Ideas Conversation: Has Public Health Gotten Too Political?

© Catering Natalia Linos (left) and Benjamin Mazer.

for Dr. Benjamin Mazer, a Baltimore-based pathologist and medical author, published an article in the Nov. 24 issue of the New England Journal of Medicine "a perfect case study for Substack." It's an online platform where he recently launched a newsletter on "diagnosis, medical evidence and media," as he puts it.

The article you describe was written by a public health researcher in Boston. By analyzing data from schools that lifted mask mandates last winter, scientists determined that in the first 15 weeks after the state allowed the policy change, schools without mandates in the Boston area had 45 more cases of COVID per 1,000 students and staff than they had. otherwise would have, on the contrary. . they will This represents 29 percent of COVID cases in these schools in that time frame.

Some critics question the validity of comparing case numbers between provinces, given that other factors, such as COVID immunity and testing rates, also fluctuate. But Mazer thinks the study's statistical methods seem plausible. What bothered him were the comments that accompanied the statement. Policies on school headscarves should also take into account health equity concerns “for students and staff who are already vulnerable to historical and contemporary systems of oppression (for example, racism, capitalism, xenophobia, and mastism), the researchers wrote.

For Mazer, these and other references in the article to oppression and capitalism go too far. "Writer shot himself," he wrote on Substack. "Public health has become highly politicized during the pandemic. Why would you want to contribute more by undermining your credibility as a scientific representative?... A well-designed study can help convince political leaders and ordinary Americans that covering up the Mandate is effective, but covering it up is anti-capitalist, which will immediately lead to their downfall.

He referred Mazer's criticism to one of the article's authors, Natalia Linos, a social epidemiologist and executive director of the FXB Center for Health and Human Rights at Harvard University. He suggested that Globe Ideas set up a conversation between him and Mazer. So I introduced them via video call in November, and edited and summarized discussion highlights followed.

Linus : By definition, a COVID policy is a policy. We want to be open about that and also point out that COVID policies have different impacts on different groups. He was very proud that the document was about politics, power and economic inequality. Why don't doctors in clinics read the New England Journal of Medicine look at patients and think, "Why am I seeing more black patients in my clinic with COVID?" Public health research requires attention to causes. We're seeing different patterns in COVID rates, not because of genetics or biology, but because of the structures we put in place. So the optimist in me says there's something we can do.

Mazer : I'm sort of the target audience for the New England Journal of Medicine. I am a physician who wants to follow the major advances in this field. And I really enjoyed reading this article especially because of the high quality of natural experimental methods. I find this to be a very good methodology. I then moved on to the discussion section, finding it interesting and a little boring. It seems irrelevant to the purpose of the document, which is to assess the impact of certain social interventions on COVID rates.

References to capitalism caught my attention. In fact, masks have nothing to do with capitalism. In discussion I found him to be very direct and knowledgeable but I thought he would be provocative. I want politicians to be able to step away from some of the political divisions and say, "Can we use good evidence to guide our decision making?" Some Republican governors have done this with their COVID interventions, and I think that's the kind of people they're targeting. Because it revives some of these political divisions in discussion, this message may go unnoticed by those who might receive it.

Linus : That's a useful point and we've taken it into account. Another argument, and that is, did you have a chance to put something in front of all these doctors at some point? After the killing of George Floyd, is the rest of the world arguing about how we think about racism? And in this country, unfortunately, racism and ethno-capitalism go hand in hand. It is no coincidence that most of the poor in our cities are also people of color. So if you get a chance to tell clinicians and the public who aren't trained in social epidemiology to get a feel for that conversation, the hope is that it doesn't get shut down. I see your point that it can be confusing sometimes. I just think that when the COVID pandemic has shown so clearly that our country is worse off than other countries because of structural issues, for example, how can we not protect low wage workers from sick leave? This is a discussion that doctors should have. have. If we don't have discussions in medical journals, we lose the entire audience I want to invite into the conversation. And we have to be able to say the word "racism" to begin to react to it.

Mazer : In that sense, it's commendable for bringing this issue to the fore, because we're having this conversation here. I think unfortunately you haven't given yourself the space to really engage people and explain things. There are conservative doctors, there are Republican doctors, and there are doctors who may not understand how certain words are used in certain academic contexts. There's this focus on capitalism and racism and these unequal structures, but there's very little question about our system of government and our political system. Much of this inequality is generated by our democratic institutions, not by free markets. You've talked about the very different quality of school infrastructure, class sizes, notable differences in education, and that is the failure of government. I mean, it's a government run public school.

Linus : Yes, exactly. When we talk about structural racism, we are talking about institutions, policies and governments. Should public health be political? My answer is: Of course. Because the government has the opportunity to solve many of these public health problems. And if we assert that public health is not politics and that scientific knowledge can be imparted impartially, we are not questioning the status quo, which allows pandemics to have very different effects on different people.

Mazer : I think there's an important difference between being a politician and being a party. And I think a lot of public health is starting to see it as one-sided, and I think that's where public health has lost some people. I have lost confidence. And it allows political advocates to say, "Hey, science is wrong because they are just crooked Democrats and not committed scientists."

The pandemic highlighted a lot of these structural inequalities, but I think the idea that we're about to experience major political change may have made people more partisan, even to some of the actions that might be more approved of.

The idea : Ben, you say that it is one thing to identify the structural and therefore political causes of health inequalities, but another thing to propose highly political recipes or goals that are wholly democratic. Natalia, do you think it is possible for the public health profession to stop being an advocate while remaining as effective as they should be?

Linus : I don't know if it's possible. I feel very comfortable talking about issues that are unfortunately seen as partisan, like sick leave or maternity leave, which I don't think are controversial. Similarly, when it comes to climate change, there is now mounting evidence that fossil fuels and air pollution are bad for you. We can't stay silent. I think it's our responsibility to use our data and our institutions to show how different policies are.

Now, you could accuse someone like me of going too far. For example, we had a panel at FXB where we asked: Can compensation close the health gap between blacks and whites? Economists, historians and others debate compensation. Many public health professionals may think, "This has nothing to do with us." But part of me wonders, if you dedicate your life to health and you see this health difference, you can't help but be a part of that conversation. Yes, at this point it doesn't seem like a Republican-supported issue, but I hope some of this conversation can be normalized by a different political viewpoint.

Mazer : I think there are ways to keep the public health side of politics going without being seen as partisan.

One is the way policies are grouped. Many different ideas have been floated during the pandemic that are starting to achieve long-standing Democratic goals. I agree with most of them. But, you know, things like single-payer healthcare aren't necessarily completely related to the pandemic, whereas something like sick leave... I think you're going to really find a lot of agreement about finding ways to offer people more medical time off. In fact, it may appeal to some Republicans, at least at the state level.

And I think another way that public health can become political by being less partisan is by looking at the outcomes that you want to change, the kinds of inequalities that you want to eliminate. Like paid sick leave, in practice there are different ways to implement this policy across different types of political philosophies, and it applies differently around the world. Same with various public health interventions. Maybe you can give people a list of options and say, "This is a more conservative approach. This is a classic liberal approach. Everyone is working toward this outcome that we think is important."

Doctors are a very powerful political group. They are involved in lobbying, fundraising and large donations to political leaders. As a group, they talk about important public health and medical issues and, of course, their personal interests. So I hope we can use the political power of doctors to promote public health. So I think if you want to better bring doctors into public health as a political force, you need to do what you can to remove that one-sided label and find common ground.

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