The Election and After.
Few events have been more written about, talked about, and thought about than this week’s election. It has been a national preoccupation, arguably, since the day President Trump won his first term. We are approaching the moment where all that can be said about it likely has been said, where there is nothing left to do but vote. Many, of course, have voted early, not waiting longer than necessary to engage with the political process which has such a profound effect on our lives.
The stakes of the election have been underlined by the ongoing COVID-19 pandemic, which has highlighted both the critical role of federal leadership in navigating a health crisis and the link between political policies and the conditions that shape health. Many members of our school community and the broader public health community have engaged with the politics of this moment, towards the goal of ending the pandemic and building a healthier world. This has unfolded in the context of the movement for racial justice which came to new prominence last summer after the killing of George Floyd. This movement, too, reinforced the stakes of the moment for health, by helping the country to see the disproportionate burden of COVID-19 infections borne by communities of color and the systemic roots of this inequity.
All this speaks to the core truth that this election is fundamentally about health. Many would likely say this is obvious, that of course the pandemic has ensured health would be the key issue on voters’ minds. But even if the pandemic had never struck, I would still have said that this election is fundamentally about health—as I did in my Note to the school community before the 2016 election. Because all elections are fundamentally about health. I have written quite a bit about how this current administration has affected health by affecting the issues that shape it. These include immigration, climate change, reproductive justice, investment in the institutional structures that support health, and the public debate which shapes our attitudes—and, ultimately, our policies—about these issues. At key points over the last four years, each of these issues has captured the focus of the national conversation.
This started with then-candidate Trump’s denunciation of Mexican immigrants, which later informed polices such as family separation at the US-Mexico border and threats to the DACA program. In seeing this unfold, we were forced to confront how anti-immigrant attitudes, embraced at the political level, can threaten the health of this vulnerable population. The administration’s decision to withdraw the US from the Paris Climate Agreement was a reminder of the threat climate change poses to health, and how the choices of political actors shape our engagement with this generation-defining crisis. Recent changes to the Supreme Court have called to mind a range of issues which matter for health that intersect with that branch of government, including abortion and marriage equality. The COVID-19 pandemic, and our country’s shortcomings in addressing this crisis reflect a long-term political disinvestment in the administrative structures meant to address such challenges. The disease’s proliferation in the US also reflects the reservoir of preexisting conditions which, in turn, reflect the failure of our society and our politics to create a context which generates health at all levels; the fact that so much of this vulnerability is concentrated among marginalized populations—older adults, communities of color, the economically disadvantaged—reflects how this failure is characterized by fundamental injustice.
The first step towards addressing these issues at the political level is to vote. Voting is not the end of our engagement with these issues, of course. But it is a necessary condition for this engagement. This week, we are presented with two very different visions for dealing with the issues that are central to health. By engaging with the electoral process on Tuesday, we are taking one of the most significant actions possible towards creating a healthier world.
Yet it is important to remember that no matter who wins the election, we in public health still have much to do. It is true that the two candidates running for president have different visions for the issues that matter to health. But it is also true that many of the systemic challenges to health, the roots of sickness in our society, long predate this moment, with a history which runs through many political eras. The challenge of racism, for example, has been with us since before the country’s founding. No candidate on the 2020 ballot has the power to solve this problem simply by winning the election, nor even by governing for four to eight years. Addressing racism will take long-term engagement, guided by the values of public health—to improve health in populations by addressing the structures that shape it, with special care for the health of the marginalized and dispossessed. This approach to health requires our collective willingness to shape a healthier world at the local, national, and global level. The election will mark the continuation of these efforts, as we recommit, as a school and a public health community, to pursuing our goal of a healthier world, no matter which way the political winds blow.
This year is the 45th anniversary of the Boston University School of Public Health. To mark this anniversary, we launched SPH45: Public Health. Now is the time, an initiative showcasing the work of our school community. We chose the phrase “Now is the time,” because this historical moment calls for the work of public health. Even before the pandemic, we saw new receptivity to public health solutions addressing the systemic roots of challenges like gun violence, climate change, economic inequality, and the marginalization of groups due to race, sex/gender, immigration status, or LGBTQ identity. Advancing these solutions is a long-term project, one which may be helped or hindered by the results of the election, but which ultimately transcends this moment, pointing toward the broader struggle to bend the arc of the universe towards better health. Voting, engaging with the political process, is a keystone of this work, but is not the whole structure. Building an edifice which fully supports health will take time and collective commitment, guided the values which inform everything we do at our school. Regardless of Tuesday’s results, we will continue our commitment to this work, to these values. Thank you for being part of these efforts, as we work towards a healthier world. We have much to do.
Warm regards,
Sandro
Sandro Galea, MD, DrPH
Dean and Robert A. Knox Professor
Boston University School of Public Health
Twitter: @sandrogalea
Acknowledgement: I would like to acknowledge the contribution ofEric DelGizzoto this Dean’s Note.
Previous Dean’s Notes are archived at: http://www.bu.edu/sph/tag/deans-note/