In the week since finishing my first semester in seventeen years, I’ve wanted to write about the semester. I’ve simultaneously been too bone-weary to muster additional words and unsure what, exactly, I wanted to write about the semester: the period that began my formal journey toward a public health career. I haven’t known what to say, at least not in a handful of words.
Wednesday evening, I came across an article that helped me clarify what I want to say, for now. The article movingly wove together themes showing up throughout the semester in both my classes; most noteworthy, however, was how it explicitly joined themes from final assignments in both my Spring 2021 courses.
In Ed Yong’s The Atlantic article “The Fundamental Question of the Pandemic is Shifting,” he succinctly but beautifully captures the essence of public health as relates to this moment in our current COVID-19 pandemic timeline. While these threads weave through Yong’s entire article, they show up immediately; in the first paragraph, Yong writes that “public-health practitioners work to prevent sickness in entire populations.” Knowing that “infectious diseases are always collective problems because they are infectious,” they work to identify and mitigate the impacts of “societal factors, such as poverty and discrimination” on health outcomes.
The final module of my Intro to Public Health course was on epidemiology. I was thrilled by the discussion assignment, which asked students to consider how public health experts should use data in times of pandemic.
Yes, I was literally “thrilled.” My last post here (“because: evidence”) reflects my passion for questions around how data is and is not used in situations of real-world risk. In the real world, as opposed to the world of textbooks in which some policy-makers appear to believe we live, risks are distributed unequally. In this context of real-world, non-abstract risk, policies that may appear neutral on their face have profoundly disparate impacts on different populations. About this, I wrote in my assignment:
Early conversations about face masks in COVID were maddening to me. In the absence of what many scientists I then followed on Twitter deemed adequate evidence, those scientists dismissed the merits of face mask. Having read the works of Nassim Nicholas Taleb (including a 1/26/20 paper he co-authored about “the necessity of a precautionary approach” in the face of “The novel coronavirus emerging out of Wuhan, China”), I could not have disagreed more. If, while waiting for data on efficacy of an intervention to come in, the cost of an interim intervention like wearing a face mask is a mild nuisance whereas the cost of non-intervention includes potential death, it’s especially critical to intervene sooner than later. In addition to protecting individuals, it can help protect populations.
Beyond intervening sooner than later, it’s essential to maintain interventions while the risk is still active. In the case of COVID-19, the risk is still very, very active, as Yong captures masterfully in his below address of the CDC’s May 13 announcement “that fully vaccinated Americans no longer needed to wear masks in most indoor places”:
[The] problem—that collective behavior was starting to change against collective interest—shows the weaknesses of the CDC’s decisions. “Science doesn’t stand outside of society,” Cecília Tomori, an anthropologist and a public-health scholar at Johns Hopkins, told me. “You can’t just ‘focus on the science’ in the abstract,” and especially not when you’re a federal agency whose guidance has been heavily politicized from the get-go. In that context, it was evident that the new guidance “would send a cultural message that we don’t need masks anymore,” Tomori said. Anticipating those reactions “is squarely within the expertise of public health,” she added, and the CDC could have clarified how its guidelines should be implemented. It could have tied the lifting of mask mandates to specific levels of vaccination, or the arrival of worker protections. Absent that clarity, and with no way for businesses to even verify who is vaccinated, a mass demasking was inevitable. “If you’re blaming the public for not understanding the guidance—wow,” Duke’s Gavin Yamey said. “If people have misunderstood your guidance, your guidance was poor and confusing.”
Again, in the real world, the risks of getting all this wrong are not equally distributed. Instead, writes Yong in line with everything I learned last semester (and prior): “Predictably, the new pockets of immune vulnerability map onto old pockets of social vulnerability.” The most vulnerable groups are “immunocompromised people, for whom the shots may be less effective; essential workers, whose jobs place them in prolonged contact with others; and Black and Latino people, who are among the most likely to die of COVID-19 and the least likely to have been vaccinated.”
This leads directly to my final assignment in my Health and Social Justice course. Having grown up in poverty and intimately correlated violence, and then later lost my mom first to severe mental illness and then cancer for which poverty had physically primed her, I have never been confused about how ill financial and ill biomedical health are systemically linked, or how they are then expressed in more frequent illness and infirmity among those systemically made most vulnerable.
Yong touches on this in his article, too:
Unvaccinated people are not randomly distributed. They tend to cluster together, socially and geographically, enabling the emergence of localized COVID-19 outbreaks. Partly, these clusters exist because vaccine skepticism grows within cultural and political divides, and spreads through social networks. But they also exist because decades of systemic racism have pushed communities of color into poor neighborhoods and low-paying jobs, making it harder for them to access health care in general, and now vaccines in particular.
I’ll share my last assignment in a separate post. Here, today, however, I’ll simply share the comment I added for my professor’s review when submitting the assignment. Despite my in-bone knowledge of systemic vulnerability’s impacts, I was surprised by the intensity of my twin sorrow and fury as I wrote my assigned “letter to the editor” on … vaccine equity. To my (phenomenal!) professor, I wrote,
This assignment was especially emotionally challenging for me. Given my particular background, I’ve watched with horror as the pandemic raged. Part of what’s made it so devastating is knowing my mom, my siblings, and I would absolutely have been ravaged by COVID, had it spread a few decades earlier. Another part is understanding how absolutely avoidable all of this was, had only people in places of power listened to, for example, my favorite author and his co-authors in their 1/26/21 exhortation that decisive measures be taken quickly (https://necsi.edu/systemic-risk-of-pandemic-via-novel-pathogens-coronavirus-a-note). So, what looks on the surface like a simple school assignment is equally, for me, as much me looking head-on at this monster that could have so, so much sooner been relegated to gathering dust under a bed. I submit this assignment with gladness to have had the chance to find my own words for the importance of vaccine equity, and a heart absolutely devastated by the human costs correlated with the fact that such words need still be written.
Today, one week after finishing my first semester of public health coursework, I’d very much encourage you to read Yong’s article. As either an introduction to or brush-up on the premises and real-world work of public health, the article is outstanding.
In a time filled with so much loss and grief, I post this with gratitude for the love of humanity intrinsic in Yong’s words. For me as both a human and a public health student, they bring with them something invaluable in such harrowing times: hope that, if we can find ways to see and care about everyone’s health through paths such as those laid by Yong’s words, more of us might live to see a more just, more truly healthy world.
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
— World Health Organization