Monday, January 11, 2016

Injustice Made Clear Is Justice Reborn: The National Academies and Health Equity

Etched in the stone façade of the building in Washington D.C. that houses the National Academies of Sciences, Engineering, and Medicine are two quotations:

“Liberty is the great parent of science and of virtue; a nation will be great in both always in proportion as it is free.” Thomas Jefferson

“The right to search for truth implies also a duty; one must not conceal any part of what one has recognized to be true.” Albert Einstein

I pondered those words as I entered the National Academies’ building to do a presentation to the Institute of Medicine’s (IOM) “Committee on Community Based Solutions to Promote Health Equity in the United States.” While science and truth are mentioned in those quotations, it struck me that the focus of both was values – the values of liberty, rights, freedom, virtue, and duty. Those words gave me some hope for the eventual recommendations coming from the committee because health equity is about much more than just objective data; it is also about the aspirations we have for our society.

These façade-enhancing quotations also seemed to potentially give some credence to the core message in my presentation that public health, as articulated by Geoffrey Vickers, is about using data to continually redefine the unacceptable and move the unacceptable conditions in which people live “from the category of the given into the category of the intolerable.” Public health and the advancement of health equity is about the interaction of data and values.

Einstein was very clear in pointing out the bidirectional nature of the interaction between rights and duties – “one must not conceal any part of what one has recognized to be true.” Jefferson’s statement is more unidirectional – liberty is required for science and virtue. That gave me pause.

In Jefferson’s mind, science and virtue are siblings with liberty as their parent. We all know that the interactions of siblings are sometimes cooperative and sometimes competitive; ideally enhanced and mediated, when necessary, by parental influence. We also know that the experiences and perspectives of children often challenge and influence their parents. In this case, liberty and freedom are necessary for science and virtue to thrive; while science and virtue have the duty to influence the legacy of liberty. Implicit in these bidirectional interactions is the requirement to always search for truth and the duty to make those truths known.

As I entered the National Academies building for the IOM session on health equity, I was hoping for a broad discussion springing from the spirit of the quotations that met us as we entered. I was not disappointed. The presentations contained a great deal of data but those data were presented in the context of the values of our society and the aspiration that everyone has the opportunity to be healthy and to thrive. As I left the meeting, I was optimistic that the forthcoming recommendations of the experts on the committee will outline a path that assures the societal conditions in which everyone can be healthy.

Having some free time before my flight back to Minneapolis, I thought I’d take advantage of being in D.C. for a quick visit to a museum. Because it was just three blocks from the National Academies and being a site I had not visited before, I stopped at the Newseum, a museum dedicated to news reporting. Unexpectedly, it turned out to be a perfect capstone to the day’s discussions.

The main reason for the existence of the Newseum is to underscore how being able to freely share information, ideas, and opinions helps protect our liberty. The underlying message in every exhibit in the Newseum is the critical importance of the values embedded in the First Amendment to the Constitution which prohibits “…abridging the freedom of speech, or of the press.” That message resonated perfectly with the quotations of Jefferson and Einstein. It also resonated with the day’s focus on health equity.

The introductory exhibit in the Newseum put an exclamation point on the day. It told the story of Colonel John A. Cockerill, chief editor at the Pulitzer newspaper The World, sending Nellie Bly to report on the abuses occurring in a women’s insane asylum. According to Cockerill in his charge to Bly, “Injustice made clear is justice reborn.” Her investigative reporting which led to some needed policy changes in the prisons helped prove that point.

Since social justice is the core principle of public health, this statement also reflects the role of public health and advancing health equity. Working to make injustices clear helps us redefine what’s unacceptable and move injustices from the category of the given into the category of the intolerable. In that way, justice and equity can be reborn.


Ed