From the Dean: The Governance We Need

From the Dean: The Governance We Need

To a great degree government is a reflection of society, and of our values and aspirations for society. This is particularly true of democracy, which, if it's to work, must be participatory. But participation requires effort. Many of us are so busy putting food on the table, looking after our families, and getting by, that we barely have the bandwidth to engage in meaningful debate over government, unless it's in a pub or a restaurant or at the inevitable family reunion or wedding—sometimes to disastrous effect.

And yet it's critical that we take a hard look at the level and degree of our participation in democracy, both as individuals and collectively. To paraphrase Alexis de Tocqueville, we get the government we deserve. We can watch TV and listen to sound bites, or we can probe more deeply. The responses that we demand from our politicians are frequently shallow and lend themselves to neat, crisp statements that avoid the core question: what is to be done about complex issues for which there is no single answer?

One of those issues is health care. As a nation, we're deeply divided over this topic, in part because it's the most expensive issue we face. When you look closely, the debate over "health care" is really about who pays for it, and what kind of insurance people should or should not have, and at what price.

The current model of health in this country is based on that most American of ideals, freedom—freedom to do whatever we can, whenever we want, however we may, with few of us pausing to think about the consequences of our actions. We are most definitely not our brothers' keepers. One result of this approach is that we have a "sick care" system that emphasizes the diagnosis and treatment of disease over its prevention. We have not yet agreed that it's better to prevent disease than to spend a disproportionate amount of wealth treating it.

So regardless of the outcome of this year's elections, it's time to engage in a thoughtful, national, and indeed global, conversation about the role public health can and should play in good government.

Through the assiduous study and investigation of those factors that promote health, prevent disease, or otherwise make us susceptible to disease, public health researchers and practitioners are fast accumulating a wealth of information, most of it complex and much of it indecipherable to non-experts.

It's our duty to translate that complexity into useful information for our elected officials, policymakers, and regulators, so that they can make sensible, evidence-based decisions to protect the health of both populations and individuals.

Not that it'll be easy. The complexity of issues like obesity, tobacco use, and environmental hazards frequently precludes clear-cut answers. Resources are limited, and there's often a gap between what the various sectors of our communities and nation view as the major threats to their well-being. It's all too easy to resort to slogans and sound bites that prioritize individual over societal rights, or vice versa. And it's easy to let political stalemate or paralysis by analysis impede action.

As we endeavor to move forward on the question of public health's role in government—and government's role in public health—we must be guided by a common sense of shared governance (not government), and a profound sense of our ethical responsibility to our bodies, families, communities, and environment, while simultaneously promoting innovation, economic growth, and opportunity—each of which we know has positive effects on health. We must avoid the great temptation to cherry-pick those facts that support our position.

This is not a time for politics—it is a time for sound, evidence-based policy. It is not a time for bickering sound bites but for meaningful, substantive debate on the Solomonic decisions that need to be made if we're going to move forward.

Schools like ours are an oasis in a cacophonous world. We bring together policymakers, physicians, scholars, and practitioners for nuanced and profound reflection and debate on the difficult issues of our age. Sometimes it's messy. Even in this school there's debate and disagreement. But this is precisely the kind of place where we should have those debates. As part of a great interdisciplinary research and teaching institution, we welcome different points of view, and we recognize our critical role as a local, state, national, and global resource for the generation of new knowledge, the scientific interpretation of that knowledge, and the communication of that knowledge to those charged with making wise decisions about complicated issues. At the end of the day, we must indeed be our brother's keeper.

-Martin Philbert
Dean and Professor of Toxicology

Send correspondence about this or any Findings article to the editor at You will be contacted if your letter is considered for publication.