Building a Healthier World in the New Year
On advancing a vision of health in 2023.
As we return from the holiday intersession, a word of welcome to our community. I hope everyone had a relaxing, joyous time with family and friends. Over the past week it has been wonderful to reconnect with colleagues, to hear about travels, about books read over the break, dinner table conversations, and new ideas that emerged from holiday reflections.
We are now at the beginning of a new year. This has historically been a time for making resolutions, using the fresh start of the season to become the best possible versions of ourselves. The tradition of making resolutions began about 4,000 years ago with the ancient Babylonians, who also held the first recorded new year celebrations. During a festival, the Babylonians would promise their gods that they would pay their debts and return anything they had borrowed.
Looking ahead to the new year, it strikes me that the Babylonian tradition provides a useful lens through which to view our own resolutions. We, too, owe debts. As a public health community, we owe a debt to those who came before us, on whose shoulders we build. We also owe a debt to those who have worked throughout the years—sometimes at great personal risk—to build a better, more just world. And we owe a debt to all those whose ideas helped shape the small-l liberal inheritance that formed the basis for much of the political, technological, and social development of recent centuries. Paying these debts in the new year—and in years to come—means continuing to work towards a world that is fully supportive of health for ourselves and for future generations.
How can we best pursue this work in 2023? Last month, I wrote a perspective suggesting three principles to guide the US towards better health for all. These principles emerged from much reflection, consultation with colleagues, and conversations we have had as a school community. They can also perhaps serve as resolutions as we look to improve health in the new year
Resolution 1. Work towards a vision of health equity.
In many ways, we live in a world of unprecedented progress. Yet not everyone shares this progress. Globally, we see increasing material prosperity, but it is concentrated among some at the expense of many. We have made strides towards social justice, but progress has been slow and many still have not seen it. In the US, certain populations remain far sicker than the rest because of the material conditions of their lives. A vision of health equity comes from the understanding that we are not fully healthy until we have addressed the forces that create health gaps. The start of a new year can be a time for triumphalism about our collective progress, and there is indeed much about which to be triumphal. But we must also have the humility to see where our progress masks our failure to address health gaps, then take steps to close these gaps, guided by a vision of health equity. Addressing health gaps requires us to engage with the foundational drivers of health. We can do this by rethinking our strategic investments in health, in both the public and private sector, towards the goal of ending health inequities. The new year is a chance for such a rethink, as we work to create the conditions for all to be healthy by broadening access to the material resources that support health.
Resolution 2. Make structural changes to remedy historical under-investments in health.
Broadening access to the material resources that generate health means creating new structures to support this access. This requires us to think creatively about shaping a new status quo around health. In the US, for example, Black-white health gaps are a central inequity, undermining American health for generations, with deep historic roots. Closing these gaps will take engagement with the intergenerational causes of this inequity. This engagement could take the form of a program of reparations, with investments in housing, a stronger safety net for children and older adults, and safer neighborhoods among many possible initiatives. Such investment would align with the broader mission of public health—to support the health of populations, with special concern for the marginalized and vulnerable, by creating the structural conditions for better health.
Resolution 3. Gain public trust and buy-in by embracing a vision of open and engaged public debate.
Creating the structural change that shapes a healthier world requires public support for an ambitious public health agenda. It is simply not enough to state that we want health equity or that we want reinvestment in the structures that generate health. Building this support means engaging in a public conversation that advances a bold vision while nevertheless meeting people where they are, to cultivate public buy-in and trust, underpinned by the hard work of incremental change. In the present moment, disruptive influences like emerging media and political polarization have complicated our capacity, as a society, to have such conversations. The COVID-19 moment amply showed us how these influences have made it difficult to conduct nuanced discussions that weigh tradeoffs in one hand and public health necessity in the other. This speaks to the need for engagement, compromise, and respect for the complexity inherent in any conversation about issues of consequence for health, to advance a vision of public health that enjoys the broadest possible support.
As we work collectively, as a school community and as a field, toward a heathier world, these resolutions can, I think, do much to help guide our efforts in the new year. Thank you to each member of our community for your work in support of a healthier world.
I look forward to all we will do this year to help ensure it is a time of progress and better health for all.
Sandro Galea, MD, DrPH
Dean and Robert A. Knox Professor
Acknowledgement: I am grateful to Eric DelGizzo for his contributions to this Dean’s Note.
Previous Dean’s Notes are archived at: http://www.bu.edu/sph/tag/deansnote/