Skip to main content
Tufts Public Health

The Four Horseman Revisited: Public Health Musings for the Tufts Public Health Graduates of 2020

Wednesday, May 20, 2020

By Anthony L. Schlaff
Director, Public Health Program
Professor, Department of Public Health and Community Medicine
Tufts University School of Medicine

This is a strange time, perhaps especially for those in public health, and for those of you launching your careers in public health. In our profession, when the world pays attention to us, it’s usually not a good thing. The COVID-19 pandemic is a tragedy – a largely preventable one – that has and will cause enormous suffering and death, further exacerbate the gross inequities in our society, and change the world in ways we can only partly predict.

Even as all of us in public health are focused on COVID-19, I want – with you – to look a bit further ahead. With or without this pandemic, I think there are two key issues that will determine whether we have a healthy future as a species, or not. One is justice. Justice has three critical and interrelated components to it – political justice, economic justice, and racial justice. Without justice in all those dimensions, I do not see how we address the second key issue: a sustainable economy. Without a different economic model than the extractive and exploitative growth model we live with today, we cannot protect the environment we depend on for survival. Climate change is the clearest and most existential threat that flows from our current model, but it is not the only one. The emergence of the SARS-CoV-2 virus itself is almost certainly tied to our encroachment on an ever-shrinking natural world.

If these are the key issues, what can we do? One big challenge that public health has not figured out is how we drive outside our lane. Justice and economics are subjects that belong to lawyers, politicians, economists, and businesspeople. Again, our experience with COVID-19 has lessons for us. Even in this crisis – so clearly a public health crisis – it is the politicians and not the public health people who command the podiums, and it is often not the public health people who whisper in the politicians’ ears and control the narrative that these politicians have spun. The narrative we hear now is about the choice between health and the economy. Public health people know this is a false choice. An economy is supposed to be a tool that helps a society meet human needs. Tolerating catastrophic death and suffering to revive the stock market is not an acceptable tradeoff. Furthermore, there is plenty of work to do to meet human needs, and plenty of resources to sustain every person who participates in that work. That is the economy that we should be building with or without, and certainly after, this pandemic. The tragedy is not that the extractive and exploitive economy we have is imploding – the tragedy is we have never built one to sustain all of us, whether in good times or bad.

We in public health have to insert our voices into conversations and decisions, not just in public health, but in those related to economics and justice.

What are the most important public health goals for the coming generation?

For economic justice, we need taxation, trade, economic, and labor policies that start to reverse the appalling inequities in our society, so that everyone has a living wage and the basic necessities of life. For political justice we need to make sure everyone can exercise their right to vote, and we need to get corporate power and big and dark money out of politics. Money is not speech, corporations are not people, and so-called originalists who see THAT in the constitution are laughably hypocritical. For racial justice we need a true reckoning with and reparations for centuries of white supremacy, and we need to dismantle the continuing structures that exclude so many people of color from access to opportunity.

A sustainable economy is one that meets human needs – every human’s needs - while leaving the planet at the end of each day just as we found it. It’s the same lesson our parents taught us about parks. We must use only those resources that are truly renewable and that do not require exploitation or environmental destruction to harness. The most critical of these resources is of course energy. Carbon is the new poop – the waste product with which we are fouling our own nest and that will kill us if we do not change course. But there are other resources that we need to make sure are used only in sustainable ways and at a sustainable pace – food sources, fresh water, land, and the oceans.

Massive die offs in the near future – from pandemics, from famine, from drought, from environmental catastrophe, or from wars over resources – are possible, along with the massive suffering these catastrophes bring, but they are not a certainty. They can be prevented, and we have public health tools, along with the science, technology, and human ingenuity, to support and sustain human populations so long as we truly focus on building sustainable and equitable systems

So to my colleagues – and especially to my new colleagues graduating this year - go out and do the day to day work of public health, but keep these bigger prizes of justice and sustainability in mind and in sight, or the small victories of the day to day will not mean so much.