For Health, We Need Compassion
Recently, we ran a Dean’s Note about the impasse surrounding the fate of DACA recipients—undocumented immigrants who were brought to this country as children, and who now face deportation unless a political compromise is reached that allows them to stay. In the note, I reflect that, while such a compromise would be welcome, the cruelty of making about 800,000 Americans wait in fear is not something that is easily undone; the stress of their ordeal poses a lasting challenge to their health. This week’s approaching Valentine’s Day, a time for reaffirming the connections that hold our society together, throws the Trump administration’s callousness towards DACA recipients, and to the well-being of immigrants generally, into sharp relief. With this in mind, we today rerun a modified Dean’s Note on compassion, hoping that we will soon see a return to compassion in the US, and that the country will choose to embrace, not exclude, those who wish to make a home here.
In public health, we are, in part, professional observers of the many ways that the world can be a cruel, dangerous place. The effects of disease on the health of populations, of war and natural disasters, of the challenge of institutionalized racism and daily bigotry—we evaluate the causes and consequences of these problems as we work to mitigate them. Recent years have shown us just how quickly a society can turn towards cruelty at the political level, as many of our leaders have embraced policies hostile to Muslims, immigrants, reproductive rights, and even the climate itself. The push to repeal the Affordable Care Act (ACA) and replace it with a law that would strip 22 million Americans of insurance coverage is a further example of the troubling acceptance of cruelty that has, for the moment, come to characterize much of our public life. In such times, it is perhaps more important than ever that we practice compassion, not only to understand the plight of others, but to understand the conditions that cause harm in populations.
Compassion is defined as “a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering.” It is arguably a deeper form of feeling than empathy. While empathy helps us to understand, on an emotional level, the experience of another, compassion challenges us to go further. It asks that we acknowledge the conditions that create disadvantage in society and work to improve them. Martin Luther King, Jr once said, “True compassion is more than flinging a coin to a beggar; it comes to see that an edifice which produces beggars needs restructuring.” King’s distinction speaks to a key feature of compassion—it motivates us to act. We may, for example, give someone a coin because we feel for her, but when our empathy deepens into true compassion, we are compelled to take the next step and fight for affordable housing, addiction recovery resources, and a fairer, more inclusive economy to reduce poverty everywhere. In this sense, empathy is a necessary but not sufficient condition for practicing compassion. Our emotional response opens the door to compassion, but empathy alone can be a momentary reaction to suffering. For compassion to take hold, it must, definitionally, involve a commitment to building a better world.
Why is compassion important to the work of public health? By linking our emotional response to suffering with meaningful action, compassion helps to ground solutions that can sometimes seem abstract in a depth of feeling, a reality that is understandable to all. Consider the problem of gun violence in America. It has become commonplace, in the aftermath of shootings, for lawmakers to offer their “thoughts and prayers” to gun violence victims and their families. While such a statement suggests an entirely human and empathetic response to tragedy, it is not, in itself, enough. Thoughts and prayers alone do not lower the rate of gun violence in communities; laws do. A compassionate response to gun violence would move beyond simply expressing the horror that we all feel in the wake of mass shootings, and towards restructuring our society so that such events do not occur in the future. And while data increasingly point to the difference that sensible gun laws can make, it is our appeal to compassion that can lend our case the emotional and moral force necessary for it to resonate with the public, motivating a long-term effort for change.
Compassion also helps us to hone our focus on the well-being of marginalized groups. As WH Auden wrote, it is sometimes true that we “believe/in the common world of the uninjured, and cannot/imagine isolation.” Too often, disadvantaged groups are isolated in their injury and sickness, as society turns a blind eye to the vulnerability endemic to these populations. This is true, for example, in how we sometimes treat older adults and the dying. We provide them with care, but frequently neglect a deeper level of engagement. Compassion challenges us to make the mental leap necessary to “imagine isolation.” It shows us how the same conditions that make other people sick can just as easily undermine our own health, or the health of those closest to us. It reminds us that just because we are well now does not mean we will stay well, and that the conditions that eventually sicken us will likely be the same conditions that presently afflict our neighbor. This understanding is particularly relevant to the healthcare debate. ACA repeal would be devastating for marginalized groups, such as the poor, the sick, the old, and people with addiction. Compassion shows us how our own well-being is tied to the fate of these populations, and to the broader state of health care in this country, as we in public health realize that the life we save may indeed be our own. It teaches us that there is no “common world of the uninjured.” There are only those who are sick, those who will one day become sick, and the social, economic, and environmental conditions that determine whether their hour of illness will be soon or far in the future.
Compassion allows us to remain cognizant of the interdependence of individuals, of how the fate of one person is tied to the fate of all, and of how our collective health is ultimately a product of the networks we have created that uphold or undermine well-being. Unfortunately, we have not always, in public health’s disciplines, led with compassion. A commentary in The Lancet went so far as to suggest that “epidemiology is congenitally deaf to suffering.” I am not so sure. But perhaps a moment to reflect on compassion is a small way to ensure that this is not the case. Fundamentally, compassion not only keeps our focus on the conditions that shape the health of populations—especially marginalized populations—it also keeps us human. This humanity is core to our thinking about population health, and to our ongoing mission as a school.
I hope everyone has a terrific week.
Sandro Galea, MD, DrPH
Dean and Robert A. Knox Professor
Boston University School of Public Health
Acknowledgement: I am grateful to Eric DelGizzo for his contributions to this Dean’s Note.
Previous Dean’s Notes are archived at: https://www.bu.edu/sph/tag/deans-note/