they are indeed reasonable, data-informed, and subject to limits.
Most people are acting in good faith
Finally, we should pursue our work guided by the assumption that most people are acting in good faith and share our commitment to being reasonable. This means it is on us to give the benefit of the doubt to those with whom we may disagree. When someone suggests an approach that seems to us to be counterproductive, we should not leap to accuse the person suggesting it of malice. Instead, we should ask ourselves how such an approach could seem reasonable to some, and from this basis strive towards a better engagement with differing points of view.
During the pandemic, I became concerned that public health was doing much that was not reasonable. This included refusing to discuss the pros and cons of mandating vaccines for children—instead, framing all nuance on the question as evidence of bad intent—working with special interest groups to shape public health guidance which should have been based on science alone, and meeting conversations about herd immunity—an epidemiologically sound concept—with vitriol. Had we acted more reasonably, I cannot help but think that the moment might have unfolded differently and that public health would not face the crisis of trust it now confronts. Unfortunately, we strayed from principles of small-l liberalism that have long kept our work grounded in a basis of reason. This was my motivation for writing my next book, Within Reason: A Liberal Public Health for an Illiberal Time, which aims to identify where we have strayed from reason and to suggest how we might recover an approach to our work that reengages with the liberalism which was once at its heart.
Public health should not be monolithic. We should be concerned about the health of people and as such should operate as a community of people with diverse perspectives and opinions working to accomplish the goal of better health for all. This diversity of thought means that there will likely always be disagreement about what is reasonable. This disagreement is necessary, and healthy, for a robust climate of ideas. My hope is that when we are guided by values, a sensitivity to context, a respect for human nature, a realistic assessment of our own capabilities, and a restoration of small-L liberal values, we can better align ourselves with what is reasonable, to shape a more pragmatic, effective, and trusted public health.
A version of this post also appears on Substack.