as clueless as ever

a future of public health

An attempt to define health and population health. To be aware of scale, both existential and local. A note on captured leadership.

Alborz Mirzaie

20 March 2021 ยท 8 MIN READ

American academia has become more appearance than competence. Academic titles have become arguments in themselves for establishing truth; who, in our pursuit for truth, let us become so lazy?

Public health is a beautifully complex discipline, yet rarely appreciated as so; notably because so much (bullshit) has been written on the matter. I will attempt to simplify my field's aim.

In short: public health concerns the well-being of a population. Let us first define well-being: the state of being in which one is free from involuntary and unnecessary suffering, to voluntarily maximize their potential; one finds themselves amidst physiological and psychological suffering, often both. The domain of meaning, a being's relationship with reality, to make sense of it, is not found in the classical definitions; I don't know if one could claim that it can be encapsulated in the psychological domain, but I will expand on this in a future post (or not). The subjective parameters of this definition force us to redefine what well-being is in different contexts: what can be deemed as unnecessary suffering? the fulfillment of potential is measured on who's gamut? The way we chose to live our lives are the answers to these questions: an Olympian submits her body and mind under extreme stress to achieve her goal; the body of a man undergoing a prolonged fast begins to eat itself, while the man seeks to live longer with greater mental clarity; the psychedelic enthusiast risks the harmony of his current and future mental states in order to explore worlds different than his own.

What is the commonality here? That the individual has the freedom to live the life they deem as healthiest; whether one seeks to further their spirit at the cost of their body, to prolong their lifespan at the cost of their comfort, or to risk their sanity in the name of curiosity, the autonomy of this decision must rest within the individual. Otherwise, in barring this freedom, suffering will manifest in the domain of meaning; systems that don't respect this intrinsic fact inevitably fail. One could argue that we should strive towards a balance between the three, physiological, psychological, and meaning, in order to live well, and I agree; but who are you to define, and hence judge, another's balance based on your own?

Don't talk about "progress" in terms of longevity, safety, or comfort before comparing zoo animals to those of the wilderness. ― Nassim Nicholas Taleb, The Bed of Procrustes, page 08

I believe the Meikirch model of health is the most modern definition of health; while necessary in creating a definition of public health, it is not sufficient: it does not address the collapse of societies. More on all this later.

The frame I am trying to establish is in direct confrontation to the spirit of interventionism. Public health must tread lightly, to maximize our freedoms while safeguarding our psychological and physiological well-being; our well-being is delicate, fragile. While intervention en masse can empirically be proven to improve well-being in one domain, it may be proven catastrophic in another. Unfortunately, we don't have the luxury of foresight to know the consequences of our interventions. Opioid medications to relieve chronic/acute pain caused much more morbidity and mortality, crippling families and killing many in the last thirty years. The inorganic drive for a standard's based education system has left millions of children in states of anxiety, nihilism, and agony. If we are to implement an intervention for the well-being of the population, we must proceed exceedingly cautiously. Even further, we should learn from these iatrogenic mistakes to not needlessly limit the freedoms of individuals through our myopia.

How best should we proceed then, given the future holds so much uncertainty? Clearly not in the spirit of interventionism for the sake of interventions; children are given crayons, not tattoo pens, to flex their creative capacities. Innovations in public health must first be prototyped locally for it to be even considered a national, or graver, a global solution. Anyone who claims they hold a global solution in their pocket, including the WEF's Great Reset agenda, are false prophets and are toying with humanity's well-being in the name of progress.

Localism is the scale where public health interventionism should be conducted; moreover, complexity science should be seen as the primary tool for such research. This school of thought both respects the freedom of the individual, while also allowing for the necessary experimentation needed to progress in a safe and sustainable manner. Sustainability is key here: lacking in public health discourse is the mitigation of existential risk; yet if public health is to have aims, this should be the highest aim of them all. I have not read anything more illuminating than Toby Ord's The Precipice, who highlights that anthropogenic risk accounts for the overwhelming bulk of the total existential risk we currently hold for the coming century (1/6 chance we, and our future potential, don't come to be). How does localism address this? The cost of failed interventions in different localities would only be borne by the localities implementing them, not endured at a scale larger than necessary; likewise, the information from successful interventions would be shared and implemented across communities.

Unfortunately, given the current trajectory of public health bureaucracies, with their myopic drive towards equality of outcome and their mania for health equity, I don't see their pursuits symbiotic with public health innovation; the skillful (yet equally distasteful) manipulation of public health marketing, embarrassingly dependent on the Overton window (and importantly not on truth), leads me no choice but to label media from legacy public health institutions as propaganda. Simply look at how the COVID-19 pandemic has been overseen by the World Health Organization and the Centers for Disease Control and Prevention; their malfeasance has made the names of these heralded organizations ironic. Establishing green-zones by identifying local transmission, closing inter/intranational borders when needed, abusing the power of rapid tests, and systematically isolating positive individuals has proven to work remarkably well; the insistence on vaccination as the primary intervention will increase morbidity and mortality until thorough vaccine distribution. Why not opt for the cheaper, community-first route? There may be many reasons but I can provide two: grave incompetence and fiat.

The vaccine was an incredible feat: I am not trying to disparage the wondrous tool of science; yet the vaccine is the only American success I could point to and be proud of in the entirety of this pandemic. Innovation in public health is not found in academia, far from the truth; it is principally found in technological progress, the creators of tools and thought (often the former). Imagine the sheer magnitude of truth and privacy blockchain technology can establish in our world; is this not liberating? Will this not improve the well-being of the populace? Public health has been hijacked by researchers selling their spirit for citations; there is little skin in the game here.

I received my bachelor's degree in public health from the University of California, Berkeley; it was the failed attempt at getting a minor in philosophy, with its beautiful classes and discussions, that drove my inquiry in public health. Much of my time in the public health department was uneventful. I'm going to be pursuing my masters of science degree either at JHSPH or National Taiwan University (I have yet to decide). I hope they will offer me more than a title; I doubt it, but I'll be sure to let you know.