I have long believed that ideas shift and change through a process of thinking, writing, and debate. It was in this spirit that I wrote the essays which became my upcoming book, Within Reason: A Liberal Public Health for an Illiberal Time. The book aims to hold a mirror up to the work of public health, to consider both our strengths and where we have stumbled, to challenge our field to be its best.

Such conversations can be difficult, uncomfortable. Just as the process of exercise can result in sore muscles, self-reflective discussions can generate disagreement and criticism. In my thinking, this disagreement lets us know we are doing something right. It indicates that our conversations are addressing something real towards advancing progress that makes us better as a field. I can, for example, anticipate, and indeed welcome, several criticisms which may emerge in response to the ideas I have shared in these posts. They reflect the start of a conversation that can, hopefully, help us move toward a new understanding of public health in this moment.

The first criticism is that, in addressing areas where public health can potentially do better, I have forsaken the values that have long been the basis of public health, abandoning a radical vision of a healthier world for something more reactionary, even right wing. This is not the case. I have spent my career arguing for a range of progressive, even radical, policies in pursuit of a healthier world. They include Medicare for all, a more welcoming immigration policy, a world without guns, reparations for slavery, and a more robust social safety net. I still believe in these policies and support working towards them pragmatically, embracing a “radical incrementalism” that helps get us to a better world.

The second criticism is that, when an empowered right wing is pursuing policies that threaten the health of populations, it is dangerous to be pointing out the shortcomings of public health. I address this with a passage from George Orwell:

“A phrase much used in political circles in this country is ‘playing into the hands of’. It is a sort of charm or incantation to silence uncomfortable truths. When you are told that by saying this, that or the other you are ‘playing into the hands of’ some sinister enemy, you know that it is your duty to shut up immediately.

For example, if you say anything damaging about British imperialism, you are playing into the hands of Dr Goebbels. If you criticize Stalin you are playing into the hands of the Tablet and the Daily Telegraph. If you criticize Chiang Kai-Shek you are playing into the hands of Wang Ching-Wei—and so on, indefinitely.

Objectively this charge is often true. It is always difficult to attack one party to a dispute without temporarily helping the other. Some of Gandhi’s remarks have been very useful to the Japanese. The extreme Tories will seize on anything anti-Russian, and don’t necessarily mind if it comes from Trotskyist instead of right-wing sources. The American imperialists, advancing to the attack behind a smoke-screen of novelists, are always on the look-out for any disreputable detail about the British Empire. And if you write anything truthful about the London slums, you are liable to hear it repeated on the Nazi radio a week later. But what, then, are you expected to do? Pretend there are no slums?”

Public health is not perfect and to pretend otherwise is to leave its imperfections dangerously unaddressed in a moment when we need to be at our best. There is, of course, a case to be made that we need a more radical approach, that we are at a time when a liberal engagement with issues is unacceptably milquetoast, inadequate to the challenges of the moment, and that those who espouse a return to liberal principles are enabling a status quo that harms health. I respect this perspective, and have, at times, felt the frustration that underlies it. To argue for a liberal approach in a time of crisis can be to seem, at best, as out of touch with the moment, and, at worst, as a counterproductive influence. In this context, the case for pragmatism can appear tantamount to the case for inaction, for giving up on addressing the injustices that create poor health.

In response to this, I would cite an example from history. In his famous broadcast against Senator Joseph McCarthy, Edward R. Murrow said, “This is no time for men who oppose Senator McCarthy’s methods to keep silent, or for those who approve.” In speaking out about McCarthy, Murrow and his team took a risk. They were running afoul of a powerful politician who had destroyed the lives of many and who still had much support in the country. The U.S. also faced a genuine threat from the Soviet Union and, in calling out McCarthy’s redbaiting, Murrow and his team risked the charge that they were giving aid and comfort to the enemy. Yet even at that fraught moment, Murrow still made a point of saying that the public conversation needed both sides of the argument—those who opposed the Senator and those who approved of him.

This is the essence of small-l liberalism. It says that to surrender our principles in the face of challenge—to respond to the demagogue by becoming like him—is to lose ourselves and our cause. We need more debate, not less. It would be easy to spurn this engagement, to preach to the choir, embracing bumper sticker slogans over reasoned argument. There are personal and professional benefits to moral grandstanding, but they do not include the creation of a healthier world. For public health to build such a world, it needs to pitch a big tent, welcoming those from many social, political, and economic backgrounds. Insisting on ideological purity risks keeping us small, a clique rather than a movement, to the detriment of our work.